PSYCHOPATHOLOGY NOTES

CHAPTER 1
→ Abnormal psychology is concerned with understanding the nature, causes,
and treatment of mental disorders.
The Elements of Abnormality → Suffering, Violation of the Standards of
Society, Maladaptiveness, Deviancy, Social Discomfort, Irrationality and
Unpredictability, Dangerousness. No one element is sufficient to define or
determine abnormality. Culture plays a role in determining what is and is not
abnormal.
Family aggregation→ That is, whether a disorder runs in families.
→ Karo-kari (a form of honor killing where a woman is murdered by a male
relative because she is considered to have brought disgrace onto her family).
→ Within DSM-5, a mental disorder is defined as a syndrome that is present
in an individual and that involves clinically significant disturbance in
behavior, emotion regulation, or cognitive functioning. Mental disorders are
usually associated with significant distress or disability in key areas of
functioning such as social, occupational or other activities.
→ Why Do We Need to Classify Mental Disorders? At the most fundamental
level, classification systems provide us with a nomenclature (a naming
system) and enable us to structure information in a more helpful manner.
Organizing information within a classification system also allows us to study the
what causes them but also how they might best be treated.
Disadvantages of Classification → Loss of individual’s information. Stigma
and stereotyping associated with diagnosis. Labeling can impact self-concept.
֎֎֎Diagnostic classification systems do not classify people. Rather, they
classify the disorders that people have.
How Does Culture Affect What Is Considered Abnormal? → Within a given
culture, there exist many shared beliefs and behaviors that are widely accepted
and that may constitute one or more customary practices. The way some
disorders present themselves may depend on culturally sanctioned ways of
articulating distress.
Culture-Specific Disorders→ Certain forms of psychopathology highly
specific to certain cultures.
Taijin kyofusho→ It involves a marked fear that one’s body, body parts, or
body functions may offend, embarrass, or otherwise make others feel
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uncomfortable. Often, people with this disorder are afraid of blushing or
upsetting others by their gaze, facial expression, or body odor.
Ataque de nervios → Latino and Latina individuals, especially those from
the Caribbean. The symptoms of an ataque de nervios, which is often triggered
by a stressful event such as divorce or bereavement, include crying, trembling,
uncontrollable screaming, and a general feeling of loss of control. Sometimes
the person may become physically or verbally aggressive. Alternately, the
person may faint or experience a seizure-like fit. Once the ataque is over, the
person may promptly resume his or her normal manner, with little or no memory
of the incident.
Prevalence and Incidence → Epidemiology is the study of the distribution of
diseases, disorders, or health-related behaviors in a given population. Mental
health epidemiology is the study of the distribution of mental disorders. The
term prevalence refers to the number of active cases in a population during any
given period of time. Point prevalence refers to the estimated proportion of
actual, active cases of the disorder in a given population at a given point in time.
1-year prevalence figure, we would count everyone who experienced depression
at any point in time throughout the entire year. Estimate of the number of people
who have had a particular disorder at any time in their lives, called lifetime
prevalence. Incidence refers to the number of new cases that occur over a
given period of time (typically 1 year). Incidence figures tend to be lower than
prevalence figures because they exclude preexisting cases.
→ Three major national mental health epidemiology studies, with direct and
formal diagnostic assessment of participants, have been carried out in the United
States. Epidemiologic Catchment Area (ECA) study, National Comorbidity
Survey (NCS), A replication of the NCS (the NCS-R) was completed about a
decade later.
→ Comorbidity is the term used to describe the presence of two or more
disorders in the same person.
Treatment → Not all people with psychological disorders receive treatment.
When people with mental disorders do seek help, they are often treated by their
family physician rather than by a mental health specialist. The vast majority of
mental health treatment is now administered on an outpatient (as opposed to
an inpatient) basis. Outpatient treatment requires that a patient visit a mental
health facility practitioner; however, the patient does not have to be admitted
to the hospital or stay there overnight. Hospitalization and inpatient care are the
preferred options for people who need more intensive treatment than can be
provided on an outpatient basis. Patients who need inpatient care are usually
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admitted to the psychiatric units of general hospitals or to private psychiatric
hospitals specializing in particular mental disorders.
Mental Health Professionals → Clinical Psychologist, Counseling
Psychologist, School Psychologist, Psychiatrist, Psychoanalyst, Clinical Social
Worker, Psychiatric Nurse, Occupational Therapist, Pastoral Counselor,
Community Mental Health Worker, Alcohol- or Drug-Abuse Counselor.
Research Approaches in Abnormal Psychology → Through research we can
learn about the symptoms of the disorder, its prevalence, whether it tends to be
either acute (short in duration) or chronic (long in duration), and the problems
and deficits that often accompany it. Research allows us to further understand
the etiology (or causes) of disorders. Finally, we need research to provide the
best care for the patients who are seeking assistance with their difficulties.
Sources of Information → Case studies, Self-report data, Observational
approaches.
Case studies → Specific individual observed and described in detail. Subject to
bias of author of case study. Low generalizability.
Self-report data → Participants asked to provide information about themselves.
Interviews and Questionnaires. May be inaccurate.
Observational approaches → Collecting information without asking
participants directly for it. Outward behavior can be observed directly.
Biological variables can be observed via technologically advanced methods.
→ The effect size reflects the size of the association between two variables
independent of the sample size.
→ A meta-analysis is a statistical approach that calculates and then combines
the effect sizes from all of the studies.
Retrospective versus Prospective Strategies → Retrospective research
strategies involve looking back in time, try to collect information about how the
patients behaved early in their lives with the goal of identifying factors that
might have been associated with what went wrong later. Prospective research
strategies involve looking ahead in time, identify individuals who have a higher-
than-average likelihood of becoming psychologically disordered and to focus
research attention on them before any disorder manifests.
→ In certain cases, an alternative research design may be called for in which
two (or more) treatments are compared in differing yet comparable groups. This
method is termed a standard treatment comparison study.
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Single-Case Experimental Designs → Make causal inferences in individual
cases. Involve alternating baseline condition and treatment condition. One of the
most basic experimental designs in single-case research is called the ABAB
design. The different letters refer to different phases of the intervention. The
first A phase serves as a baseline condition. Here we simply collect data on or
from the participant. Then, in the first B phase, we introduce our treatment.
→ Analogue studies, in which we study not the true item of interest but an
approximation to it.
Unresolved Issues → Categorization of increasing numbers of people as
mentally ill. Financial interests of mental health professionals benefit from
inclusive definitions. How broadly should abnormality be defined?
CHAPTER 2
֍The Edwin Smith papyrus (named after its nineteenth-century discoverer)
contains detailed descriptions of the treatment of wounds and other surgical
operations. In it, the brain is described—possibly for the first time in history—
and the writing clearly shows that the brain was recognized as the site of mental
functions.
֍The Ebers papyrus offers another perspective on treatment. It covers internal
medicine and the circulatory system but relies more on incantations and magic
for explaining and curing diseases that had unknown causes.
Demonology, Gods, and Magic → Chinese, Egyptians, Hebrews, and Greeks
often attributed such behavior to a demon or god who had taken possession of a
person. Whether the “possession” was assumed to involve good spirits or evil
spirits usually depended on the affected individual’s symptoms.
Hippocrates’ Early Medical Concepts → Greek physician, father of modern
medicine, received his training and made substantial contributions to the field.
He believed that the brain was the central organ of intellectual activity and that
mental disorders were due to brain pathology. Hippocrates classified all mental
disorders into three general categories—mania, melancholia, and phrenitis
(brain fever). Hippocrates considered dreams to be important in understanding a
patient’s personality. He believed that hysteria was restricted to women,
recommended marriage as a cure. The earliest use of the concept “delirium” to
describe symptoms of mental disorders that result from fever or physical
injury or brain trauma occurred in the first century a.d. by Celsus.
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Roman physician Galen → explaining personality or temperament is the
doctrine of the 4 humors. Earth, air, fire, and water, which had attributes of
heat, cold, moistness, and dryness. These elements combined to form the 4
essential fluids of the body—blood (sanguis), phlegm, bile (choler), and
melancholer. Recognizing that psychological disorders could have both
biological and psychological causes
Early Philosophical Conceptions of Consciousness → Plato studied mentally
disturbed individuals who had committed criminal acts and how to deal with
them. Emphasized individual differences and sociocultural influences. Plato
viewed psychological phenomena as responses of the whole organism, reflecting
its internal state and natural appetites. Plato shared the belief that mental
disorders were in part divinely caused.
Aristotle who was a pupil of Plato, wrote extensively on mental disorders. Wrote
lasting description of consciousness. Aristotle generally subscribed to the
Hippocratic theory of disturbances in the bile.

Later Greek and Roman Thought → Egyptians proposed wide range of

therapeutic measures. Asclepiades (c. 124–40 b.c.) was a Greek physician born
at Prusa in Bithynia in Asia Minor and practiced medicine in Rome, developed a
theory of disease that was based on the flow of atoms through the pores in the
body and developed treatments, such as massage, special diets, bathing,
exercise, listening to music, and rest and quiet, to restore to the body.
Greek physician Galen who practiced in Rome. He made a number of original
contributions concerning the anatomy of the nervous system. Galen also took a
scientific approach to the field, dividing the causes of psychological disorders
into physical and mental categories. Roman medicine reflected the
characteristic pragmatism of the Roman people. Roman medicine focused on
comfort. They also followed the principle of contrariis contrarius (“opposite by
opposite”) —for example, having their patients drink chilled wine while they
were in a warm tub.
Early Views of Mental Disorders in China → Chinese medicine was based
on a belief in natural rather than supernatural causes for illnesses. Chung
Ching, who has been called the Hippocrates of China, wrote two well-known
medical works around. He based his views of physical and mental disorders on
clinical observations, and he implicated organ pathologies as primary causes.
Chinese views of mental disorders regressed to a belief in supernatural forces as
causal agents.
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Views of Abnormality During the Middle Ages → The first mental hospital
was established in Baghdad in a.d. 792; it was soon followed by others in
Damascus and Aleppo. Avicenna, called the “prince of physicians” and the
author of The Canon of Medicine, perhaps the most widely studied medical
work ever written.
→ Europe was plagued with mass madness and treatment included exorcism.
Supernatural explanations of the causes of mental illness grew in popularity.
Mass Madness → the widespread occurrence of group behavior disorders that
were apparently cases of hysteria. Whole groups of people were affected
simultaneously. PALESTİNİAN GİRLS
Tarantism → It occurred in Italy early in the thirteenth century. A disorder that
included an uncontrollable impulse to dance that was often attributed to the bite
of the southern European tarantula or wolf spider. This dancing mania later
spread to Germany and the rest of Europe, where it was known as Saint Vitus’s
dance.
Lycanthropy → a condition in which people believed themselves to be
possessed by wolves and imitated their behavior.
→ Europe was ravaged by a plague known as the Black Death, which killed
millions (according to some estimates, 50% of the population of Europe died)
and severely disrupted social organization.
→Today, so-called mass hysteria occurs occasionally; the affliction usually
mimics some type of physical disorder such as fainting spells or convulsive
movements. A case of apparent mass hysteria occurred among hundreds of
West Bank Palestinian girls in April 1983.
→ Ilechukwu describes an epidemic of mass hysteria that occurred in Nigeria in
1990 in which many men feared that their genitals had simply vanished. This
fear of genital retraction accompanied by a fear of death is referred to as koro
and has been widely documented in Southeast Asia.
