Chapter 1- in Historical context
Psychological disorder
● Or abnormal behavior
● 1. Psychological dysfunction
○ Breakdown in cognitive emotional or behavioral functioning
● 2. Distress or impairment
● 3. Atypical response or not culturally expected
● “Behavioral, psychological, or biological dysfunctions that are unexpected in their
cultural context and associated with present distress and impairment in
functioning, or increased risk of suffering, death, pain, or impairment”
● Rule of thumb: mental disorder = harmful dysfunction
Science of psychopathology
● Psychopathology
○ Scientific study of psychological disorders
○ Scientist-practitioner
■ Mental health professionals adopting scientific approaches or methods
● Clinical description
○ Presenting problem
● Prevalence
○ How many people in the population have it
● Incidence
○ How many new cases occur during a given period
● Course
○ Progression or pattern of disease
● Onset
○ Acute
■ Begin suddenly
○ Insidious onset
■ Develop over an extended period
● Prognosis
○ Expected course of a disorder
● Etiology
○ Study of origin of disorder
Historical conceptions of abnormal behavior
● Supernatural model
● Biological model
● Psychological model
● NOW
○ Biological model
○ Psychological model
● Supernatural tradition
○ Physical and mental disorders were considered work of devil
○ Exorcism
● Stress and Melancholy
○ Insanity was caused by mental or emotional stress
Treatments for Possession
● Pit of snakes
Mass Hysteria
● Whole groups of people were simultaneously compelled to run out in the streets, dance,
shout, rave and ump around in patterns
● Emotion contagion
○ Experience of emotion seems to spread
○ Mob psychology
Influence of the Moon and the Stars
● Lunatic
● Astrology
Major psychopathology Paradigms
● Psychoanalytic- sigmund freud
● Psychodynamic
● Humanistic
● Socio-cultural learning (behavioral)
● Cognitive
● Biological
The Biological Tradition
● Hippocrates and Galen
○ Hippocrates
■ Father of modern western medicine
■ Suggested psychological disorders could be treated like any other
disease
■ Humoral theory of disorders
● The four bodily fluids or humors
■ Coined hysteria
● Based on idea that the empty uterus is wandering to different parts
of the body
● The 19th century
○ Biological tradition was reinvigorated
○ Syphilis
■ STD caused by bacterial microorganism entering the brain
■ Led to discovery of cure that showed decrease in behavioral and
cognitive symptoms
○ John P. Grey
■ Believed causes of insanity were always physical
■ Hospitals became more humane, livable institutions
The Development of Biological Treatments
● Benjamin franklin and electric shock therapy
● During the 1950s, first effective drugs for severe psychotic disorders were developed
● Discovery of reserpine
● Neuroleptics
● Benzodiazepines
The Psychological Tradition
● Moral Therapy
○ Treating patients as normally as possible
○ Nurturing relationships
● Asylums
○ Appeared in 16th century
○ More like prisons
● Asylum reform and decline of moral therapy
○ After mid 19th century, humane treatment declined
○ Patient loads higher
○ Immigrants
● Dix
○ Mental hygiene movement
■ Human treatment became available
■ Led to influx of patients
● Psychoanalysis
● Behaviorism
○ Watson
Psychoanalytic Theory
● Mesmer
○ Father of hypnosis
○ Charcot
■ Demonstrated that some techniques of mesmerism were effective in
treating certain disorders
● Freud and breuer
○ Unconscious mind
○ Catharsis
■ Release of emotional material
○ Psychoanalytic model
■ Most of it turned out to be incorrect or remains unproven
■ Had strong influence
■ (1) the structure of the mind
● The id
○ The animal within people
○ Libido
○ Thanatos
■ Death instinct
○ Driven by pleasure principle
○ Primary process
■ Processing emotionally, irrationally and illogically
● The ego
○ Ensures that we act realistically
○ The mediator
○ Driven by reality principle
○ Secondary process
● Superego
○ Conscience
○ Driven by moral principles
○ Intrapsychic conflicts
■ Conflicts within our mind
■ (2) Defense mechanisms
● Unconscious protective processes
■ (3) psychosexual stages of development
● Phallic stage
○ Mother thing
○ Castration anxiety
○ Penis envy
■ Neuroses
● Neurotic disorders
● Later developments in psychoanalytic thought
