Module 1: Looking at Abnormality

The 5 D’s of Abnormality

Psychopathology or Abnormal
Deviance
Psychology Different from social norms, behaviors that are unusual, and
It is the study of people. inability to conform.
People who suffer mental, emotional, and physical pain.
Some people’s experience with psychopathology is a bit more Distress
extreme as when everyday sadness transforms into life-altering
Causes anxiety or discomfort in coping up with changes.
depression.

Dysfunction
Mental Illness Abnormality and emotion that disturbs normal behavior
A significant behavioral or psychological syndrome or pattern that
occurs in an individual and is associated with distress, disability, or Disability
a significantly increased risk of suffering, death, pain, or loss of
Inability to function effectively in daily tasks.
freedom.

Cultural Norms Danger

Behavior which possesses threats. Risk of harm to oneself or to
Cultural norms can influence how mental health is perceived and others.
understood within a particular culture.
The four Ds together make up mental health professionals’

Cultural Relativism
definition of behaviors or feelings as abnormal or maladaptive.
Behaviors, thoughts, and feelings are dysfunctional when they
There is no universal standard in labeling abnormality. interfere with the person’s ability to function in daily life, to hold a
It honors the norms and traditions of different cultures. job, or to form close relationships. The more dysfunctional
behaviors and feelings are, the more likely they are to be
considered abnormal by mental health professionals.
Behaviors and feelings that cause distress to the individual or to
others around him or her are also likely to be considered Psychological Theories - Believed that abnormal behavior is a
abnormal. result of traumas such as chronic stress

Highly deviant behaviors, such as hearing voices when no one

else is around, lead to judgments of abnormality. What is deviant
Ancient Theories
is influenced by cultural norms Based on artifacts, fragments of bones, ancient writings about
Some behaviors and feelings, such as suicidal gestures, are of abnormal behavior believing that abnormality needs a special
potential harm to the individual, whereas other behaviors and explanation
feelings, such as excessive aggression, could potentially harm
others. Such dangerous behaviors and feelings are often seen as Driving Away Evil Spirits
abnormal.
Tool used for drilling the skull is called Trephine.
Duration The operation is called Trephination.
Length of time of the symptoms experienced.
Ancient Egypt, Greece, Rome:
Degree Biological Theories Dominate:
Level in which a symptom or a group of symptoms is experienced
Egyptians believed that the uterus could become dislodged

Historical Perspectives of
interfering with the other organs. They named the disorder Hysteria
meaning ‘uterus’
Abnormality
Moral Treatment in the Eighteenth
3 Types of Theories that explains and Nineteenth Centuries
abnormal behavior Mental hygiene movement - Treatment of people with mental
Biological Theories - It is caused by the breakdown of health problems.
systems in the body. Moral Treatment - A movement made by Philippe Pinel “To
Supernatural Theories - Viewed abnormal behavior as a result detain maniacs in constant seclusion and load them with
of divine interventions, demonic possessions, curses, and chains…”
being a sinner.
 Classical Conditioning - Dogs could be conditioned to
The Emergence of Modern salivate when presented with stimuli (bell) other than food if

Perspectives
the food was paired with these stimuli. Pavlov was able to
condition the dogs to salivate at the sound of the bell alone.
Behaviorism - The study of the impact of reinforcements and
The twentieth century made tremendous advances in the
punishment on the behavior.
scientific study of disorders. These advances laid the
Cognitions - It is the thought process like attention,
groundwork for the biological, psychological and social
interpretation of events, and beliefs that influence the
theories of abnormality that dominate psychology and
behavior and emotion.
psychiatry
Self-efficacy beliefs - Crucial in determining people’s well
being.
The Psychoanalytic Perspective
Mesmer’s treatments were the hysterical disorders in which
Modern Mental Health Care
Deinstitutionalization
people lose functioning or feeling in some part of the body
with no apparent reason.

Mesmer cured illness including psychological disorders. Patients’ rights movement - Argued that Mental patients can
His method is known as ‘mesmerism’. recover more fully with the support of community based
treatment facilities.
Breuer and Freud collaborated on a paper published in 1983 Deinstitutionalization - Known as the process of the patients’
as ‘On the Psychical Mechanisms of Hysterical Phenomena’ rights movement.
which led to their discoveries about hypnosis, the Community mental health movement - Provide coordinated
unconscious, and the therapeutic value of catharsis. mental health services to people.
Community mental health centers - A move that has had both
Psychoanalysis - The study of the unconscious.
positive and negative consequences.
Halfway houses - Offer people with long term mental health
The Roots of Behaviorism problems and gives opportunity to live in a structured and
supportive environment.
van Pavlov (1849-1931), a Russian Psychologist. Developed Day treatment centers - Allow people to obtain treatment
methods and theories for understanding the behavior in terms during the day.
of stimuli and responses rather than in terms of the Managed care - Coordinate services for existing medical
unconscious mind. problems and to prevent future medical problems.
 Module 2: Theories and Treatment of Abnormality
Biopsychosocial approach - Psychological symptoms often
3 General Approaches to result from a combination of biological, psychological, and

understanding Psychological
sociocultural factors.
Risk Factors - Referred to factors. Can be biological, such as

Disorders a genetic predisposition.