Exorcism and Witchcraft → In the Middle Ages in Europe, management of the
mentally disturbed was left largely to the clergy. Monasteries served as refuges
and places of confinement. Treatment” consisted of prayer, holy water,
sanctified ointments, the breath or spittle of the priests, the touching of relics,
visits to holy places, and mild forms of exorcism. In some monasteries and
shrines, exorcisms were performed by the gentle “laying on of hands.”
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→ For a fiend-sick man: When a devil possesses a man, or controls him from
within with disease, a spewdrink of lupin, bishopswort, henbane, garlic. Pound
these together, add ale and holy water.
Robert Burton (1576–1640) → The Anatomy of Melancholia (1621).
Toward Humanitarian Approaches → During the latter part of the Middle
Ages and the early Renaissance, scientific questioning reemerged and a
movement emphasizing the importance of specifically human interests and
concerns began—a movement (still with us today) that can be loosely referred to
as humanism. Consequently, the superstitious beliefs that had hindered the
understanding and therapeutic treatment of mental disorders began to be
challenged.
The Resurgence of Scientific Questioning in Europe → Paracelsus, insisted
that the dancing mania was not a possession but a form of disease, and that it
should be treated as such. He also postulated a conflict between the instinctual
and spiritual natures of human beings, formulated the idea of psychic causes for
mental illness, and advocated treatment by “bodily magnetism,” later called
hypnosis.
Paracelsus rejected demonology, his view of abnormal behavior was colored by
his belief in astral influences (lunatic is derived from the Latin word luna, or
“moon”). He was convinced that the moon exerted a supernatural influence over
the brain—an idea, incidentally, that persists among some people today.
→ Johann Weyer was so deeply disturbed by the imprisonment, torture, and
burning of people accused of witchcraft that he made a careful study of the
entire problem. About 1583 he published a book, On the Deceits of the Demons,
that contains a step-bystep rebuttal of the Malleus Maleficarum, a witch-
hunting handbook published in 1486 for use in recognizing and dealing with
those suspected of being witches. He was scorned by his peers, many of whom
called him “Weirus Hereticus” and “Weirus Insanus.”
→ St. Vincent de Paul (1576–1660), at the risk of his life, declared, “Mental
disease is no different than bodily disease and Christianity demands of the
humane and powerful to protect, and the skillful to relieve the one as well as the
other.”
The Establishment of Early Asylums → From the sixteenth century on, special
institutions called asylums—sanctuaries or places of refuge meant solely for the
care of the mentally ill—grew in number. Most early asylums, often referred to
as “madhouses.” The first asylum established in Europe was probably in Spain
in 1409.
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Humanitarian Reform → By the late 18th century, most mental hospitals in
Europe and America were in great need of reform. The humanitarian treatment
of patients received great impetus from the work of Philippe Pinel (1745–1826)
in France.
→Philippe Pinel unchained of inmates and treated them with kindness at La
Bicêtre hospital. Pinel’s experiment represented both a great reform and a major
step in devising humanitarian methods of treating mental disorder.
→English Quaker named William Tuke (1732–1822) established the York
Retreat, a pleasant country house where mental patients lived, worked, and
rested in a kindly, religious atmosphere.
→ Benjamin Rush (1745–1813), the founder of American psychiatry and also
one of the signers of the Declaration of Independence. Wrote the first systematic
treatise on psychiatry in America, Medical Inquiries and Observations upon
Diseases of the Mind (1812); and was the first American to organize a course in
psychiatry.
►During the early part of this period of humanitarian reform, the use of moral
management—a wide-ranging method of treatment that focused on a patient’s
social, individual, and occupational needs—became relatively widespread.
Despite its reported effectiveness in many cases, moral management was nearly
abandoned by the latter part of the nineteenth century. The reasons were many
and varied. One was the rise of the mental hygiene movement, which
advocated a method of treatment that focused almost exclusively on the
physical well-being of hospitalized mental patients. Although the patients’
comfort levels improved under the mental hygienists, the patients received no
help for their mental problems and thus were subtly condemned to helplessness
and dependency.
Dorothea Dix and the Mental Hygiene Movement → Dorothea Dix (1802–
1887) who became a champion of poor and “forgotten” people in prisons and
mental institutions for decades during the nineteenth century. Not only was she
instrumental in improving conditions in American hospitals but she also directed
the opening of two large institutions in Canada and completely reformed the
asylum system in Scotland and several other countries. She was a tireless
reformer who made great strides in changing public attitudes toward the
mentally ill.
The Military and the Mentally Ill → The first mental health facility for
treating mentally disordered war casualties was opened by the Confederate
Army in the American Civil War. More extensive and influential program of
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military psychiatry evolved in Germany during the late 1800s. Lengweiler
(2003) reviews the evolution of military psychiatry in Germany between the
Franco-Prussian War in 1870 and World War I in 1914.
19th Century Views of Mental Disorders → In the early part of the nineteenth
century, mental hospitals were controlled essentially by laypersons because of
the prominence of moral management in the treatment of “lunatics.” Medical
professionals—or “alienists,” as psychiatrists were called at this time in
reference to their treating the “alienated,” or insane—had a relatively
inconsequential role in the care of the insane and the management of the
asylums of the day. Mental disorders were only vaguely understood, and
conditions such as melancholia (depression) were considered to be the result of
nervous exhaustion. The mental deterioration or “shattered nerves” that
supposedly resulted from a person’s using up precious nerve force came to be
referred to as “neurasthenia,” a condition that involved pervasive feelings of
low mood, lack of energy, and physical symptoms that were thought to be
related to “lifestyle” problems brought on by the demands of civilization.
Mental Health in the Early Twentieth Century → By the end of the
nineteenth century, the mental hospital or asylum— “the big house on the hill”
—with its fortress-like appearance, had become a familiar landmark in America.
Clifford Beers (1876–1943), whose book A Mind That Found Itself was first
published in 1908. He publicized the brutal treatment that many mental
patients received.
Mental Hospital Care in the 20th Century → mental hospitals grew
substantially in number. Mary Jane Ward published a very influential book,
The Snake Pit, served to publicize the plight of the mentally ill. o in 1946,
the National Institutes of Mental Health was organized and provided active
support for research and training through psychiatric residencies and (later)
clinical psychology training programs. The Hill-Burton Act, a program that
funded community mental health hospitals, was passed during this period. This
legislation, along with the Community Health Services Act of 1963, helped to
create a far-reaching set of programs to develop outpatient psychiatric clinics,
inpatient facilities in general hospitals, and community consultation and
rehabilitation programs.
Book → Asylums, by the sociologist Erving Goffman.
Due to the success of chlorpromazines that emerged in the 1950s to alleviate
psychotic symptoms, there was a concerted effort to close mental hospitals
and return psychiatrically disturbed people to society. A large number of
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psychiatric hospitals were closed. This movement was called
deinstitutionalization.
The Emergence of Contemporary Views of Abnormal Behavior → Four
major themes in abnormal psychology that spanned the nineteenth and twentieth
centuries and generated powerful influences on our contemporary perspectives
in abnormal behavior: (1) biological discoveries, (2) the development of a
classification system for mental disorders, (3) the emergence of
psychological causation views, and (4) experimental psychological research
developments.
❶ A major biomedical breakthrough, for example, came with the discovery of
the organic factors underlying general paresis—syphilis of the brain. The
discovery of a cure for general paresis began in 1825, when the French
physician A. L. J. Bayle differentiated general paresis as a specific type of
mental disorder. Julius von Wagner-Jauregg, chief of the psychiatric clinic of the
University of Vienna, introduced the malarial fever treatment of syphilis and
paresis because he knew that the high fever associated with malaria killed off the
bacteria. Brain deterioration resulted in general paresis.
❷ Scientists began to focus on diseased body organs as the cause of physical
ailments. In 1757 Albrecht von Haller (1708–1777), in his Elementa
physiologae corporis humani, emphasized the importance of the brain in
psychic functions and advocated postmortem dissection to study the brains of
the insane. The first systematic presentation of this viewpoint, however, was
made by the German psychiatrist Wilhelm Griesinger. In his textbook The
Pathology and Therapy of Psychic Disorders, Griesinger insisted that all
mental disorders could be explained in terms of brain pathology.
❸ Emil Kraepelin (1856–1926), another German psychiatrist, played a
dominant role in the early development of the biological viewpoint. His
textbook Compendium der Psychiatrie, published in 1883, not only emphasized
the importance of brain pathology in mental disorders but also made several
related contributions that helped establish this viewpoint. Emphasized the
importance of brain pathology in mental disorders. The most important of
these contributions was his system of classification of mental disorders, which
became the forerunner of today’s DSM classification.
❹Freud developed a comprehensive theory of psychopathology that emphasized
the inner dynamics of unconscious motives (often referred to as
psychodynamics) that are at the heart of the psychoanalytic perspective. The
methods he used to study and treat patients came to be called psychoanalysis.
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► Mesmerism: Franz Anton Mesmer (1734–1815), an Austrian physician who
further developed the ideas of Paracelsus about the influence of the planets on
the human body. Mesmer believed that the planets affected a universal
magnetic fluid in the body, the distribution of which determined health or
disease. Mesmer concluded that all people possessed magnetic forces that could
be used to influence the distribution of the magnetic fluid in other people, thus
effecting cures.
The patients usually displayed considerable emotion and, on awakening from
their hypnotic states, felt a significant emotional release, which was called a
catharsis. It was this approach that thus led to the discovery of the unconscious
—the portion of the mind that contains experiences of which a person is
unaware—and with it the belief that processes outside of a person’s awareness
can play an important role in determining behavior. Freud and Breuer published
their joint paper On the Psychical Mechanisms of Hysterical Phenomena,
which was one of the great milestones in the study of the dynamics of the
conscious and unconscious. Two related methods enabled him to understand
patients’ conscious and unconscious thought processes. One method, free
association, involved having patients talk freely about themselves, thereby
providing information about their feelings, motives, and so forth. A second
method, dream analysis, involved having patients record and describe their
dreams. These techniques helped analysts and patients gain insights and achieve
a better understanding of the patients’ emotional problems.
►The Nancy School: Ambrose August Liébeault (1823–1904), a French
physician who practiced in the town of Nancy, used hypnosis successfully in
his practice. Also in Nancy at the time was a professor of medicine, Hippolyte
Bernheim (1840–1919), who became interested in the relationship between
hysteria and hypnosis. hysteria was a sort of self-hypnosis. The physicians who
accepted this view ultimately came to be known as the Nancy School.
► In 1879 Wilhelm Wundt established the first experimental psychology
laboratory at the University of Leipzig. Lightner Witmer (1867–1956),
combined research with application and established the first American
psychological clinic at the University of Pennsylvania. Witmer, considered to
be the founder of clinical psychology.
Classical Conditioning → A form of learning in which a neutral stimulus is
paired repeatedly with an unconditioned stimulus that naturally elicits an
unconditioned behavior. After repeated pairings, the neutral stimulus becomes a
conditioned stimulus that elicits a conditioned response. This work began with
the discovery of the conditioned reflex by Russian physiologist Ivan Pavlov.
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► Thorndike (1874–1949) and subsequently B. F. Skinner (1904–1990) were
exploring a different kind of conditioning, one in which the consequences of
behavior influence behavior. Behavior that operates on the environment may be
instrumental in producing certain outcomes, and those outcomes, in turn,
determine the likelihood that the behavior will be repeated on similar occasions.
Thorndike studied how cats could learn a particular response, such as pulling a
chain, if that response was followed by food reinforcement. This type of
learning came to be called instrumental conditioning and was later renamed
operant conditioning by Skinner.