○ Anna freud
■ Ego psychology
○ Kohut
■ Formation of self-concept
■ Neurosis )health)
■ Self-psychology
○ Object relations
■ Study of how children incorporate the images memories and values of a
person who was important to them and to whom they are emotionally
attached
■ Object- the people
■ Introjection- process of incorporation
○ Jung
■ Collective unconscious
■ Wisdom accumulated by society
■ Passed from generation to generation
○ Adler
■ Inferiority complex
○ Both jung and adler believed basic quality of human nature is positive
○ Self-actualization
○ Erik erikson
Psychoanalytic Psychotherapy
● Free association
● Dream analysis
● Transference
○ Patients resent therapist
● Psychodynamic psychotherapy
○ Mixture of tactics
■ Focus on affect and expression
■ Exploration of attempts to avoid topics
■ Identification of patterns in thought
■ Emphasis on past experiences
■ Focus on interpersonal experiences
■ Emphasis on therapeutic relationship
■ Exploration of patients wishes dreams
Humanistic Theory
● Self-actualizing
○ Everyone can reach their highest potential
● Maslow
○ Hierarchy of needs
● Carl Rogers
○ Most influential humanist
○ Person-centered therapy
The Cognitive-Behavioral Model
● Pavlov and classical conditioning
○ Stimulus generalization
■ Response generalizes to similar stimuli
● Watson and rise of behaviorism
○ Decided that to base psychology on introspection was to head in the wrong
direction
○ Psychology could be made as scientific as physiology
Behavior Therapy
● Wolpe
○ Systematic desensitization
○ Extinction of fear
● BF skinner and operant conditioning
○ Science must be based on observable events
○ Reinforcement
○ Shaping
The Present: The Scientific Method and an Integrative Approach
Summary
● A psychological disorder is 1. A psychological dysfunction with an individual that is 2.
Associated with distress or impairment in functioning and 3. Is a response that is not
typical or culturally expected
Chapter 2- An integrative approach to
psychopathology
● Multidimensional integrative approach
○ Both biological dimensions and psychological dimensions
● Developmental influences
Genetic Contributions to Psychopathology
● Different forms of alleles are called polymorphisms
● Quantitative genetics
○ Contributes of genes that code for dimensional traits
● Epigenetics
○ Interaction of genes and environment
● Genes account for less than 50% of psychopathology
● Erik Kandel gene-environment interactions
○ Genetic structure of cells changes as a result of learning experiences
○ An inactive gene may become active because of environmental influences
The Diathesis-Stress Model
● Individuals have certain tendencies to express certain traits or behaviors, which may be
activated under conditions of stress
● Diathesis or vulnerability
○ The inherited vulnerability
Reciprocal Gene-Environment Correlation Model
● Reciprocal gene-environment model
● Outcomes are a result of interactions between genetic vulnerabilities and experience
● People might have a genetically determined tendency to create the very environmental
risk factors that trigger a genetic vulnerability
● Can apply to depression for example
○ Some people may tend to seek out difficult relationships or other circumstances
that lead to depression
Epigenetics and the Nongenomic “Inheritance of Behavior
● Telomeres
○ Cap the end of chromosomes
○ Exposure to adverse stressors has been associated with shortening of telomere
length
● Genetic contribution to a personality trait or to a psychological disorder is about 50%
● Environment can change gene expression
○ Methylation
○ Hydroxymethylation
Neuroscience and Its Contributions to Psychopathology
● CNS
● PNS
● Hindbrain
○ Medulla- autonomic processes
■ Heart rate blood pressure respiration
○ Pons- regulates sleep stages
○ Cerebellum- physical coordination
● Midbrain
○ Coordinates movement with sensory input
○ Contains reticular activating system (RAS)
■ Light correlating with sleep
● Limbic system
○ Emotional center
● Basal ganglia
○ Thought to partially control motor activity
● Forebrain
○ Sensory, emotional, cognitive processing
● Left hemisphere
○ Verbal
○ Language
○ Cognitive processes
● Right hemisphere
○ Perceiving world around us
○ Creating images
● Endocrine system
