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Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview

Psychopathology Abnormal Behavior


Study of why people think, behave, and feel in abnormal, Given social, cultural, and situational factors, any behavior or
unexpected ways. thought that is maladaptive or has a negative affect
Characteristics:
“something wrong with a person’s psychology” • Personal Distress (emotional pain and suffering)
A search by clinicians for the reasons why people behave, think, and • Disability (impairment in a key area)
act in abnormal ways. Focus is on
• Violation of Social Norms (makes others uncomfy)
• Description
Cultural relativism: behavior determined by culture and
• Causes society
• Treatment • Dysfunction: Wakefield’s harmful dysfunction
DSM-IV-TR includes all these characteristics

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Stigma What are the three historical views?
Having a negative connotation – how we think about mental illness. (guiding perspectives over time)
Labeling someone based on our assumptions, and negativity is
Supernatural: mental illness is due to supernatural forces
attached in a big way.
(demonology, God, possession, etc)
Biological: originated with Hippocrates, says that psychopathology is
Apply label refers to undesirable attributes people seen as due to dysfunction in the brain, it is similar to physical disease
different discrimination
Psychological: says that psychopathology is due to something in the
environment like stress or trauma

These views dictated how mental illness has been treated, and how
people with mental illness were treated

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Freud Behaviorism
• Influenced by Bruer Suggests that behavior develops through classical conditioning,
operant conditioning, or modeling. People with symptoms just need
• Emphasized stages of psychosexual development
to reinforce OTHER behaviors. Shift was towards observing things that
• Importance of unconscious processes we can see, and moving away from unconscious
Repression and defense mechanisms • John Watson father of behaviorism, focused on learning
and observable behavior
Influenced psychoanalytic theory:
• BF Skinner: positive and negative reinforcement, showed
• Free association
that operant conditioning can shape behavior
• Analysis of transference
• Understand conflicts and find healthier ways dealing with
them,.

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Cultural Relativism Wakefield’s Harmful Dysfunction
Says that behavior is determined by culture and society, and that Says that must be harmful to the self or society, and must be an
there is no universal for human behavior. element of dysfunction, something operating in a way that deviates
from how it should operate.
• Think of gender roles in different parts of the world

Someone might deny harm to themselves or society but actually be


doing harm!

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Demonology Hippocrates
Earliest idea of mental illness. Believed that demons and evil spirits Gave earliest biological explanation
possessed the mind to cause mental illness, and that exorcism was
Thought that mental illness was caused by natural as opposed to
the only treatment. They drilled holes in the skull to let the, escape
supernatural causes, and that it was located In the brain
(trepanning)
• Imbalance of four humours of the body
Black bile (infection)
Yellow bile (anxiety)
Phlegm
Blood
Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Timeline of Psychopathology Lunacy Trials
Organized by the government (13th century England) to determine
sanity. Lunacy refers to theory that attributes insanity to misalignment
Supernatural  Biologicacl (Hippocrates) Dark Ages (supernatural)
of the room and stars
 Witches  Lunacy Trials  Aslyums (Priory of St Mary of Bethlehelm
 Pinel (humanitarian treatment)  William Tuke and Society of
Friends  Dorthea Dix  NAME  can be inherited (Behavioral
genetics)  Eugenics  Psychological Approaches  Mesmer 
Bruer  Freud (psychoanalytic theory)  Neo-freudians  Adler 
Behaviorism (Watson, Thorndike, skinner)  Modeling (Bandura and
Menlove)  Behavior therapy

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Priory of St. Mary of Bethlehelm Phillipe Pinel
• One of the first mental institutions Pioneered humanitarian treatment
• Exploited those with mental illness Took Control of Aslyum
• Origin of term bedlam Wanted to treat people with dignity, like humans, to cure
• Treatment non-existent or harmful

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Moral Treatment Dorthea Dix
• William Tuke and Sociey of Friends, York Retreat Crusaders for prisoners and mentally ill in the United States
• Provided a calming environment Urged improvements in institutions
• Gave patients purposeful activity Established 32 new public hospitals,
• Talked with attendants But too large to maintain moral treatment
Hospitals staffed with physicians