►Behavioral perspective is organized around a central theme: the role of
learning in human behavior. Although this perspective was initially developed
through research in the laboratory rather than through clinical practice with
disturbed individuals, its implications for explaining and treating maladaptive
behavior soon became evident. John B. Watson changed the focus of
psychology to the study of overt behavior rather than the study of theoretical
mentalistic constructs, an approach he called behaviorism.
Unresolved Issues ► Interpretation of historical events and influence of biases.
Controversy over importance and relevance of some historical events.
CHAPTER 3- Causal Factors and Viewpoints
Risk factors → variables correlated with an abnormal outcome.
Etiology → causal pattern of abnormal behavior.
Necessary Cause → If Disorder Y occurs, then Cause X must have preceded it
Sufficient Cause → If Cause X occurs, then Disorder Y will also occur.
Contributory Cause → If X occurs, then the probability of Disorder Y
increases.
► Some causal factors occurring relatively early in life may not show their
effects for many years; these would be considered distal causal factors that
may contribute to a predisposition to develop a disorder. By contrast, other
causal factors operate shortly before the occurrence of the symptoms of a
disorder; these would be considered proximal (immediate) causal factors.
►A reinforcing contributory cause is a condition that tends to maintain
maladaptive behavior that is already occurring. An example is the extra
attention, sympathy, and relief from unwanted responsibility that may come
when a person is ill; these pleasant experiences may unintentionally discourage
recovery.
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► When more than one causal factor is involved, as is often the case, the term
causal pattern is used.
Perceived Hostility ►A boy with a history of disturbed interactions with his
parents routinely misinterprets the intentions of his peers as being hostile. He
develops defensive strategies to counteract the supposed hostility of those
around him such as rejecting the efforts of others to be friendly, which he
misinterprets as patronizing. Confronted by the boy’s prickly behavior, those
around him become defensive, hostile, and rejecting, thus confirming and
strengthening the boy’s distorted expectations. In this manner, each opportunity
for new experience and new learning is in fact subverted.
Diathesis-Stress Models → A predisposition toward developing a disorder is
termed a diathesis. Stress, the response or experience of an individual to
demands that he or she perceives as taxing or exceeding his or her personal
resources. The diathesis or vulnerability results from one or more relatively
distal necessary or contributory causes, but is generally not sufficient to cause
the disorder. Instead, there generally must be a more proximal undesirable event
or situation (the stressor), which may also be contributory or necessary but is
generally not sufficient by itself to cause the disorder except in someone with
the diathesis.
֍ Researchers have proposed several different ways that a diathesis and stress
may combine to produce a disorder. In what is called the additive model,
individuals who have a high level of a diathesis may need only a small
amount of stress before a disorder develops, but those who have a very low
level of a diathesis may need to experience a large amount of stress for a
disorder to develop. In interactive model, some amount of diathesis must be
present before stress will have any effect. Thus, in the interactive model,
someone with no diathesis will never develop the disorder, no matter how
much stress he or she experiences, whereas someone with the diathesis will
show increasing likelihood of developing the disorder with increasing levels of
stress.
֍ Protective factors, which are influences that modify a person’s response to
environmental stressors, making it less likely that the person will experience the
adverse consequences of the stressors. Resilience is the ability to adapt
successfully to events in very difficult circumstances. Protective factors are
not necessarily positive experiences. Indeed, sometimes exposure to stressful
experiences that are dealt with successfully can promote a sense of self-
confidence or self-esteem and thereby serve as a protective factor; thus
some stressors paradoxically promote coping. This “steeling” or
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“inoculation” effect is more likely to occur with moderate stressors than
with mild or extreme stressors.
֍In sum, we can distinguish between causes of abnormal behavior that lie
within and are part of the biological makeup or prior experience of a person—
diatheses, vulnerabilities, or predispositions—and causes that pertain to current
challenges in a person’s life—stressors. Typically, neither the diathesis nor the
stress is by itself sufficient to cause the disorder, but in combination they can
sometimes lead the individual to behave abnormally.
֍ The diathesis-stress models need to be considered in a broad framework of
multicausal developmental models.
֍ Developmental psychopathology, which focuses on to understand what is
within the range of normal development so as to have a better
understanding of what is abnormal at any point in development by
comparing and contrasting it with the normal and expected changes that occur in
the course of development.
The Biological Viewpoint and Biological Causal Factors → Neurotransmitter
and hormonal abnormalities, Genetic vulnerabilities, Temperament, Brain
dysfunction and neural plasticity.
Imbalances of Neurotransmitters and Hormones
Synapse: A tiny fluid-filled space between the axon endings of one neuron (the
presynaptic neuron) and the dendrites or cell body of another neuron (the
postsynaptic neuron). The synapse is the site of communication between the
axon of one neuron and the dendrites or cell body of another.
Neurotransmitters: chemical substances that are released into the synapse by
the presynaptic neuron when a nerve impulse occurs.
1- Nerve impulses travel from the cell body or dendrites of one neuron (nerve
cell) down the axon. Axons have branches at their ends called axon endings.
These are the sites where neurotransmitter substances are released into the
synapse.
2- The neurotransmitter substances released into the synapse then act on the
postsynaptic membrane of the dendrite (or cell body) of the receiving neuron,
which has specialized receptor sites where the neurotransmitter substances pass
on their message. The neurotransmitters can stimulate that postsynaptic neuron
to either initiate an impulse or inhibit impulse transmission.
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3-Once the neurotransmitter substance is released into the synapse, it does not
stay around indefinitely. Sometimes the neurotransmitters are quickly destroyed
by an enzyme such as monoamine oxidase, and sometimes they are returned to
storage vesicles in the axon endings by a reuptake mechanism — a process of
reabsorption by which the neurotransmitters are reabsorbed or effectively sucked
back up into the axon ending.
֍The belief that imbalances in neurotransmitters in the brain can result in
abnormal behavior is one of the basic tenets of the biological perspective today.
Sometimes psychological stress can bring on neurotransmitter imbalances.
These imbalances can be created in a variety of ways:
֍֍Neurotransmitters released into the synapse may be reuptaken into the axon
endings from which they originated, it’s called deactivation.
1) There may be excessive production and release of the neurotransmitter
substance into the synapses, causing a functional excess in levels of that
neurotransmitter. 2) There may be dysfunctions in the normal processes by
which neurotransmitters, once released into the synapse, are deactivated. 3)
There may be problems with the receptors in the postsynaptic neuron, which
may be either abnormally sensitive or abnormally insensitive.
►Neurons that are sensitive to a particular neurotransmitter tend to cluster
together, forming neural paths between different parts of the brain known as
chemical circuits.
Negative feedback loop once cortisol is produced by the adrenal gland. Cortisol
tells hypothalamus to stop producing CRH and ACTH, which in turn reduces the
release of cortisol and adrenaline. When negative feedback system malfunctions,
there is an increased risk for depression and PTSD.
֍ 5 different kinds of neurotransmitters have been most extensively studied
in relationship to psychopathology: norepinephrine, dopamine, serotonin,
glutamate, gamma aminobutyric acid(GABA). The first three belong to a class
of neurotransmitters called monoamines because each is synthesized from a
single amino acid. Norepinephrine has been implicated as playing an
important role in the emergency reactions our bodies show when we are
exposed to an acutely stressful or dangerous situation, as well as in attention,
orientation, and basic motives. Some of the functions of dopamine include
pleasure and cognitive processing, and it has been implicated in
schizophrenia as well as in addictive disorders. Serotonin has been found to
have important effects on the way we think and process information from our
environment as well as on behaviors and moods. It seems to play an important
 PSYCHOPATHOLOGY NOTES
role in emotional disorders such as anxiety and depression, as well as in suicide.
Glutamate, which has been implicated in schizophrenia. GABA, which is
strongly implicated in reducing anxiety as well as other emotional states
characterized by high levels of arousal.
► Medications that facilitate the effects of a neurotransmitter on the
postsynaptic neuron are called agonists, and those that oppose or inhibit the
effects of a neurotransmitter on a postsynaptic neuron are called antagonists.
Hormonal Imbalances → Hormones are chemical messengers secreted by a set
of endocrine glands in our bodies. Our central nervous system is linked to the
endocrine system (in what is known as the neuroendocrine system) by the
effects of the hypothalamus on the pituitary gland, which is the master gland of
the body, producing a variety of hormones that regulate or control the other
endocrine glands.
► One particularly important set of interactions occurs in the hypothalamic-
pituitary-adrenal axis (HPA axis). Activation of this axis involves:
Messages in the form of corticotrophin-releasing hormone (CRH) travel from
the hypothalamus to the pituitary. In response to CRH, the pituitary releases
adrenocorticotrophic hormone (ACTH), which stimulates the cortical part of the
adrenal gland (located on top of the kidney) to produce epinephrine (adrenaline)
and the stress hormone cortisol, which are released into general circulation.
Cortisol mobilizes the body to deal with stress. Cortisol in turn provides
negative feedback to the hypothalamus and pituitary to decrease their release of
CRH and ACTH, which in turn reduces the release of adrenaline and cortisol.
This negative feedback system operates much as a thermostat does to regulate
temperature.
► Sex hormones are produced by the gonadal glands.
Genetic Vulnerabilities → Most mental disorders show at least some genetic
influence ranging from small to large. Some of these genetic influences, such as
broad temperamental features, are first apparent in newborns and children.
However, some genetic sources of vulnerability do not manifest themselves until
adolescence or adulthood, when most mental disorders appear for the first time.
More typically, however, personality traits and mental disorders are not
affected by chromosomal abnormalities per se. Instead they are more often
influenced either by abnormalities in some of the genes on the chromosomes or
by naturally occurring variations of genes known as polymorphisms.
Vulnerabilities to mental disorders are almost always polygenic, which means
they are influenced by multiple genes or by multiple polymorphisms of
 PSYCHOPATHOLOGY NOTES
genes, with any one gene having only very small effects. In other words, a
genetically vulnerable person has usually inherited a large number of genes, or
polymorphisms of genes, that operate together in some sort of additive or
interactive fashion to increase vulnerability
Genotype and Fenotype → A person’s total genetic endowment is referred
to as her or his genotype. The observed structural and functional characteristics
that result from an interaction of the genotype and the environment are referred
to as a person’s phenotype. When the genotype shapes the environmental
experiences a child has in this way, we refer to this phenomenon as a genotype–
environment correlation. Researchers have found 3 important ways in which an
individual’s genotype may shape his or her environment.
1. The child’s genotype may have what has been termed a passive effect on the
environment, resulting from the genetic similarity of parents and children.
2. The child’s genotype may evoke particular kinds of reactions from the social
and physical environment—a so-called evocative effect.
3. The child’s genotype may play a more active role in shaping the environment
—a so-called active effect. In this case the child seeks out or builds an
environment that is congenial—a phenomenon known as “niche building.”
People with different genotypes may be differentially sensitive or susceptible to
their environments; this is known as a genotype– environment interaction.
Methods for Studying Genetic Influences → Three primary methods have
traditionally been used in behavior genetics, the field that focuses on studying
the heritability of mental disorders. (1) the family history (or pedigree)
method, (2) the twin method, and (3) the adoption method.

1- The pedigree method requires that an investigator observe samples of

relatives of each proband or index case (the subject, or carrier, of the trait or
disorder in question) to see whether the incidence increases in proportion to the
degree of hereditary relationship.
2- The twin method: Identical (monozygotic) twins share the same genetic
endowment. If a given disorder or trait were completely heritable, one
would expect the concordance rate—the percentage of twins sharing the
disorder or trait—to be 100 percent. That is, if one identical twin had a
particular disorder, the other twin would as well. However, there are no forms of
 PSYCHOPATHOLOGY NOTES
psychopathology where the concordance rates for identical twins are this high,
so we can safely conclude that no mental disorders are completely heritable.