Assessment - is the process of gathering information about
Sociocultural Approach - Results of environmental conditions people’s symptoms and the possible causes of these
and cultural norms. symptoms.
Biological Approach - Result of abnormal genes or Diagnosis - is a label for a set of symptoms that often occur
neurobiogical dysfunction. together.
Psychological Approach - Result of thinking processes,
personality styles, and conditioning. Validity
Theory - Set of ideas that provides a framework for asking
questions. The accuracy of a test in assessing what it is supposed to
Therapy - A treatment that addresses those factors the theory measure.
says cause the phenomenon.
Face Validity
Diathesis (Hereditary Predisposition) Test appears to measure what it is supposed to measure.
Biological factor (genes, brain anomalies)
Social factor (maladaptive upbringing, chronic stress) Predictive Validity
Psychological factor (unconscious conflicts, maladaptive
Test predicts the behavior it is supposed to measure
cognitions)

Concurrent Validity
Stress (Triggers)
Test yields the same results as other measures of the same
Biological factor (exposure to toxins, onset of a disease) behavior, thoughts, or feelings.
Social factor (major loss, traumatic event)
Psychological factor (violation of trust, loss of control)
 2. is scored in a “standard” or consistent manner, which makes it
Construct Validity possible to compare the relative performance of individuals
Test measures what it is supposed to measure, not something else
Clinical Interview
Reliability May include a mental status exam, which assesses the person’s
Its consistency in measuring what it is supposed to measure. general functioning

Test-retest Reliability 5 types of Information

Test produces similar results when given at two points in time 1. Appearance and behavior
2. Thought process
3. Mood and affect
Alternate form Reliability 4. Intellectual functioning
Two versions of the same test produce similar results. 5. Appropriately oriented to place, time, and person

Internal Reliability Structured Interview

Different parts of the same test produce similar results. The format of the questions and the entire interview is
standardized, and the clinician uses concrete criteria to score the
Interrater, or interjudge Reliability person’s answers. (most reliable form of interview)
*Structured = standardized
Two or more raters or judges who administer and score a test
come to similar conclusions. Unstructured Interview
Standardization Highly flexible in terms of questions asked, also called as non-
directive interview.
is any form of test that:
Symptom Questionnaires
1. requires all test takers to answer the same questions, or a
selection of questions from common bank of questions, in the A yes/no questionnaire with brief and simple items. It contains
same way state scales of depression, anxiety, anger-hostility, and somatic
symptoms.
 Personality Inventories Hindbrain
Usually are questionnaires meant to assess people’s typical ways Includes all structures
of thinking, feeling, and behaving. located in the hind (posterior)
Closest to the spinal cord.
Behavioral Observation Sits on top of the spinal cord

A functional, utilitarian approach in that it focuses on the clearly It contains:

observable ways in which the client interacts with his or her
environment.
1. Medulla
Self-Monitoring Helps control breathing and
Keeping track of the number of times per day they engage in a reflexes
specific behavior and the conditions under which this behavior
occurs. 2. Pons
Important for attentiveness and
Intelligence Tests timing of sleep

Are used to get a sense of an individual’s intellectual strengths and

weaknesses, particularly when mental retardation or brain damage 3. Reticular Formation
is suspected.
A network of neurons that control arousal and attention to stimuli.

Biological Approaches 4. Cerebellum

3 Causes of Abnormality Coordination of movement.
Brain Dysfunction - Often focuses on biological approaches.
Biochemical Imbalances - Midbrain
Genetic Abnormalities
Located in the middle of the brain.

It contains:
 1. Superior Colliculus Connected by the corpus callosum.

Located at the roof of the midbrain. Each hemisphere is divided into 4 lobes:
Receives visual information.
Involves in integrating visual information with other sensory
inputs, such as auditory and somatosensory information.
a. Frontal Lobe
Located at the front of the brain.
Responsible for higher level functions.
2. Inferior Colliculus Ex. Problem solving, decision making, motor control, and such.
Located at the floor of the midbrain.
Receives auditory information.
Plays an important role in the localization of sound sources, as
b. Parietal Lobe
well as in the processing of complex auditory information, such Located at the top and the back of the brain.
as speech and music Responsible for integrating sensory information.

3. Substantia Nigra c. Occipital Lobe

Pathway that regulates responses to reward. Located at the back of the brain.
Responsible for visual information.

Forebrain
Ex. Vision (color, shape, motion, depth)

Includes the structures located in the front (anterior) part of the c. Temporal Lobe
brain.
Relatively large and developed compared to that of other Located at the side of the brain.
organisms Responsible for cognitive and behavioral abilities.
Ex. Hearing and language processing, Memory formation and
It contains: retrieval, Object and facial recognition, and Emotion regulation.

1. Cerebral Cortex 2. Thalamus

Outer layer of the cerebrum. Directs incoming information from sense receptors to the
Composed of 2 hemispheres, on the left and right sides of the cerebrum
brain.
 Degradation - Occurs when the receiving neuron releases an
3. Hypothalamus enzyme into the synapse that breaks down the
neurotransmitter into other biochemicals.
A small structure below the thalamus, regulates eating, drinking,
and sexual behavior, it is also involved in processing basic
emotions. Different Neurotransmitters
4. Limbic System Serotonin
Closely interconnected with the hypothalamus. Travels through many areas of the brain, affecting the function of
Have instinct behaviors such as reactions to stressful events those areas. It can increase or decrease one’s activity.

5. Amygdala Dopamine
Structure of limbic system that is critical in emotion such as fear It is affected by substances we find rewarding .
Important to the functioning of muscles systems that plays an
important role in disorders involving control over muscles
6. Hippocampus
Part of the limbic system that plays a role in memory. Norepinephrine (Noradrenaline)
Produced mainly by neurons in the brain stem.
Biochemical Imbalances Cocaine and amphetamine prolong the action of norepinephrine
Neurotransmitters - Biochemicals that act as messengers by slowing its reuptake process.
carrying impulses from one neuron, or nerve cell, to another.
Dendrites - The short branches in every neuron in a cell body. Gamma-aminobutyric acid (GABA)
The dendrites and cell body receives impulses from adjacent Plays an important role in anxiety symptoms.
neurons.
Axon - A tubelike extension.
Synaptic terminals - A small swellings at the end of the axon. Different Neurotransmitters
Synaptic gap or Synapse - The slight gap between the synaptic
terminals and the adjacent neurons. Endocrine System
Reuptake - Occurs when the initial neuron releasing the Produces chemicals called ‘hormones’ which are released directly
neurotransmitter decreases the amount left in the synapse into the blood.
 Hormone
Carries messages throughout the body. It can affect a person’s Antidepressant Drugs
mood, energy level, and such.
Reduce symptoms of depression.