○ Stress-related physical disorders
○ May play role in depression, anxiety, schizophrenia
○ HPA axis
● Neurotransmitters
○ Changes in neurotransmitter activity may make people more or less likely to
exhibit certain kinds of behavior in certain situations without causing the behavior
directly
○ Inverse agonists
■ Produce effects opposite to those produced by the neurotransmitter
○ Monoamines and amino acids
■ Have been most studied in regard to psychopathology
■ Synthesized in the nerve
○ Glutamate and GABA
■ Fast acting
■ Gaba
● Reduces postsynaptic activity
● Reduces anxiety
● Benzodiazepines
○ Serotonin
■ Six major circuits
■ Low activity
● Less inhibition
● Instability
● Tendency to overreact
■ Low levels
● Aggression
● Suicide
● Impulsi e overeaten
■ SSRIS
■ St. johns wort
■ Psychedelics and hallucinogens like LSD
■ MDMA
○ Norepinephrine
■ Stimulates
■ Alarm responses and basic bodily processes
● Alpha-adrenergic receptors
● Beta-adrenergic receptors
○ Beta-blockers
■ For hypertension or heart rate
■ Blocks beta-receptors so that their response to a
surge of norepinephrine is reduced
■ Related to states of panic
○ Dopamine
■ Implicated in schizophrenia, addiction, ADHD
■ L-dopa
■ Pleasure-seeking behaviors
● Implications for Psychopathology
○ OCD
■ Increased activity in the part of the frontal lobe called orbital surface
■ Also in cingulate gyrus
■ Orbital frontal cortex
● Psychosocial Influences on Brain Structure and Function
○ Initiating factors
■ Reasons a problem develops in the first place
○ Maintaining factors
■ Reasons that problem persists
○ Can psychological treatment be powerful enough to affect brain circuit directly
without drugs or surgery
■ CBT
■ ERP
■ Brain scans changed
○ Placebos
■ Positive expectations produce positive results
○ Change differences between therapy and drugs
■ Brain imaging can predict if a patient will be more responsive to
psychotherapy or drugs
● Interactions of Psychosocial Factors and Neurotransmitter Systems
○ Neurological activity can change as a result of psychotherapy
○ Stress and early development
○ Rhesus monkey experiment
■ Feeling control vs no control
○ Neurotransmitters have different effects depending on previous psychosocial
experience
○ Life experiences change the way you respond to normal changes of
neurotransmitters
○ Putting a bigger mouse in a cage with a smaller mouse to bully produced
changes in the mesolimbic dopamine system of the smaller mouse
● Psychosocial Effects on the Development of Brain Structure and
Function
○ Our experiences change the structure and shape of neurons
● The Brain-Gut connection
○ Microbiota
■ Microorganisms in gut
■ Influence cells in the lining of the gut that can release neurotransmitters
○ People with depression show deficits in some bacterial species involved in
dopamine production
○ Psychobiome
○ Evidence of links between gut disorders and brain disorders
○ Bacteria stimulates the vagus nerve
● Behavioral and Cognitive Science
○ Cognitive science
■ How we acquire and process information and how we store and ultimately
retrieve it
○ Conditioning and Cognitive Processes
■ Robert Rescorla (1988)
● Contiguity
○ Learned Helplessness
■ Animals learned that their behavior has no effect on their environment
■ Develop depression
■ People make an attribution that they have no control
■ Learned optimism
● Longer lifespan
○ Social Learning
■ Organisms do not have to experience certain events in their environment
to learn effectively
■ Modeling
○ Prepared Learning
■ We have become prepared for learning about certain objects situations
even without experience
■ Organisms are biologically prepared to learn some associations more
readily than others
■ Snakes, spiders,
○ Unconscious
■ Blind sight or unconscious vision
■ Dissociation between behavior and consciousness
■ Implicit memory
■ Black box
● Unobservable feelings and cognitions inferred from an individuals
self-report or behaviors
■ Stroop paradigm
● Emotions
○ Fight or flight response
○ The Physiology and purpose of fear
■ Fear
● Feeling of terror
■ Emotion
● Action tendency
● Short-lived temporary states lasting from several minutes to
several hours
■ Mood
● A more persistent period of affect or emotionality
■ Affect
● Valence dimension