3- Adoption method capitalizes on the fact that adoption creates a situation
in which individuals who do not share a common family environment are
nonetheless genetically related. In one variation on this method, the biological
parents of individuals who have a given disorder (and who were adopted away
shortly after birth) are compared with the biological parents of individuals
without the disorder (who also were adopted away shortly after birth) to
determine their rates of disorder. If there is a genetic influence, one expects to
find higher rates of the disorder in the biological relatives of those with the
disorder than in those without the disorder.
֍ Shared environmental influences are those that would make children in a
family more similar, whether the influence occurs within the family (e.g., family
discord and poverty) or in the environment (e.g., two high-quality schools, with
one twin going to each). Nonshared environmental influences are those in
which the children in a family differ. These would include unique experiences at
school and also some unique features of upbringing in the home, such as a
parent treating one child in a qualitatively different way from another.
Linkage Analysis and Association Studies → Linkage analysis and
association studies attempt to determine the actual location of genes
responsible for mental disorders. Linkage analysis studies of mental
disorders capitalize on several currently known locations on chromosomes of
genes for other inherited physical characteristics or biological processes (such as
eye color, blood group, etc.). Linkage analysis techniques have been most
successful in locating the genes for single-gene brain disorders such as
Huntington’s disease. Association studies start with two large groups of
individuals, one group with and one group without a given disorder. Researchers
then compare the frequencies in these two groups of certain genetic markers that
are known to be located on particular chromosomes (such as eye color, blood
group, etc.). If one or more of the known genetic markers occur with much
higher frequency in the individuals with the disorder than in the people without
the disorder, the researchers infer that one or more genes associated with the
disorder are located on the same chromosome. For most mental disorders that
are known to be influenced polygenically, association studies are more
promising than linkage studies for identifying small effects of any particular
gene.
Temperament→ Temperament refers to a child’s reactivity and characteristic
ways of self-regulation. When we say that babies differ in temperament, we
 PSYCHOPATHOLOGY NOTES
mean that they show differences in their characteristic emotional and arousal
responses to various stimuli and in their tendency to approach, withdraw, or
attend to various situations. Starting at about 2 to 3 months of age,
approximately 5 dimensions of temperament can be identified: fearfulness,
irritability and frustration, positive affect, activity level, and attentional
persistence and effortful control.
♣♣♣Three important dimensions of adult personality: (1) neuroticism or
negative emotionality, (2) extraversion or positive emotionality, and (3)
constraint (conscientiousness and agreeableness).
♣♣♣ Children with high levels of positive affect and activity are more likely to
show high levels of mastery motivation, whereas children with high levels of
fear and sadness are less likely to show mastery motivation.
♣♣♣ Temperament may also set the stage for the development of various forms
of psychopathology later in life. Children who are fearful and hypervigilant
in many novel or unfamiliar situations have been labeled behaviorally
inhibited by Kagan, Fox, and colleagues.
♣♣♣ Conversely, 2-year-old children who are highly uninhibited, showing little
fear of anything, may have difficulty learning moral standards for their behavior
from parents or society.
Brain Dysfunction and Neural Plasticity→ Specific brain lesions with
observable defects in brain tissue are rarely a primary cause of psychiatric
disorders.
Neural plasticity→ flexibility of the brain in making changes in organization
and function in response to pre- and postnatal experiences, stress, diet,
disease, drugs, maturation, and so forth. Existing neural circuits can be
modified, or new neural circuits can be generated. The effects can be either
beneficial or detrimental. Many postnatal environmental events also affect the
brain development of the infant and child.
approach: This approach acknowledges not only that genetic activity
influences neural activity, which in turn influences behavior, which in turn
influences the environment, but also that these influences are bidirectional.
The Impact of the Biological Viewpoint→ Biological treatments seem to have
more immediate results than other available therapies, and the hope is that they
may in most cases lead to a “cure-all” —immediate results with seemingly
little effort. Establishing the biological substrate does not bear on this issue
because all behavior—normal and abnormal—has a biological substrate. As
 PSYCHOPATHOLOGY NOTES
Gorenstein also pointed out, the effects of psychological events are always
mediated(?) through the activities of the central nervous system because all our
behaviors, beliefs, emotions, and cognitions are ultimately reducible to a set of
biological events in the brain.
THE PSYCHOLOGICAL VIEWPOINTS
Psychosocial perspectives attempt to understand humans not just as biological
organisms but also as people with motives, desires, and perceptions. There are 3
major psychosocial perspectives on human nature and behavior:
1. Psychodynamic 2. Behavioral 3. Cognitive-behavioral
Also includes 2 other perspectives:
1. humanistic perspective 2. existential perspective.
The Psychodynamic Perspectives→ Sigmund Freud founded the
psychoanalytic school, which emphasized the role of unconscious motives and
thoughts and their dynamic interrelationships in the determination of both
normal and abnormal behavior. The conscious part of the mind represents a
relatively small area, whereas the unconscious part, like the submerged part of
an iceberg, is the much larger portion. In the depths of the unconscious are the
hurtful memories, forbidden desires, and other experiences that have been
repressed—that is, pushed out of consciousness.
The Structure of Personality: Id, Ego, and Superego (Personalityden biliyoruz)
Id can generate mental images and wish-fulfilling fantasies, referred to as
primary process thinking, it cannot undertake the realistic actions needed to
meet instinctual demands. The ego’s adaptive measures are referred to as
secondary process thinking, and the ego operates on the reality principle.
Because the ego mediates among the desires of the id, the demands of reality,
and the moral constraints of the superego, EGO is often called the executive
branch of the personality.
Anxiety is a warning of impending real or imagined dangers as well as a painful
experience, and it forces an individual to take corrective action.
 Ego Psychology: Anna Freud (1895–1982), who was much more concerned
with how the ego performs its central functions as the “executive” of
personality. According to this view, psychopathology develops when the ego
does not function adequately to control or delay impulse gratification or does
not make adequate use of defense mechanisms when faced with internal
conflicts. This school became known as ego psychology.
 PSYCHOPATHOLOGY NOTES
 Object-Relations Theory: Developed by a number of prominent theorists
including Melanie Klein, Margaret Mahler, Fairburn, and Winnicott,
starting in the 1930s and 1940s. They share a focus on individuals’
interactions with real and imagined other people (external and internal
objects) and on the relationships that people experience between their
external and internal objects. Object in this context refers to the symbolic
representation of another person in the infant’s or child’s environment, most
often a parent. Through a process of introjection, a child symbolically
incorporates into his or her personality (through images and memories)
important people in his or her life.
֍ Otto Kernberg, is an influential American analyst who has a theory that
people with a borderline personality, whose chief characteristic is instability
(especially in personal relationships), are individuals who are unable to achieve
a full and stable personal identity (self) because of an inability to integrate and
reconcile pathological internalized objects.
 The Interpersonal Perspective: Alfred Adler. Focused on social
determinants of behavior. We are social beings, and much of what we are is a
product of our relationships with others. It is logical to expect that much of
psychopathology reflects this fact—that psychopathology is rooted in the
unfortunate tendencies we have developed while dealing with our
interpersonal environments. Emphasizes social and cultural forces rather than
inner instincts as determinants of behavior. In Adler’s view, people are
inherently social beings motivated primarily by the desire to belong to and
participate in a group.
֍ Over time, a number of other psychodynamic theorists also took issue with
psychoanalytic theory for its neglect of crucial social factors. Erich Fromm and
Karen Horney. Fromm focused on the orientations, or dispositions (exploitive,
for example), that people adopted in their interactions with others. He believed
that when these orientations to the social environment were maladaptive, they
served as the bases of much psychopathology. Horney independently
developed a similar view and, in particular, vigorously rejected Freud’s
demeaning psychoanalytic view of women (for instance, the idea that women
experience penis envy).
֍ Erik Erikson also extended the interpersonal aspects of psychoanalytic
theory. He elaborated and broadened Freud’s psychosexual stages into more
socially oriented concepts, describing crises or conflicts that occurred at eight
stages, each of which could be resolved in a healthy or unhealthy way.
 Attachment Theory: John Bowlby’s attachment theory, which can in many
ways be seen as having its roots in the interpersonal and object-relations
perspectives, has become an enormously influential theory in child
 PSYCHOPATHOLOGY NOTES
psychology and child psychiatry as well as in adult psychopathology.
Bowlby’s theory emphasizes the importance of early experience,
especially early experience with attachment relationships, as laying the
foundation for later functioning throughout childhood, adolescence, and
adulthood. He stresses the importance of the quality of parental care to the
development of secure attachments, but he also sees the infant as playing a
more active role in shaping the course of his or her own development than
had most of the earlier theorists.
Two of Freud’s contributions stand out as particularly noteworthy:
1. He developed therapeutic techniques such as free association and dream
analysis for becoming acquainted with both the conscious and the unconscious
aspects of mental life. The results obtained led Freud to emphasize several
points that have been incorporated (in modified forms) into current thinking: (a)
the extent to which unconscious motives and defense mechanisms affect
behavior, meaning that the causes of human behavior are generally not obvious
or available to conscious awareness; (b) the importance of early childhood
experiences in the development of both normal and abnormal personality; and
(c) the importance of sexual factors in human behavior and mental disorders.
2. He demonstrated that certain abnormal mental phenomena occur in the
attempt to cope with difficult problems and are simply exaggerations of normal
ego-defense mechanisms. This realization that the same psychological principles
apply to both normal and abnormal behavior dissipated much of the mystery and
fear surrounding mental disorders.
The Behavioral Perspective→ Behavioral psychologists believed that the study
of subjective experience (e.g., free association and dream analysis) did not
provide acceptable scientific data because such observations were not open to
verification by other investigators. In their view, only the study of directly
observable behavior and of the stimuli and reinforcing conditions that control it
could serve as a basis for understanding human behavior, normal and abnormal.
Roots of the behavioral perspective are in Pavlov’s study of classical
conditioning and in Thorndike’s study of instrumental (operant by skinner)
conditioning. J. Watson did much to promote the behavioral approach to
psychology with his book Behaviorism (1924) in US. Learning—the
modification of behavior as a consequence of experience—is the central theme
of the behavioral approach. Behaviorists focus on the effects of environmental
conditions (stimuli) on the acquisition, modification, and possible elimination of
various types of response patterns, both adaptive and maladaptive.
Classical Conditioning: However, we also now know that this process of
classical conditioning is not as blind or automatic as was once thought. Rather, it
 PSYCHOPATHOLOGY NOTES
seems that animals (and people) actively acquire information about what CSs
allow them to predict, expect, or prepare for an upcoming biologically
significant event (the UCS). That is, they learn what is often called a stimulus-
stimulus expectancy. Classically conditioned responses are well maintained
over time; that is, they are not simply forgotten (even over many years).
However, if a CS is repeatedly presented without the UCS, the conditioned
response gradually extinguishes. This gradual process, known as extinction,
should not be confused with the idea of unlearning because we know that the
response may return at some future point in time (a phenomenon Pavlov called
spontaneous recovery).
Instrumental Conditioning: In instrumental (or operant) conditioning, an
individual learns how to achieve a desired goal. The goal in question may be to
obtain something that is rewarding or to escape from something that is
unpleasant. Essential here is the concept of reinforcement, which refers either to
the delivery of a reward or pleasant stimulus, or to the removal of or escape
from an aversive stimulus. It is now believed that the animal or person learns a a
response–outcome expectancy, that is, learns that a response will lead to a
reward outcome.