Pituitary Gland
Lithium
Known as the ‘master gland’. It produces the largest number of
different hormones It is a mood stabilizer, treatment for bipolar disorder.

Genetic Abnormalities Anticonvulsants

Treatment for mania
Behavioral Genetics
The study of the genetics of personality and abnormality. Antianxiety Drugs
Normal Fertilized Embryo Barbiturates
Highly addictive and life threatening that can increase one’s heart
23 - female egg
rate.
23 - male sperm
46 - chromosomes
Benzodiazepines
Polygenic (many genes) Reduce the symptoms of anxiety without interfering with an
When altered or multiple genes come together, the individual may individual’s ability to function effectively in daily tasks.
develop the disorder.

Behavioral Approaches
Drug Therapies
Focuses on the influence of reinforcements and punishments in
producing behavior.
Antipsychotic Drugs
Helps reduce symptoms of psychosis.
 Personality Inventories Behavioral Therapies
Classical Conditioning (Pavlov) Focuses on identifying the reinforcements and punishments that
Dogs could be conditioned to salivate when presented with stimuli contribute to a person’s changing specific behavior.
(bell) other than food if the food was paired with these stimuli.
Pavlov was able to condition the dogs to salivate at the sound of
the bell alone.
Cognitive Approaches
Unconditioned stimulus (US) - Naturally produces a response. Cognitive Theories
Unconditioned response (UR) - Response created by US. Not simply rewards and punishment motivate human behavior.
Conditioned stimulus (CS) - Neutral stimulus.
Conditioned response (CR) - Response that CS elicits. Causal Attribution
Operant Conditioning (Skinner) The answer to our ‘why’ questions.

The shaping of behaviors by providing rewards for desired Global Assumption

behaviors and punishments for undesired behaviors.
Broad beliefs that can be either positive and helpful to us or
Modeling and Observational Learning negative and destructive.

Cognitive Therapies
Social Learning Theory
Helps clients identify their negative thoughts and dysfunctional
People who learn behaviors by watching other people.
belief system.

Psychodynamic Theories
1. Modeling - Imitating behaviors modeled by important people in
one’s lives.
2. Observational Learning - A person observes the rewards and All behaviors, thoughts, and emotions, whether normal or
punishments that another person receives for his or her abnormal, are influenced to a large extent by unconscious
behavior and then behaves in accordance with those rewards processes.
and punishment
 Determined by interactions among
Psychoanalysis (Sigmund Freud)
the id, ego, and superego.
Refers to a theory of personality and psychopathology.
Method of investigating the mind
Unconscious Preconscious
Occur out of awareness Intermediate between the
Catharsis unconscious and conscious.
Emotion connected to the memories.
Conscious
Repression Aware of our thoughts, feelings, and surroundings.
Motivated forgetting of a difficult experience

The Id, Ego, and Superego

Libido
Sexual drive

Id
Operates the pleasure principle.

Ego (Reality principle)

Seeks to gratify the needs in ways to constraint of outside reality.

Superego
Internalize the moral standard
 Psychosexual Stages
Object Relations - Early relationships in the development of
Child receiving from his or her caregivers strongly influences self-concept and personality.
personality development. Self psychology and Relational Psychoanalysis - It
emphasizes the unconscious dimensions of the relationship
Oral Stage (18 months) with pregnancy and infancy throughout all of life.
Collective Unconscious - Wisdom.
Stimulation of the mouth area, through feeding or sucking.

Psychodynamic Therapies
Anal Stage (18 months to 3
Helps clients to recognize their maladaptive coping strategies and
years of age) unconscious conflicts.
Focus of gratification is the anus. Interested in toilet activities.
Free Association
Phallic Stage (ages 3-6) Whatever comes to mind, saying anything without thinking.

Labeled as Oedipus complex. Resistance

Central conscious conflicts.
Latency Stage (ages 6-12)
Attention turns to developing skills and interest. Transference
Unconscious conflict and needs.
Genital Stage (age 12)
- Sexual desires emerge when they enter puberty.
Walking through
Allows clients to move forward from their lives

Later Psychodynamic Theories Interpersonal Therapy

Ego Psychology - Importance of the ability of an individual to Unconscious conflicts of an individual.
regulate defenses in the reality of the society.
 Module 3: Assessing and Diagnosing Abnormality
Assessment
Content Validity
Is the process of gathering information about people's
symptoms and its possible causes A test assess all the important aspects of a phenomenon that
Information used or gathered in an assessment is needed its purpose is to measure
to determine appropriate diagnosis for a person's problem

Concurrent Validity
Diagnosis
The extend which a test yields the same results as others
Is a label for a set of symptoms that occur together established measures of the same behavior, thoughts or
feelings
Assessment Tools Person's score on a new anxiety questionnaire should
bear some relation to information gathered from the
person's answer to an established anxiety questionnaire
Validity
The accuracy of a test in assessing what it is supposed to Predictive Validity
measure
The best way to determine is to see if the result of the If it is good at predicting how a person will think, act, or feel in
test yield the same information as an objective and the future
accurate indication

Face Validity Construct Validity

Which a test measures what it is supposed to measure and
Face validity on face value
not something else altogether
Face validity of anxiety meeting the standards of validity
 Clinical Interview
Reliability
This interview may include a mental status exam that
Indicates its consistency in measuring assesses the person's general functioning