● (positive or negative)
■ Circumplex model of emotions
● Arousal dimension and valence dimension
● Positive or negative valence
● High or low arousal
● Time dimension
■ Affective style
● Common emotional characteristic of an individual
○ Components of Emotion
■ Behavior
■ Physiology
■ Cognition
● Appraisal
○ Anger and Your Heart
■ Negatively valenced emotions such as hostility and anger increase a
person's risk of developing heart disease
■ Anger caused participants heart to pump blood less efficiently
■ Inflammation produced by an overactive immune system in particularly
hostile individuals may contribute to clogged arteries
■ Adopting a forgiving attitude
● Can neutralize toxic effects of anger
○ Emotions and Psychopathology
■ Suppressing emotional response increases sympathetic nervous system
activity
■ Emotions can lead to disorders
■ Mood disorders
● Cultural, Social, and interpersonal Factors
○ Voodoo, the Evil Eye, and Other Fears
■ Fright disorders
■ Susto in Latin America
■ Social fears
○ Gender
■ Women more likely to have insect or small animal phobia
■ Gender roles play a part
■ Some males drink alcohol instead of admitting they're afraid
■ Psychotherapy
● Women may maintain treatment gains because of ability to recall
emotional memories
■ Bulimia nervosa
■ Tend and befriend
● Response to stress from women
● Nurturing behavior
○ Social Effects on Health and Behavior
■ Social relationships protect us
● Against psychological and physical disorders
■ Social isolation increases the risk of death about as much as smoking
cigarettes and more than physical inactivity
■ Social relationships provide meaning to life
■ Promote health-promoting factors
■ Cities affect schizophrenia
○ Social and Interpersonal Influences on the Elderly
■ Poor social networks except if ill
■ Older people population is growing
○ Social Stigma
■ Less chance of full recovery and less social support
○ Global Incidence of Psychological Disorders
■ WHO reveals mental disorders account for 13% of the global burden
of disease
● Life-span Development
○ Erik Eriskon suggested that we go through 8 major crises during our lives
○ Prenatal experiences affect brain structure
○ Influence of developmental stage and prior experience has a substantial impact
on the development of psychological disorders
● The principle of equifinality
○ Equifinality
■ We must consider a number of paths to a given outcome
○ Different paths can result from interaction of psychological and biological factors
● Conclusions
○ Psychoanalytic theory
○ behavioral and cognitive influences
○ Emotional influences
○ Social and cultural influences
○ Genetics
○ Neuroscience
○ Life-span developmental factors
○ Psychological disorders do not have just one cause
DO CONCEPT CHECK
Chapter 3- Clinical Assessment and Diagnosis
Assessing Psychological Disorders
● Clinical assessment
○ Systematic evaluation and measurement of psychological, biological and
social factors in an individual presenting with a possible psychological disorder
● Diagnosis
○ Process of determining whether the particular problem meets criteria for a
psychological disorder
○ Degree of fit between symptoms and diagnostic criteria
○ DSM 5
● Assessment
○ Clinician collects a lot of information and narrows down focus
○ Purpose
■ Understanding the individual
■ Predicting behavior
■ Treatment planning
■ Evaluating outcomes
○ Funnel analogy
○ Reliability
■ Degree to which a measurement is consistent
■ Two different evaluators reach same conclusion
○ Validity
■ Degree to which a technique measures what it is designed to measure
■ Concurrent
● Between results of one assessment with another measure known
to be valid
■ Predictive
● How well the assessment predicts outcomes
○ Standardization
■ Consistency
■ Consistent use of techniques
■ Provides normative population data
■ Administration procedures
■ Scoring
■ Evaluation of data
● The Clinical Interview
○ Gathers information on current and past behavior, attitudes and emotions
○ Educational, family, religious attitudes
● Mental Status Exam
○ Observation when any person interacts with another
○ Systematic observation
○ Five categories
■ Appearance and behavior
● Physical behaviors
■ Thought processes
● What is the rate or flow of speech?