֍ A special problem arises conditioning a response in situations in which a
subject has been conditioned to anticipate an aversive event and to make an
instrumental response to avoid it. For example, a boy who has nearly drowned in
a swimming pool may develop a fear of water and a conditioned avoidance
response in which he consistently avoids all large bodies of water.
The Humanistic Perspective: Carl Rogers. The humanistic perspective views
human nature as basically “good.” Paying less attention to unconscious
processes and past causes, it emphasizes present conscious processes and places
strong emphasis on people’s inherent capacity for responsible self-direction.
This perspective is concerned with processes such as love, hope, creativity,
values, meaning, personal growth, and self-fulfillment.

The Existential Perspective: The existential perspective resembles the

humanistic view in its emphasis on the uniqueness of each individual, the
quest for values and meaning, and the existence of freedom for self-direction
and self-fulfillment. However, it takes a less optimistic view of human beings
and places more emphasis on their irrational tendencies and the difficulties
inherent in self-fulfillment—particularly in a modern, bureaucratic, and
dehumanizing mass society. In short, living is much more of a “confrontation”
for the existentialists than for the humanists.
 PSYCHOPATHOLOGY NOTES
Generalization and Discrimination→ When a response is conditioned to one
stimulus or set of stimuli, it can be evoked by other, similar stimuli; this
process is called generalization. A person who fears bees, for example, may
generalize that fear to all flying insects. Discrimination occurs when a person
learns to distinguish between similar stimuli and to respond differently to them
based on which ones are followed by reinforcement.
Observational Learning→ Learning through observation alone, without
directly experiencing an unconditioned stimulus or a reinforcement. For
example, children can acquire new fears simply observing a parent or peer
behaving fearfully with some object or situation that the child did not initially
fear. In this case, they experience the fear of the parent or peer vicariously, and
that fear becomes attached to the formerly neutral object.
Impact of the Behavioral Perspective: The behavioral perspective attempts to
explain the acquisition, modification, and extinction of nearly all types of
behavior. Maladaptive behavior is viewed as essentially the result of (1) a failure
to learn necessary adaptive behaviors or competencies, such as how to establish
satisfying personal relationships, and/or (2) the learning of ineffective or
maladaptive responses. The behavioral approach is well known for its precision
and objectivity, for its wealth of research, and for its demonstrated effectiveness
in changing specific behaviors.
The Cognitive-Behavioral Perspective→ Cognitive psychology involves the
study of basic information-processing mechanisms such as attention and
memory, as well as higher mental processes such as thinking, planning, and
decision making. Bandura stressed that human beings regulate behavior by
internal symbolic processes—thoughts. That is, we learn by internal
reinforcement. According to Bandura, we prepare ourselves for difficult tasks,
for example, by visualizing what the consequences would be if we did not
perform them. Bandura later developed a theory of self-efficacy, the belief that
one can achieve desired goals. Today the cognitive or cognitive-behavioral
perspective on abnormal behavior generally focuses on how thoughts and
information processing can become distorted and lead to maladaptive emotions
and behavior. One central construct for this perspective is the concept of a
schema, which was adapted from cognitive psychology by Aaron Beck. Our
self-schemas include our views on who we are, what we might become, and
what is important to us. We tend to work new experiences into our existing
cognitive frameworks, even if the new information has to be reinterpreted or
distorted to make it fit—a process known as assimilation. Accommodation—
changing our existing frameworks to make it possible to incorporate new
 PSYCHOPATHOLOGY NOTES
information that doesn’t fit—is more difficult and threatening, especially when
important assumptions are challenged.
֍ Implicit memory, which is demonstrated when a person’s behavior reveals
that she or he remembers a previously learned word or activity even though she
or he cannot consciously remember it.
Attributions & Attributional Style→ An attribution is simply the process of
assigning causes to things that happen. We may attribute behavior to external
events such as rewards or punishments, or we may assume that the causes are
internal and derive from traits within ourselves or others. Attributional style is
a characteristic way in which an individual tends to assign causes to bad events
or good events. Interestingly, nondepressed people tend to have what is called a
self-serving bias in which they are more likely to make internal, stable, and
global attributions for positive rather than negative events.
Cognitive Therapy→ Beck, who is generally considered the founder of
cognitive therapy, has been enormously influential in the development of
cognitive-behavioral treatment approaches to various forms of psychopathology.
Fundamental to Beck’s perspective is the idea that the way we interpret events
and experiences determines our emotional reactions to them. The cognitive-
behavioral viewpoint has had a powerful impact on contemporary clinical
psychology.
Psychological Causal Factors→ 4 categories of psychological causal factors
that can each have important detrimental effects on a child’s socioemotional
development: (1) early deprivation or trauma, (2) inadequate parenting styles,
(3) marital discord and divorce, and (4) maladaptive peer relationships.
1- Early Deprivation or Trauma: Depriving children of essential resources
such as food, shelter, love, and attention can cause irreversible psychological
scars.
► Institutionalization: Institutionalization can lack physical contact and social
stimulation, e.g., Romanian orpans.
►Neglect and Abuse in the Home: Neglect and abuse at home is alarmingly
common and results in negative effects. Parents can neglect a child in various
ways—by physical neglect, denial of love and affection, lack of interest in the
child’s activities and achievements, or failure to spend time with the child or to
supervise his or her activities. Parental neglect and abuse may be partial or
complete, passive or active, or subtly or overtly cruel.
 PSYCHOPATHOLOGY NOTES
►Separation: Bowlby (1960, 1973) first summarized the traumatic effects, for
children from 2 to 5 years old, of being separated from their parents during
prolonged periods of hospitalization. The long-term effects of separation depend
heavily on whether support and reassurance are given a child by parents or other
significant people, which is most likely if the child has a secure relationship with
at least one parent
2- Inadequate Parenting Styles: Inadequate parenting styles can make children
vulnerable to psychopathology. Inadequate parenting can stem from:
-Parental psychopathology -Parental warmth and control
-Authoritative parenting, with high warmth and moderate control, tends to
produce less problematic behavior in children than authoritarian,
permissive/indulgent, or neglectful/uninvolved parenting.
Authoritative Parenting: Parents are high on warmth and moderate on control,
very careful to set clear limits and restrictions regarding certain kinds of
behaviors.
Authoritarian Parenting: Parents are low on warmth and high on control and
often cold and demanding.
Permissive/ Indulgent Parenting: Parents are high on warmth and low on
control and discipline.
Neglectful/ Uninvolved Parenting: Parents are low on warmth and low on
control.
3- Marital Discord and Divorce: Long-standing marital discord is damaging in
its effects on both adults and children; children can learn negative interaction
styles which will influence their own adult relationships Divorce can cause
negative effects in children, but many adjust quite well. Effects of divorce can
be more favorable than staying in discordant home.
4- Maladaptive Peer Relationships: Exclusion or abuse by peers can lead to
poor school performance or to avoiding school entirely. Bullies are high in both
proactive and reactive aggression. Cyberbullying is a new form of bullying that
can have serious effects. Good peer relationships in children can lead to social
competence and preparation for real world of adulthood. There seem to be two
types of popular children—the prosocial and the antisocial types. Prosocial
popular children communicate with their peers in friendly and assertive yet
cooperative ways. They tend to be good students relative to their less popular
peers. Antisocial popular children—usually boys—tend to be “tough boys”
 PSYCHOPATHOLOGY NOTES
who may be athletically skilled but who do poorly academically. They tend to be
highly aggressive and defiant of authority.
The Sociocultural Viewpoint→ Sociology and anthropology enhance the
understanding of sociocultural factors in human development and behavior.
Individual personality development reflects the norms and values of larger
society. Stressors specific to one society can produce mental disorders specific
to that society.
Universal and Culture-Specific Symptoms of Disorders: When some tests are
translated into the language of different cultures, they need to be adapted so that
they are appropriate for the new cultural context. In addition, care must be taken
not to miss what may be culture-specific elements of various disorders such as
anxiety and depression. The Minnesota Multiphasic Personality Inventory
(MMPI-2) is the best validated and most widely used test that has been adapted
for use in many cultures.
Hikikomori in Japan, this is a disorder of acute social withdrawal in which
young people just remain in their room in their parents’ house and refuse social
interactions for at least 6 months, but often for many years. The social
withdrawal is ego-syntonic. Another example is Zar which occurs in both North
Africa and the Middle East. With Zar a person who believes he or she is
possessed by a spirit may experience a dissociative episode during which
shouting, laughing, singing, or weeping may occur.
Sociocultural Causal Factors→ Low socioeconomic status and unemployment.
Prejudice and discrimination in race, gender, and ethnicity. Social change and
uncertainty. Urban stressors: Violence and homelessness.
Prejudice and Discrimination in Race, Gender, and Ethnicity→ There are
two primary types of discrimination that occur in the workplace: access
discrimination, wherein women are not hired because they are women, and
treatment discrimination, wherein women who have a job are paid less and
receive fewer opportunities for promotion.
Chapter 4- Assesment
Early records show that some individuals used assessment methods to evaluate
potential personality problems or behaviors.
Psychological assessment refers to a procedure by which clinicians, using
psychological tests, observation, and interviews, develop a summary of the
client’s symptoms and problems.
 PSYCHOPATHOLOGY NOTES
In the initial clinical assessment, an attempt is usually made to identify the
main dimensions of a client’s problem and to predict the probable course of
events under various conditions.
Assessment is an ongoing process and may be important at various points
during treatment, not just at the beginning.
Clinical diagnosis is the process through which a clinician arrives at a general
“summary classification” of the patient’s symptoms by following a clearly
defined system.
 Function of pretreatment assessment is establishing baselines for various
psychological functions so that the effects of treatment can be measured.
Criteria based on these measurements may be established as part of the
treatment plan such that the therapy is considered successful and is
terminated only when the client’s behavior meets these predetermined
criteria.
 Administratively, it is essential to know the range of diagnostic problems
that are represented in the client population and for which treatment facilities
need to be available.
Assigning a formal diagnostic classification per se is much less important than
having a clear understanding of the individual’s behavioral history, intellectual
functioning, personality characteristics, and environmental pressures and
resources. Excesses, deficits, and appropriateness are key dimensions to be
noted if the clinician is to understand the particular disorder that has brought the
individual to the clinic or hospital.
1) Personality Factors: Assessment should include a description of any relevant
long-term personality characteristics.
2) Social Context: It is also important to assess the social context in which the
individual functions. What kinds of environmental demands are typically placed
on the person, and what supports or special stressors exist in her or his life
situation.
 The diverse and often conflicting bits of information about the individual’s
personality traits, behavior patterns, environmental demands, and so on must
then be integrated into a consistent and meaningful picture. Some clinicians
refer to this picture as a “dynamic formulation” because it not only
describes the current situation but also includes hypotheses about what is
driving the person to behave in maladaptive ways.
 PSYCHOPATHOLOGY NOTES
 Where feasible, decisions about treatment are made collaboratively with the
consent and approval of the individual. In cases of severe disorder, however,
they may have to be made without the client’s participation or, in rare
instances, even without consulting responsible family members.
It is critical for the psychologist to be informed of the issues involved in
multicultural assessment (cultural competence) and to use testing
procedures that have been adapted and validated for culturally diverse
clients.
 The challenges of understanding clients in multicultural assessment have
been described and involve both test instrument characteristics and
sociocultural factors; such as the relationships among culture, behavior, and
psychopathology.