5 types of information
Test-Retest Reliability
1. The clinician assesses the individual's appearance and
Describes how consistent the results are overtime
behavior. Will also note if the individual moves
Measures of general and enduring characteristics should
slowly/agitated
have higher test-retest reliability
2. The clinician will take note of the individual's thought
processes which includes how coherently and quickly
they speak
Alternate Form Reliability 3. The clinician will be concerned with the individuals mood
and affect
Developing two or more forms of a test 4. The clinician will observe the individual's intellectual
Similar tests or answer among different parts - Internal functioning - how the person speaks and any indications
Reliability of memory or attention difficulties
5. The clinician will note if the individual seems appropriately
oriented
The tests should have higher:
Interrater or interjudge and reliability
Structured Interview
Clinician asks the respondent a series of questions about
Standardization symptoms they are experiencing/experienced
Standardized interview and concrete criteria to score the
One way to improve both validity and reliability
answers
Prevents extraneous factors from affecting a person's
End: Determine whether the symptoms qualify for a
response
diagnosis of any major psychological problems
 Symptom Questionnaires Behavioral Observation
Quick way to determine a person's symptoms and Self Monitoring
Can cover a wide variety of symptoms representing
different disorders
Behavioral Observation
Most Common: To assess deficits in their skills or wats of handling
situation
Beck Depression Inventory Looks for specific behaviors and what precedes
Direct behavioral has the advantage of not relying on
21 items
individual's reporting and interpretation of their behavior
Describe four levels of a given symptoms of depression
Disadvantage: individuals may alter their behavior when
Used by clinicians on treating depressed people
watched; different observers may draw different
conclusions
Personality Inventories Low interrater reliability
Questionnaires meant to assess people's typical ways of
thinking, feeling and behaving Self Monitoring
Used as a part of an assessment procedure to obtain
information on people's well-being, self concept, etc. Keeping track of the number of times per day they engage
in a specific behavior
Open to biases in what individuals notice about their
Minnesota Multiphasic behavior and are willing to report
Disadvantage: Individuals will discover the behavior and
Personality Inventory might lead into changing it
Widely used
1930s by Starke Hathaway and Charnley McKinley Intelligence Tests
1989 - updated version
Used to get a sense of an individual's intellectual
Describes moral and social attitude, behavior etc.
strengths and weaknesses
Developed empirically
Also used in schools to identify gifted children
 Battery Test:
Also used in military
Were designed to measure basic intellectual abilities Halsteid-Reitan Test and Luria
Controversial little consensus
Nebraska Test
Example test:
Wechsler Adult Intelligence Scale Contains about specific information about individual's
Stanford-Binet Intelligence Test functioning in several skills area
Wechsler Intelligence Scale for children
Brain-Imaging Techniques
Culture-Fair Test Used to determine if a person has a brain injury or tumor
Search for differences in brain activity or structure
Equally applicable to all groups between people with or without psychological disorders
Attempted but disappointing results
Computerized Tomography
Neuropsychological Tests Enhancement of X-ray procedures
Useful in detecting specific cognitive deficit Can reveal brain injury, tumors, and structural
abnormalities
Limitations: exposes patients to x-ray; provides brain
(One) Bender Gestalt Test structure than brain activity

Frequently used Positron-Emission Tomography

Assess individual's sensorimotor skills by producing nine
drawings Can provide a picture of activity in the brain
Good at differentiating people with brain damage but does Requires injecting the patient with a harmless radioactive
not specify what type of brain damage isotope
Detects photons at which are annihilated and construct
image
 Single Photon Emission Thematic Apperception Test
Computed Tomography Consists of pictures
People's stories reflect their concerns and traits
Like PET but different tracer substance is injected

Challenges in Assessment
Less accurate but less expensive

Magnetic Resonance Imaging Resistance to providing information

Does not require exposing the patient to any radiation
Such problems arise when assessment are part of legal case
Can be used repeatedly

Evaluating Children
Projective Tests
Children cannot describe their feelings
Based on the assumption that people are presented with an
When distressed, children may talk about physical aches
ambiguous stimulus they will interpret the stimulus in line with
May show distress in non-verbal behavior
their current concerns and feelings
Parents: Primary sources but is not accurate, may also be
the problem
Most Frequently: Teachers: Also provide information different from parents

Rorschach Inkblot Tests and Evaluating Individuals Across Cultures

Thematic Apperception Test
Challenges arise when there are significant cultural difference

Rorschach Inkblot Test (1921)

between the assessor and the person being assessed
Over diagnosis: Tries to describe the symptoms in the
assessor's language but the assessor interprets the
Hermann Rorschach
individual's confused description
Consists of 10 cards with symmetrical ink blot
Under diagnosis: An individual cannot articulate complex
emotions perceptual experiences in the assessors language
 Mistranslation
Diagnostic and Statistical Manual
Cultural biases: unique cultural background of Mental Disorders (DSM)
The official manual for diagnosing psychological disorders
Diagnosis First edition: 1952
Fifth edition: 2013
Is a label we attach to a set of symptoms that occurs Outlined the diagnostic criteria for all the mental disorders
together Criteria was somewhat vague descriptions
Heavily influenced by psychoanalytic theory
Syndrome The second edition of DSM (1968) included newly
recognized disorders
Set of symptoms Is also abstract and theoretically based; reliability was
Not a list but set that occurs together within individuals low
Clinicians use this manual only about 70%
Classification System Low reliability of diagnoses can be due to many factors

Set of syndromes and the rules for determining whether an Continuing Debates About DSM
individual's symptoms are part of these syndromes
Reifying Diagnoses
Hippocrates Means seeing the diagnosis as real and true rather than as
the product of set of judgements about how it occurs
Proposed the first classification system 4th Century BCE Made by experts and be based on the best empirical
Divided all mental disorders into mania, melancholia, science of time
paranoia, and epilepsy
Category / Continuum
Emil Kraeplin
Their diagnostic criteria defined where normality ends and
Published the first modern classification system psychopathology begins
It introduces a continuum or dimensional perspective on a
number of disorders
 Differentiating Mental Disorders
from one another
Difficulty in differentiating the mental disorders from one
another
Comorbidity: One disorder but also diagnosed in another