● Do ideas have a connection?
● Evidence of delusions?
● Ideas of reference
● Hallucinations
■ Mood and affect
● Does the person seem down or elated?
● Appropriate affect
■ Intellectual functioning
● Do they seem to have reasonable vocabulary
● Persons memory
■ Sensorium
● General awareness of our surroundings
● Do they know the date, time
● Case of Frank
○ OCD
● Semi Structured Clinical Interviews
○ Made up of questions that have been carefully phrased and tested to elicit useful
information
○ However, clinicians can still depart from set questions to follow up on specific
issues
● Physical Examination
○ Psychological disorder could be related to a toxic state
■ Lack of nutrients, wrong amount or type of medicine, onset of medical
condition
■ Thyroidism
● Behavioral Assessment
○ Direct observation to formally assess an individual's thoughts, feelings, and
behavior
○ Target behavior
■ Behavior of interest that needs to be increased or decreased
○ Good for individuals who may not be old enough or skilled enough to report their
problems and experiences
○ Role-play
○ Going into persons home or workplace
○ Analogue
■ Similar setting to see a certain behavior
○ Hypnosis
○ ABCs of observation
■ Immediate behavior
■ Antecedents (what happened just before the behavior)
■ behavior
■ Consequences (what happened afterward
■ Formal observation
● Identifying specific behaviors that are observable and measurable
○ Self-Monitoring
■ Ex: people trying to quit smoking may write down the number of cigarettes
they smoke and the times when and places they smoke
■ When the people are in the best position to observe the behavior
○ Behavior rating scales
■ Screens for psychotic disorders
■ Somatic concern, guilt, grandiosity
○ Reactivity
■ Can distort any observational data
■ Presence can cause them to change behavior
■ When people self-monitor, the behaviors they want to increase tend to
increase and behaviors they want to decrease decrease
● Psychological Testing
○ Responses that might be associated with disorder
○ Projective Testing
■ Pictures or things
■ People project their own own personality and unconscious fears onto
other people and things
■ Rorschach inkblot tests
■ Thematic Apperception Test (TAT)
● Telling a story about a picture
● Children's apperception test
■ Most clinicians that use them have their own methods
■ Reliability issue
○ Personality Inventories
■ Magazines with personality tests
● Face validity
■ Personality inventories
● Self-report questionnaires that assess personal traits
● What the answers to these questions predict
■ Minnesota Multiphasic Personality Inventory MMPI
● Empirical approach
● 567 items
● Most extensively researched assessment instruments
● Some research suggests that the information provided by MMPI
does not necessarily change how clients are treated and may not
improve their outcomes
○ Intelligence Testing
■ Alfred Binet and Theodore Simon were commissioned to develop a test
■ Stanford-Binet Test
● Provides IQ
● Deviation IQ
■ Wechsler test
● Verbal scales
● Knowledge of facts
● Performance scales
■ IQ does not equal intelligence
■ Some believe that IQ does not represent intelligence
● Neuropsychological Testing
○ Measure abilities in areas such as receptive and expressive language, attention
and concentration, memory, motor skills, perceptual abilities
○ Bender Visual-Motor Gestalt Test
■ Children copy what is drawn on cards
○ False positive
■ Test shows a problem when non exists
○ False negatives
■ No problem is found even though some difficulty is present