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Kraepelin Behavioral Genetics - emergence
• Pioneered classification of mental illness based on “The extent to which behavioral differences are due to genetics”
biological cause
After Kraepelin noticed that symptoms tended to co-occur and
• Noticed groups of symptoms tended to co-occur, called it termed this a syndrome, was noted that these syndromes ran in
a syndrome, evidence of a biological cause families and could be inherited, so investigated causes
• Published first psychiatry text
Dementia Praecox (schizo) and manic depressive Eugenics: only those with desirable traits should be allowed to
psychosis (bipolar disorder) “breed” (period of enforced sterilization”

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Psychological Approaches Freud
View mental illness as due to psychological functions Psychoanalytic theory: Human behavior is determined by
unconscious forces, things we aren’t aware o that an observer
Dysfunctional thinking patterns, behavior determined by
cannot see
reward/punishment, things in the brain that couldn’t be understood
due to biology
Psychopathology results from conflicts among these unconscious
forces
Mesmer: used animal magnetism and hypnosis to treat hysteria
ID: unconscious, energy is libido, operates according to pleasure
Bruer: Used hypnosis to facilitate catharsis
principle, reduces tension through wish fulfillment and fantasies
EGO: develops to consciously control the ID, conscious and operates
according to reality principle
SUPEREGO: our conscience, societal influence
Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
**Stages of Psychosocial Development Defense Mechanisms

Oral Stage Rationalization: justifying with socially acceptable reasons over real
Anal Stage Repression: blocking threatening memory from consciousness
Phallic Stage Regression: return to more primitive levels of behavior
Latency period Denial: refusing to admit something unpleasant happening
Genital Stage Reaction formation: transforming anxious thoughts into opposite
Displacement: taking it out on someone/something else

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
**Conflict between ID,EGO,Superego Neo-Freudians (Jung and Adler)
• ID vs EGO Jung: Analytical psychology
• EGO vs Superego Collective unconscious
• Superego vs ID Archetypes

Adler: individual psychology


Striving for superiority
Inferiority complex
Move towards rational thinking

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Conditioning Conditioning continued (Skinner)
Classical Conditioning: Pavlov, learning by temporal association Skinner Box
When two events repeatedly occur close together in time, they Positive and Negative Reinforcement and Punishment
become fused in mind before long, respond in same way to both
(provide definitions and examples)
events
US (meat) --> UR (salivate) Positive Reinforcement: something added increases behavcior
US (meat) + bell --> UR (salivate) Negative reinforcement: something taken away increases behavior,
CS (bell) --> CR (salivate) so behaviors that terminate a negative stimulus are strengthened
Operant Conditioning: (Thorndike) Looked at learning through Positive punishment: something added decreases behavior
consequences.
Negative punishment: something removed decreases behavior
Law of Effect: any behavior followed by a pleasurable consequence
will be repeated, unpleasant consequence will be discouraged.

Chapter 1 Introduction and Historical overview Chapter 1 Introduction and Historical overview
Modeling and Shaping Behavioral Therapy
Modeling: Learning without any reinforcement “Application of procedures and principles used in operant
conditioning”
• Bandura and Menlove (children and fear of dogs)
• Must identify problems causing behavior and replace
Shaping: reward a sequence of responses that approximate a final
response (rats and pushing a lever) them with better ones. Therapist is like a coach
Counterconditioning: causing same stimulus to elicit a different
response (instead of fearing the bridge, being able to drive over it)
Systematic Desensitization: used often in treatment of phobias and
anxiety disorders. Identify phobia and then use relaxation
techniques and expose to what afraid of at different levels, lead up
to ultimate fear
**Aversive Conditioning**
Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology
Paradigm Genetic Paradigm
A conceptual framework or general perspective. Says that psychopathology is caused or influenced by heritable
factors. Heredity plays some role in most behavior!
Ways that people think about mental disorder, how we organize
information around it, has implications for how people are treated Genes and the environment interact, and this leads to
psychopathology. Think of nature via nurture
Helps shape what we investigate treat and how we define abnormal
behavior Gene Exoression: proteins influence whether the action of a specific
gene will occur
Heritability: extent to which variability is due to genetics. Is a group
rather than an individual indicator
Shared environment: events and experiences family members have
in common
Nonshared environment: events and experiences unique to member