 The most widely used personality measure, the Minnesota Multiphasic
Personality Inventory (MMPI-2) has been widely evaluated both in
international applications with translated versions. Computerbased MMPI
interpretation systems typically employ powerful actuarial procedures.
descriptions of the actual behavior or other established characteristics of
many subjects with particular patterns of test scores have been stored in the
computer. Whenever a person has one of these test score patterns, the
appropriate description is printed out in the computer’s evaluation.
How clinicians go about the assessment process often depends on their basic
treatment orientations.
→ A biologically oriented clinician is likely to focus on biological assessment
methods aimed at determining any underlying organic malfunctioning that may
be causing the maladaptive behavior.
→A psychodynamic or psychoanalytically oriented clinician may choose
unstructured personality assessment techniques, such as the Rorschach inkblots
or the Thematic Apperception Test (TAT), to identify intrapsychic conflicts or
may simply proceed with therapy, expecting these conflicts to emerge naturally
as part of the treatment process.
→A behaviorally oriented clinician, in an effort to determine the functional
relationships between environmental events or reinforcements and the abnormal
behavior, will rely on such techniques as behavioral observation and self-
monitoring to identify learned maladaptive patterns.
→For a cognitively oriented behaviorist, the focus would shift to the
dysfunctional thoughts supposedly mediating those patterns.
 PSYCHOPATHOLOGY NOTES
Reliability is a term describing the degree to which an assessment measure
produces the same result each time it is used to evaluate the same thing. In
the context of assessment or classification, reliability is an index of the
extent to which a measurement instrument can agree that a person’s
behavior fits a given diagnostic class. If the observations are different, it
may mean that the classification criteria are not precise enough to determine
whether the suspected disorder is present.
Validity is the extent to which a measuring instrument actually measures
what it is supposed to measure. In the context of testing or classification,
validity is the degree to which a measure accurately conveys to us
something clinically important about the person whose behavior fits the
category, such as helping to predict the future course of the disorder.
The validity of a mental health measure or classification presupposes
reliability. Good reliability does not in itself guarantee validity.
Standardization is a process by which a psychological test is administered,
scored, and interpreted in a consistent manner.
 In order for psychological assessment to proceed effectively and to provide a
clear understanding of behavior and symptoms, the client being evaluated
must feel comfortable with the clinician.
֍ When patients are given appropriate feedback on test results, they tend to
improve—just from gaining a perspective on their problems from the testing.
The test feedback process itself can be a powerful clinical intervention. When
persons who were not provided psychological test feedback were compared with
those who were provided with feedback, the latter group showed a significant
decline in reported symptoms and an increase in measured self-esteem as a
result of having a clearer understanding of their own resources.
Assessment of physical organism incorporates with General physical
examination, Neurological examination, and Neuropsychological
examination.
General physical examination: In cases in which physical symptoms are part
of the presenting clinical picture, a referral for a medical evaluation is
recommended. A physical examination consists of the kinds of procedures most
of us have experienced when getting a “medical checkup”.
Neurological examination: Because brain pathology is sometimes involved in
some mental disorders a specialized neurological examination can be
administered in addition to the general medical examination.
 PSYCHOPATHOLOGY NOTES
 EEG: graphical record of brain’s electrical activity. DYSRHYTMİA
 CAT scan: uses X-ray technology to provide images of brain structures
that may be damaged or diseased. A CAT scan is limited to
distinguishing anatomical features such as the shape of a particular internal
structure.
 MRI: uses magnetic imaging to measure oxygen flow (using water
content) in brain; produces sharper images than CAT scan.
 PET scan: tracks metabolic activity of specific compounds, such as glucose;
can reveal problems that are not necessarily anatomical in nature. A PET
scan allows for an appraisal of how an organ is functioning.
 fMRI: measures changes in oxygen (blood flow) while patient undergoes a
task; can map psychological activity to specific regions in the brain. fMRI
was effective at detecting neural correlates for self-critical thinking. fMRI
can be an effective procedure at detecting malingering or lying.
Neuropsychological assesment: Involves the use of various testing devices to
measure a person’s cognitive, perceptual, and motor performance as clues
to the extent and location of brain damage. In many instances of known or
suspected organic brain involvement, a clinical neuropsychologist administers a
test battery to a patient. The person’s performance on standardized tasks,
particularly perceptual-motor tasks, can give valuable clues about any cognitive
and intellectual impairment following brain damage.
♣♣ The use of a constant set of tests has many research and clinical advantages,
although it may compromise flexibility. The Halstead-Reitan battery is
composed of several tests and variables from which an “index of impairment”
can be computed. In addition, it provides specific information about a subject’s
functioning in several skill areas.
i. Halstead Category Test: Measures a subject’s ability to learn and remember
material and can provide clues as to his or her judgment and impulsivity. The
subject is presented with a stimulus (on a screen) that suggests a number
between 1 and 4.
ii. Tactual Performance Test: Measures a subject’s motor speed, response to
the unfamiliar, and ability to learn and use tactile and kinesthetic cues.
iii. Rhythm Test: Measures attention and sustained concentration through an
auditory perception task. It includes 30 pairs of rhythmic beats that are
presented on a tape recorder.
 PSYCHOPATHOLOGY NOTES
iv. Speech Sounds Perception Test: Determines whether an individual can
identify spoken words. Nonsense words are presented on a tape recorder, and
the subject is asked to identify the presented word in a list of four printed
words. This task measures the subject’s concentration, attention, and
comprehension.
v. Finger Oscillation Task: Measures the speed at which an individual can
depress a lever with the index finger. Several trials are given for each hand.
Psychosocial assessment attempts to provide a realistic picture of an individual
in interaction with his or her social environment. This picture includes relevant
information about the individual’s personality makeup and present level of
functioning, as well as information about the stressors and resources in her or his
life situation.
Assessment Interviews: An assessment interview, often considered the central
element of the assessment process, usually involves a face-to-face interaction in
which a clinician obtains information about various aspects of a client’s
situation, behavior, and personality.
 Structured and Unstructured Interviews: Structured interviews follow a
predetermined set of questions throughout the interview. The beginning
statements or introduction to the interview follow set procedures. The themes
and questions are predetermined to obtain particular responses for all items.
The interviewer cannot deviate from the question lists and procedures. All
questions are asked of each client in a preset way. Each question is structured
in a manner so as to allow responses to be quantified or clearly determined.
On the negative side, structured interviews typically take longer to administer
than unstructured interviews and may include some seemingly tangential
questions. Clients can sometimes be frustrated by the overly detailed
questions in areas that are of no concern to them. Unstructured assessment
interviews are typically subjective and do not follow a predetermined set of
questions. The beginning statements in the interview are usually general, and
follow-up questions are tailored for each client. The content of the interview
questions is influenced by the habits or theoretical views of the interviewer.
The interviewer does not ask the same questions of all clients; rather, he or
she subjectively decides what to ask based on the client’s response to
previous questions. Because the questions are asked in an unplanned way,
important criteria needed for a DSM-5 diagnosis might be skipped.
Responses based on unstructured interviews are difficult to quantify or
compare with responses of clients from other interviews. Thus, uses of
unstructured interviews in mental health research are limited. On the positive
 PSYCHOPATHOLOGY NOTES
side, unstructured interviews can be viewed by clients as being more
sensitive to their needs or problems than more structured procedures.

# Structured interviews restrict freedom to explore but increase reliability.

# Unstructured interviews allow for more exploration but decrease
reliability.
One of the traditional and most useful assessment tools that a clinician has
available is direct observation of a client’s characteristic behavior. The
main purpose of direct observation is to learn more about the person’s
psychological functioning by attending to his or her appearance and behavior
in various contexts. Some practitioners and researchers use a more controlled,
rather than a naturalistic, behavioral setting for conducting observations in
contrived situations. These analogue situations, which are designed to yield
information about the person’s adaptive strategies, might involve such tasks as
staged role-playing, event reenactment, family interaction assignments, or
thinkaloud procedures.
Self-monitoring: self-observation and objective reporting of behavior, thoughts,
and feelings as they occur in various natural settings. This method can be a
valuable aid in determining the kinds of situations in which maladaptive
behavior is likely to be evoked.
֎ The use of rating scales in clinical observation and in self-reports helps
both to organize information and to encourage reliability and objectivity.
The most useful rating scales are those that enable a rater to indicate not only
the presence or absence of a trait or behavior but also its prominence or degree.
►One of the rating scales most widely used for recording observations in
clinical practice and in psychiatric research is the Brief Psychiatric Rating
Scale (BPRS). The BPRS provides a structured and quantifiable format for
rating clinical symptoms such as overconcern with physical symptoms, anxiety,
emotional withdrawal, guilt feelings, hostility, suspiciousness, and unusual
thought patterns.
Most useful intelligence tests are WAIS, WISC-IV, Stanford-Binet test.
Projective personality tests are unstructured in that they rely on various
ambiguous stimuli such as inkblots or vague pictures rather than on explicit
verbal questions, and in that the person’s responses are not limited to the “true,”
“false,” or “cannot say” variety. Rorscach and TAT most known.
 PSYCHOPATHOLOGY NOTES
→ David’s TAT Response: I’ll call him Karl, found this machine gun … a
Browning automatic rifle … in his garage. He kept it in his room for protection.
One day he decided to take it to school to quiet down the jocks that lord it over
everyone. When he walked into the locker hall, he cut loose on the top jock,
Amos, and wasted him. Nobody bothered him after that because they knew he
kept the BAR in his locker.”
It was inferred from this story that David was experiencing a high level of
frustration and anger in his life. The extent of this anger was reflected in his
perception of the violin in the picture as a machine gun—an instrument of
violence. The clinician concluded that David was feeling threatened not only by
people at school but even in his own home, where he needed “protection.”
Another projective procedure that has proved useful in personality assessment
is the sentence completion test. A number of such tests have been designed for
children, adolescents, and adults. Sentence completion tests, which are related to
the freeassociation method, a procedure in which the client is asked to respond
freely, are somewhat more structured than the Rorschach and most other
projective tests.
Objective personality tests are structured—that is, they typically use
questionnaires, selfreport inventories, or rating scales in which questions or
items are carefully phrased and alternative responses are specified as choices.
One virtue of such quantification is its precision, which in turn enhances the
reliability of test outcomes.
NEO-PI provides information on the major dimensions in personality and is
widely used in evaluating personality factors in normal-range populations.
Millon Clinical Multiaxial Inventory (MCMI-III), was developed to evaluate
the underlying personality dimensions among clients in psychological treatment.
MMPI, a self-report questionnaire, consisted of 550 items covering topics
ranging from physical condition and psychological states to moral and social
attitudes. Typically, clients are encouraged to answer all of the items either
“true” or “false.”
Advantages and Limitations of Objective Personality Tests: Objective
personality tests have the benefits of being cost-effective and highly reliable.
They have been criticized for being too mechanistic and requiring too much
reading ability and cooperation.
---Case of Andrea C. Test bankası çalış cok uzun.---
 PSYCHOPATHOLOGY NOTES
► Assessment data from various sources must be integrated into a coherent
working model. Integration can be done by one mental health professional or a
team. Sometimes, a definitive picture emerges. Sometimes, there are
discrepancies that necessitate further assessment.
Ethical Issues in Assessment→ Potential cultural bias. Theoretical
orientation of clinician. Under-emphasis on external situation. Insufficient
validation. Inaccurate data or premature evaluation.
Underemphasis on the External Situation: Many clinicians overemphasize
personality traits as the cause of patients’ problems without paying enough
attention to the possible role of stressors and other circumstances in the patients’
life situations.
Inaccurate Data or Premature Evaluation: There is always the possibility that
some assessment data—and any diagnostic label or treatment based on them—
may be inaccurate or that the team leader (usually a psychiatrist) might choose
to ignore test data in favor of other information. Some risk is always involved in
making predictions for an individual on the basis of group data or averages.