Addressing Cultural Issues

Distinct ways of conceptualizing mental disorders

The Social Psychological Dangers

of Diagnosis
Thomas Szasz
Having a mental disorder that the entire system of
diagnosis is corrupt and should be abandoned
People in power use psychiatric diagnosis to label and
isolate people who do not fit in
Mental disorders does not really exists those who suffer
are oppressed by the society

David Kosenhan (1973)

Admits to 12 different mental hospitals
We cannot distinguish the sane from insane
 Module 7: Mood Disorders and Suicide
Mood Disorders Along the Bipolar disorder is one of the two major types of mood

Continuum
disorders. The other type is depressive disorders. People with
depressive disorders experience only depression, and not
mania.
Typical mood symptoms in response to events
Feeling blue or down but able to function normally; feeling happy
and exuberant because something good happened Mood Disorders
Potentially meets criteria for hypomania Bipolar Disorder or Manic Depression – emotional roller-
Moderate and frequent elation, inflated self-esteem, some coaster
impulsiveness, high energy Mania - a distinct period of abnormally and persistently
elevated, expansive, or irritable mood. People with mania
Potentially meets criteria for depression
have unrealistically positive and grandiose self-esteem. It
Moderate and frequent symptoms of sadness, apathy, fatigue,
may be delusional and hallucinations.
etc., that somewhat interfere with functioning
Symptoms of Manic Episode: Must show an elevated,
Likely meets criteria for manic episode expansive, irritable mood for at least 1 week.
Expansive mood including irritability, grandiosity, racing thoughts, Hypomania - A distinct period of abnormally and persistently
and decreased need for sleep that significantly interferes with elevated, expansive, or irritable mood and abnormally and
functioning persistently increased activity or energy, lasting at least 4
consecutive days and present most of the day, nearly every
Likely meets criteria for major depressive episode
day. Symptoms are milder than Mania. No hallucination &
Severe symptoms of sadness, apathy, hopelessness, low
delusion.
energy, etc., that significantly interfere with functioning
The emotional roller-coaster ride Kay Jamison describes is known
as bipolar disorder, or manic depression. First, Jamison had
2 Major Types of Mood Disorder
mania, with great energy and enthusiasm for everything, talking
and thinking so fast that her friends could not keep up with her. Bipolar Disorder
Eventually, though, she crashed into a depression. Depressive Disorder
 Major Depressive Disorder, Single Episode – people who
People with depressive disorders experience only
experience only 1 depressive episode
depression, and not mania.
Major Depressive Disorder, Recurrent Episode – two or
more episodes separated by at least 2 consecutive months
Symptoms of Depression without symptoms.
Anhedonia – the lost of interest in everything in life; even
when they try to do something enjoyable, they may feel
DSM-5 Criteria for Major
no emotion Depressive Disorder
Psychomotor Retardation – people with depression may
walk more slowly, gesture more slowly, and talk more Complicated Grief – Bereaved people that are
slowly and quietly. They are prone to more accidents characterized by strong yearning for the deceased person
since they cannot react quickly enough to avoid them. and preoccupation with the loss, persistent regrets about
Psychomotor Agitation – people feel physically agitated, one’s own or others’ behavior toward deceased, difficulty
cannot sit still, and move around or fidget aimlessly accepting the finality of the loss, and a sense that life is
Delusion - False beliefs due to incorrect inference about empty and meaningless.
external reality. Fixed beliefs that are not amenable to Persistent Depressive Disorder (Dysthymia or Dysthymic
change considering conflicting evidence. They may hear Disorder & Chronic Major Depressive Disorder) – a chronic
voices accusing them of having committed an atrocity or depression that is present for most days over a period of
instructing them to kill themselves two years.
Children & Adolescence – Depressed or irritable mood for a
People with depression may experience guilt, hopelessness, duration of at least 1 year
lose touch with reality, delusions, and hallucinations
Symptoms:
a. Poor Appetite
Symptoms of Depression b. Insomnia or Hypersomnia
c. Low energy or fatigue
Major Depressive Disorder – severe bout of depression
d. Low self-esteem
symptoms lasting 2 weeks or more. It requires that a
e. Poor concentration
person experience either depressed mood or loss of
f. Hopelessness
interest in usual activities. These symptoms must be
severe enough to interfere with person’s ability to function
DSM – IV notion that dysthymic disorder was a less severe form
in everyday life.
of depression.
 DSM-5 Criteria for a Manic Episode
Subtypes of Depression A. A distinct period of abnormally and persistently elevated,
Anxious Distress – people have prominent anxiety expansive, or irritable mood and abnormally and persistently
symptoms as well as depressive symptoms. increased goal directed activity or energy, lasting at least 1
Mixed Features – people with this subtype meet the week and present most of the day, nearly every day for any
criteria for a major depressive disorder, but do not meet duration if hospitalization is necessary).
the full criteria for a manic episode. B. During the period of mood disturbance and increased energy
Ancholic Features – physiological symptoms of or activity, three (or more) of the following symptoms (four if the
depression are particularly prominent. mood is only irritable) are present to a significant degree, and
Psychotic Features - in which people may experience represent a noticeable change from usual behavior:
delusions and hallucinations.
Catatonic Features – people show the strange behaviors 1. Inflated self-esteem or grandiosity
collectively known as catatonia, which can range from a 2. Decreased need for sleep
complete lack of movement to excited agitation. 3. More talkative than usual or pressure to keep talking
Atypical Features - odd assortment of symptoms, are not 4. Flight of ideas or subjective experience that thoughts are
particularly unusual. racing
Seasonal Pattern/ Seasonal Affective Disorder (SAD) – 5. Distractibility, as reported or observed
have a history of at least 2 years of experiencing and fully 6. Increase in goal-directed activity (either socially, at work or
recovering from major depressive episodes. They become school, or sexually] or psychomotor agitation
depressed when the daylight hours are short, recover 7. Excessive involvement in activities that have a high potential
when the daylight hours are long. for painful consequences
Peripartum onset – given to women when the onset of a
major depressive episode occurs during pregnancy or in C. The mood disturbance is sufficiently severe to cause marked
the 4 weeks following childbirth. impairment in social or occupational functioning or to
Premenstrual Dysphoric Disorder – not a subtype of necessitate hospitalization to prevent harm to self or others, or
major depressive disorder. Some women regularly there are psychotic features.
experience significant increases in distress during the D. The episode is not attributable to the direct physiological