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


Neuroscience Paradigm Psychoanalytic Paradigm
Emphasizes the role of the brain, neurotransmitters and other systems like the • Derives from the work of Freud
HPA axis in psychopathology. View that behavior can best be understood by
reducing it to its basic biological components. Ignores more complex views of • Contemporary contributions are in treatment, including
behavior.
ego analysis and brief therapy
Axon includes:
• Criticized, but highlights importance of childhood
Cell body, dendrites, axon, and terminal button
experience, the unconscious, and that causes of behavior
Treatment is often via drugs and biological treatments to rectify specific aren’t always obvious
problems of the brain.
Neurotransmitter: chemical substance released in the synapse of a
presynaptic neuron
Receptor sites on postsynaptic neuron absorb NT (excitatory or inhibitory
reaction)
Reuptake: reabsorption of leftover NT by the presynaptic neuron

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


Cognitive Behavioral Paradigm Emotion (and factors across paradigms)
Behavior is reinforced by consequences! Plays a predominant role in a number of disorders
• Attention, escape or avoidance, sensory stimulation, Expression, experience, and physiology of emotion can be disrupted
access to desired object or events
Expression: showing emotion
• To alter behavior, alter the consequences
Experience: feeling it
• Systematic desensitization
Physiological: how the experience of the emotion affects
Emphasizes schemas, attention, and irrational interpretations and physiological state
their influence on behavior as major factors in psychopathology
• Disturbance of emotion seen in 90% of disorders
• Has usually blended cognitive findings with the behavioral
Other factors important in psychopathology: Culture, ethnicity,
in an approach to intervention that is referred to as the
gender, social support, relationships. Women more likely depressed
cognitive behavioral (beck and ellis focused on altering
than men, social support determines success of therapy
patients negative schemas and interpretations)

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


Diathesis-Stress Behavior Genetics
Integrates several points of view Study of individual differences in behavior attributable to differences
in genetic makeup
Assumes that people are predisposed to react adversely to
environmental stressors. Genotype: genetic material inherited by an individual, unobservable
Diathesis: underlying predisposition: m ay be genetic, Phenotype: expressed genetic material, observable behavior and
neurobiological, or psychological and may be caused by characteristics
Stress the triggering event, like early childhood experience,
genetically influenced personality trait, or sociocultural influences So phenotype = genotype + environment interaction!
• Diathesis is within a person (genetic neurobiological) and Gene Environment Interaction: ones response to a specific
stress is external to person environmental event is influenced by genes, interaction is recipricol.

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


Epigenetics Neurotransmitters and Psychopathology
Study of how the environment can alter gene expression or function Norepenephrine: anxiety disorders
Rats born to mothers with low parenting skills and RAISED by mothers Seratonin and Dopamine: depression and schizophrenia
with high parenting skills showed lower levels of stress reactivity, AND
GABA: anxiety
increased gene expression implicated in stress response
Possible Mechanisms:
• Excessive or inadequate levels
Graph: having at least one short Allele means greater lilklihood of
developing depression. • Insufficient reuptake
• Excessive number or sensitivity of postsynaptic neuron
Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology
Brain Structure and Function Autonomic Nervous System
Sulci: define regions or lobes Responsible for involuntary functions, involved in anxiety disorders
Frontal: thinking and reasoning abilities Sympathetic Nervous System: (fight or flight): excitatory functions
Parietal: touch recognition Parasympathetic Nervous System: quiescent function, except for
gastrointestinal activation
Occipital: recognition of sights and sounds, long term memory
Temporal: integrates visual input
Hemispheres: halves of the brain separated by corpus callosum
LEFT: speech and analytical thought
RIGHT: spatial relations and pattern re cognition

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


HPA Axis (Neuroendocrine System) Contemporary Psychodynamic Paradigms
Involved in the stress response EGO ANALYSIS:
• emphasis on the ego vs ID
1) Hypothalamus triggers release of CRF
• focus on interaction with the environment
2) Pituitary gland releases ACTH through blood
3) Adrenal cortex triggers release of cortisol, stress hormone • current experience (vs childhood events)
• Proponents were Horney, Freud, Erikson, Rapaport, etc
Blood sugar elevated and metabolic rate increases

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


Brief Psychodynamic Therapy Criticism of Psychoanalysis
• Time limited • No formal research
• Active therapist involvement • Inadequate and non-representative samples
• Concrete goals • Continuing impact
• Development of coping skill
• Current life and experiences GOOD POINTS…
• Transference downplayed Personality shaped by early childhood
Most in response to criticism from insurance companies that it takes Behavior influenced by unconscious
too long! Must have diagnosis within three sessions
Causes of behavior not always apparent or obvious