Classification involves attempt to delineate meaningful sub-varieties of
maladaptive behavior. Benefits of classification include Introduction of order,
Communication establishment, Statistical research data usei Clarification of
insurance issues.
Differing Models of Classification
→ In the dimensional approach, it is assumed that a person’s typical
behavior is the product of differing strengths or intensities of behavior
along several definable dimensions such as mood, emotional stability,
aggressiveness, gender identity, anxiousness, interpersonal trust, clarity of
thinking and communication, social introversion, and so on. uses statistical
criteria to differentiate between normal and abnormal.
→ A prototype is a conceptual entity (e.g., personality disorder) depicting an
idealized combination of characteristics that more or less regularly occur
together in a less-than-perfect or standard way at the level of actual observation.
→ The categorical approach, like the diagnostic system of general medical
diseases, assumes (1) that all human behavior can be divided into the
categories of “healthy” and “disordered,” . Each disorder has unique
symptoms.
 PSYCHOPATHOLOGY NOTES
and (2) that within the latter there exist discrete, nonoverlapping classes or types
of disorder that have a high degree of within-class homogeneity in both
symptoms displayed and the underlying organization of the disorder identified
# The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the
International Classification of Disease (ICD) are the two major classification
systems in use. ICD is more commonly used in Europe, DSM is more
commonly used in the U.S.
DSM-5: More comprehensive and more subtypes of disorders. Allows for
gender related differences in diagnosis. Provides structured interview
regarding cultural influences.
The Cultural Formulation Interview (CFI) contains sixteen questions that the
practitioner can use to obtain information during a mental health assessment
about the potential impact the client’s culture can have on mental health care.
Chapter 5- Stress and Mental Health
The field of health psychology is concerned with the effects of stress and other
psychological factors in the development and maintenance of physical problems.
Health psychology is a subspecialty within behavioral medicine. A behavioral
medicine approach to physical illness is concerned with psychological factors
that may predispose an individual to medical problems.
→ Posttraumatic Stress in a Military Nurse: Jennifer developed PTSD after
she served as a nurse in Iraq. During her deployment she worked 12- to 14-hour
shifts in 120-degree temperatures. Sleep was hard to come by and disaster was
routine. Day in and day out there was a neverending flow of mangled bodies of
young soldiers. Jennifer recalled one especially traumatic event:
I was working one evening. We received information that a vehicle, on a routine
convoy mission, had been hit by an improvised explosive device (IED). Three
wounded men and one dead soldier were on their way to our hospital. Two
medics in the back room were processing the dead soldier for Mortuary Affairs.
The dead soldier was lying on a cot. The air was strong with the smell of burned
flesh. I was staring at the body and trying to grasp what was different about this
particular body. After a while I realized. The upper chest and head of the dead
soldier was completely missing. We received his head about an hour later.
External demands refers as stressors, to the effects they create within the
organism as stress, and to efforts to deal with stress as coping strategies.
All situations that require adjustment can be regarded as potentially stressful.
Prior to the influential work of Canadian physician and endocrinologist Hans
 PSYCHOPATHOLOGY NOTES
Selye, stress was a term used by engineers. Selye took the word and used it to
describe the difficulties and strains experienced by living organisms as they
struggled to cope with and adapt to changing environmental conditions.
PTSD, Adjustment disorder, and Acute stress disorder; all part of new category
of disorders in DSM-5: trauma- and stressor-related disorders which occur in
response to identifiable stressors.
Factors Predisposing a Person to Stress
-Nature of stressor -Experience of crisis -Individual perception of stressor -
Individual stress tolerance -Life changes -Lack of external resources and social
supports
Stress tolerance refers to a person’s ability to withstand stress without
becoming seriously impaired.
Characteristics of Stressors
» The severity of the stressor
» chronicity (i.e., how long it lasts)
» timing, how closely it affects our own lives
» how expected it is
» how controllable it is
Crises are especially stressful because the stressors are so potent that typical
coping techniques are overwhelmed. Life changes, positive or negative, can
increase stress. Perceiving benefit from a disaster, such as personal growth, can
lessen the experience of stress.
Crisis is used to refer to times when a stressful situation threatens to exceed or
exceeds the adaptive capacities of a person or a group.
Holmes and Rahe (1967) developed the Social Readjustment Rating Scale.
This is a selfreport checklist of fairly common, stressful life experiences.
Life Events and Difficulties Schedule (LEDS) includes an extensive manual
that provides rules for rating both acute and chronic forms of stress.
After experiencing a potentially traumatic event, some people function well and
experience very few symptoms in the following weeks and months, called
resilience.
►Stress and the Stress Response◄
 PSYCHOPATHOLOGY NOTES
The sympathetic-adrenomedullary (SAM) system is designed to mobilize
resources and prepare for a fight-or-flight response. The stress response begins
in the hypothalamus.
Hypothalamus-pituitary-adrenal (HPA) system produces cortisol, which is
helpful in emergencies. The hypothalamus releases a hormone called
“corticotrophin-releasing hormone (CRH)”, this hormone stimulates the
pituitary gland. The pituitary then secretes adrenocorticotrophic hormone
(ACTH). In humans, the stress glucocorticoid that is produced is called cortisol.
→ The biological cost of adapting to stress is called the allostatic load. When
we are relaxed and not experiencing stress, our allostatic load is low. When we
are stressed and feeling pressured, our allostatic load will be higher.
→ Psychoneuroimmunology is the study of the interaction between the
nervous system and the immune system. Glucocorticoids can cause stress-
induced immunosuppression.
The front line of defense in the immune system is the white blood cells
(leukocytes/lymphocytes). There are 2 important types of leukocytes.
 B-cells: Produce antibodies to specific antigens (foreign invaders, tumors,
cancer cells)
 T-cells: Helper cells. Help destroy antigens after activation from a
microphage.
T-cells are unable to recognize antigens by themselves. They become activated
when immune cells called macrophages detect antigens and start to engulf and
digest them. To activate the T-cells, the macrophages release a chemical known
as interleukin-1 (cykotine).
Cytokines are small protein molecules that serve as chemical messengers and
allow immune cells to communicate with each other. Cytokines mediate
inflammatory and immune response and send signals to the brain about infection
and injury. Also stimulate the HPA axis which creates a negative feedback loop.
Positive psychology focuses on human traits and resources such as humor,
gratitude, and compassion that might have direct implications for our physical
and mental well-being.
Cardiovascular Disease
Study in this area includes Hypertension, Coronary heart disease, and Risk
and causal factors.
 PSYCHOPATHOLOGY NOTES
Hypertension is having a persisting systolic blood pressure of 140 or more and
a diastolic blood pressure of 90 or higher. Chronic hypertension can contribute
to a wide range of diseases. Hypertension is especially high in African-
Americans, and in people who don’t express anger constructively. A small
percentage of cases of hypertension are caused by distinct medical problems.
However, in the majority of cases there is no specific physical cause. This is
referred to as essential hypertension. Systolic Pressure is measured when the
blood vessel wall contracts. Diastolic Pressure is measured when the wall
relaxes between beats.
Coronary Heart Disease is a blockage of arteries that supply blood to the heart
muscle. It can lead to cardiac arrest.
Risk and Causal Factors
→ Stress increases the risk of having a heart attack. Certain personality patterns
are linked. Type A behavior pattern characterized by excessive competitive
drive, extreme commitment to work, impatience or time urgency, and hostility.
Type D personality have a tendency to experience negative emotions and also to
feel insecure and anxious. Depression, anxiety, and social isolation are also
linked to cardiovascular disease.
Treatment of Stress-Related Physical Disorders
Biological Interventions:
 Surgical procedures
 Aspirin or other anticoagulants
 Antidepressant medications
 Lipid-lowering medications
Psychological Interventions:
 Emotional disclosure: “Opening up” and writing expressively about life
problems in a systematic way does seem to be an effective therapy.
 Biofeedback: Biofeedback procedures aim to make patients more aware of
such things as their heart rate, level of muscle tension, or blood pressure.
 Relaxation and meditation
 Cognitive-behavior therapy: CBT has been shown to be an effective
intervention for headache as well as for other types of pain.
 PSYCHOPATHOLOGY NOTES
Adjustment Disorder: Psychological response to a common stressor that
results in clinically significant behavioral or emotional symptoms. Maladaptive
response to common stressor within 3 months of stressor. In adjustment disorder,
the person’s symptoms lessen or disappear when the stressor ends or when the
person learns to adapt to the stressor.
PTSD: Reaction to a traumatic stressor. Stress symptoms are very common in
the immediate aftermath of a traumatic event. However, for most people, these
symptoms decrease with time. The diagnosis of PTSD requires that symptoms
must last for at least 1 month.
Acute Stress Disorder: Acute stress disorder is a diagnostic category that can
be used when symptoms develop shortly after experiencing a traumatic event
and last for at least 2 days.
The clinical symptoms of PTSD are grouped into “4” main areas:
1) Intrusion: Recurrent reexperiencing of the traumatic event through
nightmares, intrusive images, and physiological reactivity to reminders of the
trauma.
2) Avoidance: Avoidance of thoughts, feelings or reminders of the trauma.
3) Negative cognitions and mood: This includes such symptoms as feelings of
detachment as well as negative emotional states such as shame or anger, or
distorted blame of oneself or others.
4) Arousal and reactivity: Hypervigilance, excessive response when startled,
aggression, and reckless behavior.
Causal Factors For PTSD: Individual risk factors, Nature of trauma,
Sociocultural risk factors
Individual Factors: Being female, Low levels of social support, Neuroticism,
Preexisting anxiety or depressio, Family history of anxiety or depression,
Substance abuse, and Appraisals soon after trauma increases PTSD.
Prevention and Treatment of Stress Disorders
Prevention: Stress-inoculation training, prepares people to tolerate an
anticipated threat by changing the things they say to themselves before or during
a stressful event. Reduce the frequency of traumatic events.
Treatment: National and local telephone hotlines provide help for people
under severe stress and for people who are suicidal. Crisis intervention has
emerged in response to especially stressful situations, be they disasters or family
 PSYCHOPATHOLOGY NOTES
situations that have become intolerable. Psychological debriefing approaches
are designed to help and speed up the healing process in people who have
experienced disasters or been exposed to other traumatic situations. Critical
Incident Stress Debriefing is a specific type of psychological debriefing. Several
medications can be used to provide relief for intense PTSD symptoms.
Chapter 6-Panic, Anxiety, Obsessions, and Their Disorders
→ Anxiety involves a general feeling of apprehension about possible future
danger, and fear is an alarm reaction that occurs in response to immediate
danger.
→ Obsessions are persistent and highly recurrent intrusive thoughts or images
that are experienced as disturbing and inappropriate. People affected by such
obsessions try to resist or suppress them, or to neutralize them with some other
thought or action. Compulsions are repetitive behaviors (such as handwashing
or checking) that the person feels must be performed in response to the
obsession.
→ Individuals with neurotic disorders show maladaptive and self-defeating
behaviors, they are not incoherent, dangerous, or out of touch with reality. The
term neurosis was dropped from the DSM in 1980.
→ When the fear response occurs in the absence of any obvious external danger,
we say the person has had a spontaneous or uncued panic attack. Panic attacks
are often accompanied by a subjective sense of impending doom, including fears
of dying, going crazy, or losing control.
→ Fear and panic have 3 components. Cognitive/subjective components,
physiological components, and behavioral components.