premenstrual phase of their menstrual cycle. effects of a substance (eg., a drug of abuse, a medication, or
other treatment), or to another medical condition.
Note: At least one lifetime manic episode is required for the
diagnosis of bipolar I disorder. Neurotransmitter that are implicated with Depression:
Monoamines
4 Bipolar Disorder Norepinephrine
Serotonin
Bipolar I – a manic-depressive disorder that can exist both Dopamine
with and without psychotic episodes. the depressions are
as severe as major depressive episodes. May have mixed
episode in which they experience the full criteria for manic Structural and Functional Brain
episodes. People experience Mania.
Bipolar II - consists of depressive and manic episodes
Abnormalities
which alternate and are typically less severe and do not Abnormalities found in 4 parts of the brain:
inhibit function. People experience Hypomania. Prefrontal Cortex – attention, working memory, planning,
Cyclothymic Disorder - cyclic disorder that causes brief and novel problemsolving. (Motivation to do work)
episodes of hypomania and depression, chronically over Anterior Cingulate – sub region of the prefrontal cortex.
at least a 2-year period. Less severe but more chronic Response to stress, emotional expression, and social
Rapid Cycling Disorder - Patients who experience at least behavior. (Lose attention)
four episodes (meet the criteria of manic, hypomanic, or Hippocampus – memory and in fear-related learning.
major depressive episode) during a 12-month period. Smaller volume and lower metabolic activity: major
Disruptive Mood Dysregulation Disorder – severe temper depression. (Body overreact to stress, chronic arousal of
outbursts that are grossly out of proportion in intensity body’s stress response)
and duration to a situation and inconsistent with Amygdala – help direct attention to stimuli that are
developmental level. Children may rage verbally and emotionally salient and have major significance for the
become physically violent. A child must have at least individual.
three temper outbursts per week for at least 12 months
both home and school. Neuroendocrine – regulates a number of important
DEPRESSION - common and serious mood disorder. hormones, turn affect basic functions such as sleep,
Those who suffer from depression experience persistent appetite, sexual drive, and the ability to experience
feelings of sadness and hopelessness and lose interest in pleasure. These hormones help the body respond to
activities they once enjoyed. Symptoms must be present environmental stressors.
for 2 weeks.
 3 Key Components of the Reformulated Learned Helplessness Theory - explain how
cognitive factors might influence whether a person
Neuroendocrine becomes helpless and depressed following a negative
event.
Hypothalamus
This theory focuses on people’s casual attributions for
Pituitary
events. (You blame yourself for specific reasons. Example:
Adrenal Cortex
consider a student who becomes depressed after failing a
psychology exam. The reformulated learned helplessness
Hypothalamic-Pituitary-Adrenal axis (HPA Axis) – involved
theory would suggest that she has blamed her failure on
in the fight-or-flight response - The hypothalamus has
internal causes (she did not study hard enough) rather than
cortisol receptors that detect when cortisol levels have
external causes (the exam was too hard) therefore she
increased and normally responds by decreasing CRH to
expects to fail again).
regulate the stress response.
Casual Attribution – explanation of why an event happened.
Hopelessness Depression – develops when people make
Cognitive Theories pessimistic attributions for the most important events in their
Behavioral Theories of Depression – life stress leads to lives and perceive that they have no way to cope with the
depression since it reduces the positive reinforcers in a consequences of these event. (Example: the student might
person’s life. not only conclude that she did not study hard enough, but
Learned Helplessness Theory – suggests that the type of also that there is no way she can ever graduate).
stressful event most likely to lead to depression is an Ruminative Response Styles Theory - focuses more on the
uncontrollable negative event. process of thinking than on the content of thinking as
Negative Cognitive Triad – they have negative views of contributor to depression.
themselves, the world, and the future. A cognitive response style that involves passively
Aaron Beck’s theory led to one of the most widely used brooding about one's mood, would lead to increases in
and successful therapies for depression—cognitive- depressive symptoms, while distraction and problem-
behavioral therapy. solving would lead to decreases in symptoms.
 Interpersonal Theories
Interpersonal Theories of Depression – Interpersonal Theories of Bipolar Disorder
difficulties and losses frequently precede depression and
are the stressors most commonly reported as triggering Bipolar disorder - is strongly and consistently linked to
depression. genetic factors, although the specific genetic
abnormalities that contribute to bipolar disorder are not
Rejection Sensitivity – engage in excessive reassurance
yet known
seeking, constantly looking for assurances from others
that they are accepted and love. People never quite
believe the affirmations other people give, however, and 1st Degree Relatives – parents, children, siblings, of people
anxiously keep going back for more. with bipolar disorder have 5 to 10 times higher rates of both
bipolar disorder and depressive disorders than relatives of
Sociocultural Theories people w/o bipolar disorder.
Like the depressive disorders, bipolar disorder is associated
Cohort Effect – Generational differences. When people’s
with abnormalities in the structure and functioning of the
difference on some psychological variable depends not
amygdala, which is involved in the processing of emotions
on their age but instead on the era in which they were
and the prefrontal cortex which is involved in cognitive
born and lived. (Ex. when there is an observed difference
control of emotion, planning, and judgement.
in cognitive skills between a group in their 20s and a
Striatum – part of a structure called basal ganglia, involved
group in their 60s. However, if the test was carried out on
in the processing of environmental cues of reward.
the computer, the observed results could be due to the
A circuit from the prefrontal cortex through the striatum to
fact that older people have less experience with
the amygdala is involved in adaptation to changing
electronics).
contingencies of reward.
Gender differences - One is that men and women differ in
Reward Sensitivity – refers to the degree to which people
how they respond to, or cope with, negative feelings.
experience emotional, behavioral, and biological responses
Ethnicity/Race Differences - As society becomes
to positive events they experience or anticipate.
increasingly diverse, ethnic, and racial differences in the
Another psychological factor that has been studied in
prevalence and patterns of depression support
people with bipolar disorder is stress. Experiencing stressful
sociocultural theories. Ethnic/ racial differences not only
events and living in an unsupportive family may trigger new
shed light on sociocultural factors in depression across
episodes of bipolar disorder
demographics, but also help guide treatment and
prevention efforts.
 Bupropion: A Norepinephrine-Dopamine Reuptake Inhibitor