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


Systematic Desensitization Cognitive Science
Expose someone who has fear of object or event to what they fear in Cognition: a mental process which includes perceiving, judging,
combination with relaxation techniques reasoning, conceiving, and recognizing
• Important treatment for anxiety disorders Schema: Organized network of previously accumulated knowledge
Role of attention in psychopathology: anxious individuals more likely
to attention to threatening stimuli

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology


Beck’s Cognitive Therapy Ellis’s Rational-Emotive Behavior Therapy

• Therapy that helped to identify and then change Identified and challenged patients’ irrational beliefs
maladaptive thought patterns.
Irrational beliefs: Internal, repetitive thoughts that reflect assumptions
“Nothing ever goes right for me!” abot the self
• Originally developed for depression (BDI) – depression “in order to be happy, I must be loved!”
caused by information processing biases. Made patients
• Musts or shoulders that are commonly unrealistic
search for evidence as support of their biases
demandws that we place on ourselves and others
Eg people shouldn’t make mistakes”
Chapter 2 Current Paradigms in Psychopathology Chapter 3 Diagnosis and Assessment
Paradigms of Psycopathology Diagnosis and Classification
Diagnosis: provides the first step into thinking about causes of
symptoms and in planning treatment
Psychodynamic
Advantages:
Neurobiological
• Communication among professionals, clinical care
Cognitive-Behavioral
• Advances search for causes and treatments
Genetic
• Diagnosis is important – must be made within 3 sessions
Diathesis-Stress
Classification: of disorders is by symptoms and signs so the diagnosis
is a cluster of symptoms
**only in psychopathology does classification and diagnosis get hazy
because we don’t have discrete tests

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment


Reliability Validity
ACCURACY How well test measure what we are trying to find out
Consistency of measurement
Content Validi: extent to which measure samples domain of interest
Criterion Validity: extent to which a measure is associated with
Inter-rater reliability: agreement of observers or clinicians. Why we
have the DSM – so two doctors from different backgrounds can another measure
look at same patient and make same diagnosis (.7 is acceptable)
Concurrent means that two measures are given at same time
Test-retest reliability: similarity of scores across repeated test (Hopelessness and depression)
administrations or observations (mood may not have it)
Alternate forms: similarity of scores on tests that are similar, but not Predictive means the ability of the measure to predict another
identical. Similar forms meant to test same thing should have variable measured at some future point in time (GPA and salary)
similar results… trying to test the same thing in a different way
Construct Validity: correlating multiple indirect measures of the
Internal Consistency: extent to which items on a test are related to
one another attribute to give abstract construct legitimacy (if we find correlation)
DIAGNOSES in DSM are constructs, strong one predicts many char.

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment


DSM-IV-TR History of the DSM
Manuel used for making diagnoses
Diagnostic and Statistical Manual of Mental Disorders DSM-1952: Called “reactions” because thought that soldiers came
back from WWII and reacted to trauma
In the 4th edition, 5th by 2010, multiaxial system
DSM II 1968: Neuroses (disorders) and psycos (categories)
Published by American Psychological Association (APA)
DSM III (1980) major revision (disorders and multiaxial system)
Axis I: Clinical Disorders (come and go)
DSM III-R 1987
Axis II: Mental and Personality Disorder (permanent)
DSM IV TR background of disorders added
Axis III: general medical conditions
DSM V 2010?
Axis IV: Psychosocial and environmental factors
** Most concerned with inter-rater reliability and construct validity
Axis V: GAF Score (global assessment of functioning)

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment


Axis I Disorders Improvements in DSM-IV-TR
Specific Diagnostic Criteria: less vague!
Childhood/Infancy/Adolescent Disorders: Learning and More extensive descriptions
Developmental Disorders
• Essential features
Substance related disorders
• Associative features (lab findings)
Schizophrenia and Psychotic disorders
• Differential diagnoses (helps to distinguish 2 disorders from
Anxiety Disorders (GAD, Panic disorder, OCD one another)
Mood Disorders (major depression and bipolar) Increasing number of categories: comorbidity 45%
Eating Disorders (Anorexia nervosa and Bulimia Nervosa) Issues and diagnostic categories in need of further study
Increased cultural sensitivity (cultura bound syndromes)