● Neuroimaging
○ Can either examine damage or functioning of the brain
○ Images of Brain Structure
■ CAT scan or CT scan
● X-ray
● Useful in locating brain tumors, injuries, structural abnormalities
● X-radiation
■ MRI
● Magnetic fields
● Bad for claustrophobics
○ Images of Brain Functioning
■ PET scan
● Tracer substance
● Interacts with blood, oxygen, glucose
● Shows parts of the brain that are working
● Localizing sites of trauma
● Patterns of metabolism
■ SPECT single photon emission computed tomography
● Less accurate but less expensive
■ Functional MRI
● Replaced PET scans in years
● BOLD-fMRI
● Psychophysiological Assessment
○ Measurable changes in nervous system that reflect emotional or psychological
events
○ EEG
■ Measuring electrical activity in the head
■ Event-related potential (ERP)
● Patterns in response to specific events
■ Alpha waves
■ Types of stress-reduction treatments attempt to increase freq of alpha
waves
○ Used measuring response to emotional stimuli
○ Sexual dysfunctions and disorders
○ Treatment of conditions like headaches and hypertension
Diagnosing Psychological Disorders
● Clinicians establish a prognosis
● Idiographic strategy
○ Determine what is unique about an individuals personality cultural background
● Nomothetic strategy
○ Determine the class of problems
● Classification
○ Effort of constructing groups or categories and to assign objects or people to
these categories
● Taxonomy
● Nosology
○ Taxonomic system applied to psychological or medical phenomena
● Nomenclature
○ Names or labels of disorders that make up nosology
● Classification Issues
○ Definitions of normal and abnormal are controversial
○ If one behavior belongs to another
○ Categorical and Dimensional Approaches
■ Classical categorical approach
● Ex: you either hear voices and have symptoms of schizophrenia or
you don't
● Every diagnosis has a clear underlying pathophysiological cause
● Set of causative factors do not overlap with other disorders
● Useful in medicine
● Inappropriate for the complexity of psychological disorders
■ Dimensional approach
● Several dimensions with a composite score
● MMPI
● Continuum of severity
■ Prototypical approach
● Some essential characteristics and other nonessential variations
● Blurring of boundaries
● DSM-5 criteria
○ Reliability
■ Subject to bias
■ Personality disorder classification is most unreliable
○ Validity
■ Measures what is designed to measure
■ Construct validity
● Signs and symptoms chosen for category are consistently
associated
● Familial aggregation
○ Extent to which disorder would be found among patients
relatives
■ Predictive validity
● Predict course and treatment
■ Content validity
● Diagnosis before 1980
○ Early efforts to classify psychopathology arose out of biological tradition
○ Kraepelin
■ Identified schizophrenia
○ WHO
■ Added section for mental disorders into ICD
● DSM-3
○ 1980
○ Relied on precise descriptions of disorders
○ Specificity of detail
● DSM-4
○ Distinction between organically based disorders and psychologcically based
disorders
● DMS-5
○ 2013
○ Dimensional axes
○ Frank
■ Rated 5 on sevirty scale of OCD
○ Social and Cultural Considerations in DSM-5
■ Ex: what is the primary cultural reference group of patients? Does the
patient use terms and descriptions from their country of origin to describe
the disorder? What does it mean to be disabled?
○ Criticisms of DSM-5
■ Fuzzy boundaries
■ Comorbidity
■ Emphasize reliability over validity
○ Labeling and Stigma
■ Labeling
■ Stigma
■ Labels may affect their self-esteem