Treatment of Mood Disorders Bupropion affects the norepinephrine and dopamine

systems and thus is known as a norepinephrine-
Most of the biological treatments for depression and dopamine reuptake inhibitor
bipolar disorder are drug treatments. useful in treating people suffering from psychomotor
Some people with mood disorders are treated with retardation, anhedonia, hypersomnia, cognitive
electroconvulsive therapy (ECT) slowing, inattention, and craving

The effects of bupropion address the role of

3 New Treatments for Mood

dopamine in pleasure, reward, and movement -
Basically, given to people addicted in Nicotine
Disorders Tricyclic Antidepressants
Repetitive Transcranial Magnetic Stimulation (rTMS0 Management and treatment of major depressive
Vagus Nerve Stimulation disorder
Deep Brain stimulation The first drugs shown to consistently relieve
depression but not used these days since it has
Selective Serotonin Reuptake Inhibitors (SSRI) numerous side effects.
widely used to treat depressive symptoms. The tricyclic antidepressants also can cause a drop in
These are not more effective in the treatment of blood pressure and cardiac arrhythmia in people with
depression than the other available antidepressants, heart problems.
but they have fewer difficult to-tolerate side effects. Fatal in overdose.
It is safer if taken in overdose than many older Monoamine Oxidase Inhibitors (MAOI)
antidepressants. These do not have any side-effects. Older class of drug that is no longer used frequently to
Selective Serotonin-Norepinephrine Reuptake Inhibitors treat depression.
(SNRI) An enzyme that causes the breakdown of the
Designed to affect level of norepinephrine as well as monoamine neurotransmitters in the synapse.
serotonin. Decrease the action of MAO and thereby increase the
Act the same way as SSRI but since these drugs levels of these neurotransmitters in the synapses.
influence both neurotransmitters they show a slight Side-effects are potentially quite dangerous.
advantage over the selective serotonin reuptake Can cause liver damage, weight gain, severe lowering
inhibitors in preventing a relapse of depression. of blood pressure.
 Electro conclusive Theory
Mood Stabilizers
Introduced in the early twentieth century
Lithium Originally as a treatment for schizophrenia
Work in improving the functioning of the intercellular The full ECT treatment consists of 6 to 12 sessions
processes that appear to be abnormal in the mood Electroconvulsive therapy is an effective treatment for
disorders severe depression, but it is controversial, in part because
of outdated depictions of it in the media.
Most people with bipolar dis order take lithium even ECT can lead to memory loss and difficulty learning new
when they have no symptoms of mania or depression information, particularly in the days following the
to prevent relapses. treatment.
Also effective in reducing suicide risk.

Anticonvulsant and Atypical Antipsychotic Medications

Valproate – Treat seizures. Induce fewer side effects
Newer Methods of Brain Stimulation
and is used more often than carbamazepine. Repetitive Transcranial Magnetic Stimulation (rTMS)
Lamotrigine - To treat depression in people with scientists expose patients to repeated, high intensity
bipolar disorder. Used especially for maintenance magnetic pulses focused on brain structures
treatment and preventing episode recurrence. This procedure involves placing a machine around
Anti-Epileptics - can cause birth defects if women specific locations of the brain but is noninvasive and
take them while pregnant, and they do not prevent can be done on an outpatient basis.
suicide as effectively as lithium does. The
antiepileptics may work by restoring the balance Vagus Nerve Stimulation - The vagus nerve is stimulated
between the neurotransmitter systems in the by a small electronic device, much like a cardiac
amygdala. pacemaker, that is surgically implanted under the patient’s
skin in the left chest wall.
 Deep Brain Stimulation - electrodes are surgically Interpersonal Therapy - therapists look for four types of
implanted in specific areas of the brain. The electrodes problems in depressed individuals. Focuses on relieving
are connected to a pulse generator that is placed under symptoms by improving interpersonal functioning.
the skin and stimulates these brain areas.
1. Interpersonal therapists help clients face such losses and
Light Therapy – This involves sitting by a special lamp
explore their feelings about them. Therapists also help
called a light box, usually for around 30 minutes to an hour
clients begin to invest in new relationships.
each morning
2. Interpersonal role disputes, which arise when people do
not agree on their roles in a relationship.
Psychological Treatments for Mood 3. Role transitions, such as the transition from college to
work or from work to full-time motherhood. People
Disorders sometimes become depressed over the role they must
leave behind. Sometimes, clients need help developing
Behavioral Therapy - focuses on increasing positive
new networks of social support to replace the support
reinforcers and decreasing aversive experiences in an
systems they have left behind in their old roles.
individual’s life by helping the depressed person change
4. Problems caused by deficits in interpersonal skills. Such
his or her patterns of interaction with the environment
skill deficits can be the reason people with depression
skills, such as relaxation techniques, for managing their
have inadequate social support networks
moods in unpleasant situations.