→ Anxiety disorders all have unrealistic, irrational fears or anxieties of
disabling intensity as their principal and most obvious manifestation. Among the
disorders recognized in DSM-5 are:
1) Specific phobia
2) Social anxiety disorder (social phobia)
3) Panic disorder
4) Agoraphobia
5) Generalized anxiety disorder
 PSYCHOPATHOLOGY NOTES
→ Many people with one anxiety disorder will experience at least one more
anxiety disorder and/or depression either concurrently or at a different point in
their lives.
→ Phobic disorders are the most common anxiety disorders. A phobia is a
persistent and disproportionate fear of some specific object or situation that
presents little or no actual danger and yet leads to a great deal of avoidance of
these feared situations.
 Specific Phobia: People with spesific phobia shows strong and persistent
fear that is triggered by the presence of a specific object or situation. They
often even avoid seemingly innocent representations of it such as
photographs or television images.
→ According to the psychoanalytic view, phobias represent a defense against
anxiety that stems from repressed impulses from the id. Because it is too
dangerous to “know” the repressed id impulse, the anxiety is displaced onto
some external object or situation that has some symbolic relationship to the real
object of the anxiety.
► Vicarious Conditioning: Simply watching a phobic person behaving
fearfully with his or her phobic object can be distressing to the observer and can
result in fear being transmitted from one person to another through vicarious or
observational classical conditioning. In addition, watching a nonfearful person
undergoing a frightening experience can also lead to vicarious conditioning.
֎ Our evolutionary history has affected which stimuli we are most likely to
come to fear. Primates and humans seem to be evolutionarily prepared to rapidly
associate certain objects—such as snakes, spiders, water—with frightening or
unpleasant events. This is because our evolutionary history has affected which
stimuli we are most likely to come to fear. This prepared learning occurs
because, over the course of evolution, those primates and humans who rapidly
acquired fears of certain objects or situations that posed real threats to our early
ancestors may have enjoyed a selective advantage. Thus “prepared” fears are not
inborn or innate but rather are easily acquired or especially resistant to
extinction.
 Genetics: Monozygotic twins are more likely to share phobias than dizygotic
twins.
 Temperament: Behaviorally inhibited temperament is linked to higher
vulnerability to phobias.
 PSYCHOPATHOLOGY NOTES
 Medication treatments are ineffective by themselves when dealing with any
of the specific phobias. However, d-cycloserine (facilitates extinction of
conditioned fear in animals) may enhance the effectiveness of small amounts
of exposure therapy for fear of heights in a virtual reality environment. By
itself, it has no effect.
 Social phobia (social anxiety disorder): It’s characterized by disabling fears
of one or more specific social situations (such as public speaking, urinating
in a public bathroom, or eating or writing in public. In these situations, a
person fears that she/he may be exposed to the scrutiny and potential
negative evaluation of others or that she or he may act in an embarrassing or
humiliating manner. Somewhat more common in women than men. Typically
begin during adolescence or early adulthood.
Psychological Causal Factors
→ Learned behavior: Classical conditioning that is direct or vicarious in
nature.
→ Evolutionary factors: Predisposition based on social hierarchies.
→ Perceptions of uncontrollability and unpredictability.
→ Cognitive biases toward “danger schemas” in social situations that they
will behave in awkward and unacceptable fashion, resulting in rejection and loss
of status.
Biological Causal Factors
Genetics: Twin studies suggest about 30% of variance in liability to social
phobia is due to genetic factors.
Temperament: Behavioral inhibition correlates with social phobia.

Treatments for social phobias include:

Cognitive therapy: Cognitive restructuring to change distorted automatic
thoughts. More effective than medications. In cognitive restructuring the
therapist attempts to help clients with social phobia identify their underlying
negative, automatic thoughts
Behavior therapy: Exposure to social situations that evoke fear. If added d-
cycloserine, treatment gains occur more quickly and are more substantial.
 PSYCHOPATHOLOGY NOTES
Medications: Antidepressants (MAOIs and SSRIs). Relapse rate with
medication is higher than with therapy.
 Panic Disorder: It’s defined and characterized by the occurrence of panic
attacks that often seem to come “out of the blue.” According to the DSM-5
criteria for panic disorder, the person must have experienced recurrent,
unexpected attacks and must have been persistently concerned about having
another attack or worried about the consequences of having an attack for at
least a month (often referred to as anticipatory anxiety). For such an event
to qualify as a full-blown panic attack, there must be abrupt onset of at least 4
of 13 symptoms, most of which are physical, although three are cognitive: (1)
depersonalization (a feeling of being detached from one’s body) or
derealization (a feeling that the external world is strange or unreal); (2) fear
of dying; or (3) fear of “going crazy” or “losing control”.
» Sometimes occur in situations in which they might be least expected, such as
during relaxation or during sleep (nocturnal panic).
 Agoraphobia: In agoraphobia the most commonly feared and avoided
situations include streets and crowded places such as shopping malls, movie
theaters, and stores. Standing in line can be particularly difficult. Panic
disorder without agoraphobia more common than panic disorder with
agoraphobia. Twice as prevalent in women as men. Average age of onset is
23–34 years.
►Panic attack related to locus coeruleus (earlier theories), amygdala,
hippocampus. Biochemical agents are noroepinephrine, caffeine. 2 primary
neurotransmitter systems are most implicated in panic attacks—the
noradrenergic and the serotonergic systems.
►GABA is known to inhibit anxiety and has been shown to be abnormally low
in certain parts of the cortex in people with panic disorder.
Psychological Causal Factors
Comprehensive learning theory of panic disorder: According to this theory,
initial panic attacks become associated with initially neutral internal
(interoceptive) and external (exteroceptive) cues through an interoceptive
conditioning (or exteroceptive conditioning) process.
Cognitive theory of panic: Individuals with panic disorder are hypersensitive to
their bodily sensations and are very prone to giving them the direst possible
interpretation.
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Anxiety sensitivity and perceived control: Anxiety sensitivity is a trait-like
belief that certain bodily symptoms may have harmful consequences. Such a
person would endorse statements such as, “When I notice that my heart is
beating rapidly, I worry that I might have a heart attack.” Simply having a sense
of perceived control reduces anxiety and even blocks panic.
Safety behaviors and the persistence of panic: People with panic disorder
frequently engage in safety behaviors (such as breathing slowly or carrying a
bottle with anxiolytic medication) before or during an attack.
Cognitive biases and the maintenance of panic: people with panic disorder are
biased in the way they process threatening information. Such people not only
interpret ambiguous bodily sensations as threatening, but they also interpret
other ambiguous situations as more threatening than do controls. People with
panic disorder also seem to have their attention automatically drawn to
threatening information in their environment such as words that represent things
they fear, such as palpitations, numbness, or faint.
Medications: anxiolytics (alprazolam (Xanax) or clonazepam (Klonopin),
antidepressants
Behavioral and Cognitive-Behavioral Treatments: One technique involves
the variant on exposure known as interoceptive exposure, meaning deliberate
exposure to feared internal sensations. Cognitive restructuring techniques, in
recognition that catastrophic automatic thoughts may help maintain panic
attacks. One kind of integrative cognitive-behavioral treatment for panic
disorder—panic control treatment—targets both agoraphobic avoidance and
panic attacks.
 Generalized Anxiety Disorder: Chronic or excessive worry about multiple
events and activities. Occurs more days than not for 6-month period. Twice
as common in women as in men.
Biological Causal Factors: It is modestly heritable. CRH also plays a role. The
neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a role
in anxiety. Neurobiological factors implicated in panic disorders and GAD are
not the same.
Treatments: Anxiolytic drugs are commonly used and misused. Buspirone
seems effective and nonaddictive. Cognitive-behavioral therapy has become
increasingly effective.
Obsessive-Compulsive and Related Disorders
 PSYCHOPATHOLOGY NOTES
Occurrence of unwanted and intrusive obsessive thoughts or distressing images.
These are usually accompanied by compulsive behaviors performed to undo or
neutralize the obsessive thoughts or images or as a way of preventing some
dreaded event or situation. Compulsions can involve either overt repetitive
behaviors that are performed as lengthy rituals (such as hand washing, checking,
putting things in order over and over again). Compulsions may also involve
more covert mental rituals (such as counting, praying, or saying certain words
silently over and over again). More frequent in boys than girls and greater in
severity.
♣The dominant behavioral or learning view of obsessive-compulsive disorder is
derived from Mowrer’s two-process theory of avoidance learning (1947).
According to this theory, neutral stimuli become associated with frightening
thoughts or experiences through classical conditioning and come to elicit
anxiety.
♣Thought-action fusion is the belief that thinking about something is as bad as
actually doing it.
Biological causal factors: OCD appears moderately heritable. Abnormalities in
brain function may include:
Slight structural abnormalities in the caudate nucleus. High metabolic levels in
other parts of the brain. Serotonin is strongly implicated in OCD.
♣♣♣The orbital frontal cortex, cingulate cortex/gyrus, and basal ganglia
(especially the caudate nucleus) are the brain structures most often implicated
in OCD.
♣♣♣ Anafranil (clomipramine) is often effective in the treatment of OCD.
Fluoxetine (Prozac), have also been shown to be about equally effective in the
treatment of OCD.
Treatments
Exposure and response prevention may be most effective approach to
obsessive-compulsive disorder. Exposure to anxiety-producing obsession,
prevention of compulsion typically used. Gradually move through hierarchy of
stimuli.
Medications that affect neurotransmitter serotonin have also been found helpful.
Body Dysmorphic Disorder
Classified as a somatoform disorder in DSM-IV-TR because it involves
preoccupation with certain aspects of the body. It was moved out of the
 PSYCHOPATHOLOGY NOTES
somatoform category and into the OCD and related disorders category in DSM-
5.
People with BDD are obsessed with some perceived or imagined flaw or flaws
in their appearance to the point they firmly believe they are disfigured or ugly.
Most people with BDD have compulsive checking behaviors. People with this
condition frequently seek reassurance from friends and family about their
defects, but the reassurances almost never provide more than very temporary
relief. They also frequently seek reassurance for themselves by checking their
appearance in the mirror countless times in a day. Very common to also have
diagnosis of depressionSuicide attempts and ideations are also common.
Therapy emphasizing exposure and response prevention appears to be effective.
Hoarding Disorder (İstifçilik)
Hoarding has now been added as a new disorder in DSM-5. Compulsive
hoarding (as a symptom) occurs in approximately 10 to 40 percent of people
diagnosed with OCD. However, as many as 4 out of 5 people show only
compulsive hoarding. Such individuals both acquire and fail to discard many
possessions that seem useless or of very limited value, in part because of the
emotional attachment they develop to their possessions. In addition, their living
spaces are extremely cluttered and disorganized to the point of interfering with
normal activities that would otherwise occur in those spaces, such as cleaning,
cooking, and walking through the house.
Trichotillomania (Saç Yolma)
Trichotillomania (also known as compulsive hair pulling) has as its primary
symptom the urge to pull out one’s hair from anywhere on the body (most often
the scalp, eyebrows, or arms), resulting in noticeable hair loss. The hair pulling
is usually preceded by an increasing sense of tension, followed by pleasure,
gratification or relief when the hair is pulled out. It usually occurs when the
person is alone (or with immediate family members) and the person often
examines the hair root, twirls it off and sometimes pulls the strand between their
teeth and/or eats it.
Cultural Perspectives
Latin Americans from the Caribbean → Ataque de nervos
In the Yoruba culture of Nigeria, there are 3 primary clusters of symptoms
associated with generalized anxiety: worry, dreams, and bodily complaints
China and other Southeast Asian countries → Koro
 PSYCHOPATHOLOGY NOTES
Japan → Taijin kyofusho