Cognitive-Behavioral Therapy (CBT) - represents a Interpersonal and Social Rhythm

blending of cognitive and behavioral theories of
depression. This is designed to be brief and time-limited Therapy and Family-Focused Therapy
like behavioral therapy.
Interpersonal and social rhythm therapy (ISRT)
2 general goals: an enhancement of interpersonal therapy designed
1. aims to change the negative, hopeless patterns of thinking specifically for people with bipolar disorder.
described by the cognitive models of depression. ISRT combines interpersonal therapy techniques with
2. aims to help people with depression solve concrete behavioral techniques to help patients maintain regular
problems in their lives and develop skills for being more routines of eating, sleeping, and activity, as well as
effective in their world stability in their personal relationships
 Family Focused Therapy (FFT)
designed to reduce interpersonal stress in people with Suicide may become more common in adolescence than
bipolar disorder, particularly within the context of in childhood because the rates of several types of
families psychopathologies tied to suicide, including depression,
Patients and their families are educated about bipolar anxiety disorders, and substance abuse, increase in
disorder and trained in communication and problem- adolescence.
solving skills Suicide rates also may rise during the teen years because
adolescents are more sophisticated than children in their
Suicide thinking and can contemplate suicide more clearly.
“Death from injury, poisoning, or suffocation where there
is evidence that the injury was self-inflicted, and that the College Students
decedent intended to kill himself/herself.
It is among the 3 leading causes of death worldwide The college years are full of academic and social
among people ages 15 to 44. pressures and challenges.
Suicide is associated with mood disorders. Students who had contemplated or attempted suicide
were more likely than those who had not to have
Distinguish Suicide:
experienced depression and hopelessness, loneliness,
Completed Suicides – end in death
and problems with their parents.
Suicide Attempts – may or may not end in death
Suicidal Ideation – thought
Suicide in Older Adults
Actual suicide attempts are much more common than
completed suicides. Some older people commit suicide because they cannot
While two to three times more women than men attempt tolerate the loss of their spouse or other loved ones.
suicide, men are four times more likely than women to Suicide rates are highest in the first year after a loss but
complete suicide. remain relatively high for several years.
Other older people who commit suicide wish to escape

Suicide in Children and Adolescents the pain and suffering of debilitating illness.
Escape from illness and disabilities may be a particularly
Although suicide is relatively rare in young children, it is strong motive for suicide among men, who are reluctant to
not unheard of. The rate of suicide increases substantially become a burden to others
in early adolescence.
 Non suicidal Self-Injury
People—often adolescents—repeatedly cut, burn,
Personality and Cognitive Factors
puncture, or otherwise significantly injure their skin with no in Suicide
intent to die.
NSSI is especially prevalent among adolescents. Impulsivity - the general tendency to act on one’s
NSSI often report that the experience of feeling the pain impulses rather than to inhibit them when it is appropriate
and seeing the blood calms them and releases tension. to do so
Egoistic suicide - committed by people who feel alienated Hopelessness - the feeling that the future is bleak and
from others, empty of social contacts, and alone in an there is no way to make it more positive. Hopelessness
unsupportive world. also may be one reason many people who are suicidal do
Anomic suicide - committed by people who experience not seek treatmen
severe disorientation because of a major change in their

Treatment and Prevention

relationship to society (A man who loses his job after 30
years)
Altruistic suicide - committed by people who believe that Prevention programs have focused on educating people
taking their life will benefit society broadly about suicide risk and the steps to take if they are
suicidal or know of someone who is suicidal
Suicide Cluster - When two or more suicides or
attempted suicides are nonrandomly bunched together in Crisis intervention programs - available to help suicidal
space or time, such as a series of suicide attempts in the people deal in the short term with their feelings and then
same high school or a series of completed suicides in refer them to mental health specialists for longer-term
response to the suicide of a celebrity, scientists. Suicide care. Aims to reduce the risk of an imminent suicide
clusters appear likeliest among people who knew the attempt by providing suicidal per sons someone to talk
person who committed suicide. with who understands their feelings and problems.
Suicide Contagion - occurs when exposure to a single Dialectical behavior therapy (DBT) - developed to treat
suicide increases the risk of others engaging in suicidal people with borderline personality disorder, who
behavior. Some theorists have examined the role of the frequently attempt suicide
media.
What to do if a friend is suicidal? 8. Don't promise confidentiality. You need the freedom to
contact mental health professionals and tell them precisely
1. Take the person seriously. Although most people who what is going on.
express suicidal thoughts do not go on to attempt suicide, 9. Make sure guns, old medications, and other means of self-
most people who do commit suicide have communicated harm are not available.
their suicidal intentions to friends or family members 10. If possible, don't leave the person alone until he or she is
beforehand. in the hands of professionals. Go with him or her to the
2. Get help. Call the person's therapist, a suicide hotline, 911, emergency room if need be. Then, once he or she has been
or any other source of professional mental health care. hospitalized or has received other treatment, follow up to
3. Express concern. Tell the person concretely why you think show you care.
he or she is suicidal.
4. Pay attention. Listen closely, maintain eye contact, and
use body language to indicate that you are attending to
everything the person says.
5. Ask direct questions about whether the person has a plan
for suicide and, if so, what that plan
6. Acknowledge the person's feelings in a nonjudge mental
way. For example. you might say some. thing like "I know
you are feeling really horrible right now, but I want to help
you get through this or "I can't begin to completely
understand how you feel, but I want to help you."
7. Reassure the person that things can be better. Emphasize
that suicide is a permanent solution to a temporary
problem.