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment


Diagnosis: Cultural/Ethnic Influences Criticisms of the DSM
Culture can influence: Categorical vs Dimensional Diagnosis:
• Risk factor for disorder Categorical Classification: Yes or no, it’s there or not
• Symptoms experienced and how described Dimensional Classification: having more of a gradation, degree to
which a symptom is present
• Willingness to seek help
DIMENSIONAL better capture an individuals functioning
• Availability of treatments
CATEGORICAL has advantages for research and understanding, but
clinicians don’t like because a person might be impaired in certain
New DSM-IV-TR includes framework for evaluating role of culture and areas, but doesn’t meet full criteria  doesn’t get funded for
ethnicity, and a description of the cultural factors of each disorder treatment
Chapter 2 Current Paradigms in Psychopathology Chapter 3 Diagnosis and Assessment
Should we Classify in the first place? Psychological Assessment

Criticisms of classification: Techniques employed to:


• Label  stigma • Have basis for making decision
Treated differently by others • Describe client’s problem
Difficulty finding a job • Determine causes and come to diagnosis
Never goes away, changes to “in-remission” • Develop treatment strategy
• Categories don’t capture uniqueness of person, and don’t • Monitor progress of treatment
define the person. Classification may emphasize trivial
Ideal assessment involves many measures and methods
similarities, and relevant information might be overlooked
(interviews, personality assessment, inventories)

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment


Psychological Assessment Methods Neurobiological Assessment
Brain Imaging:
Interviews Clinical (pay attention to how questions answered, if
there is appropriate emotion) and Structured (on paper) Paradigm CT or CAT scan (computerized axial tomography): reveals structural
influences information sought in interview. Good rapport is abnormalities by detecting differences in tissue density
essential.
MRI (magnetic resonance imaging): higher quality than CT
Psychological Tests
Personality Tests (MMPI) self report measure yields profile of fMRI: allows to look at blood flow (blood oxygenation levels) as an
psychiatric functioning with a subscale to catch fakers, indication of neural activity. Structure and function
Projective Tests,: response to ambiguous stimuli reflect unconscious PET Scan: Positron Emission Tomography: Brain function, less
process
common, inject radioactive isotope, radioactively tagged glucose
Intelligence Tests: good for detecting mental retardation emits positrons that are picked up from scanner
Direct Observation Antecedents  consequence unit
** not good methods for diagnosing disorder
Self Observation self monitoring, problem is reactivity

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment


Neurotransmitter Assessment Psychophysiology
Post Mortum studies: look at brain after someone has died study of bodily changes that accompany psychological
characteristics or events. How behaviors and cognitions are linked
Metabolite Assays: (byproduct of NT deactivation) can measure this
to these bodily changes
amount in the person’s body – but not great reflection of NT in brain
because is also gives NT in the entire body. Limited measure of Electocardiogram (EKG): heart rate measured by electrodes placed
causation on chest
Neuropsychologist: someone who studies how abnormalities in the Electrodermal responding (skin conductance) : sweat gland activity
brain affect aa perons’s cognition, and behavior measured by electrodes placed on hand
Neuropsychological Tests: interviews that measure brain or cognitive Electroencephalogram (EEG): Brain’s electrical activity measured by
functioning (batteries) electrodes placed on scalp

Chapter 3 Diagnosis and Assessment Chapter 4 Research Methods


Cultural Bias and Assessment Terms of Research
Measures developed for one culture or ethnic group my not be valid Science: The systematic pursuit of knowledge
or reliable for another clture. Most are developed for white men, not
Theory: method of explaining and predicting phenomena that is
just a language barrier. But also a factor
supported by empirical evidence taken as fact, set up to be
disproven
Not just a matter of translation, meaning may be lost in translation • A good theory is falsifiable
• A set of prepositions developed to explain what is
observed
Cultural bias can lead to minimizing or exaggerating psychological
problems in people that come in for help Hypothesis Specific testable predictions about what will occur if a
theory is correct

Chapter 4 Research Methods Chapter 4 Research Methods


Research Methods in Psychopathology Case Study
Case Study: Descriptive biographical information about an individual Detailed biographical description of an individual
Correlation: Relationship between two or more variables. No Family history, Medical history
manipulation by scientists, what is happening in nature. Most
Ethnicity, Gender, Personality and adjustment issues
common and easiest to conduct
Social support around them, day to day environment
Experimental Studies: Manipulation of an independent variable and
DV. DV is what we are looking fo9r change. And there is random Childhood
assignment
Educational background, and experience with therapy
Usefulness: rich description, good for hypothesis, rare disorders, good
for disproving hypothesis, also good hypothesis generator
Limitations: BIAS (paradigm may influence observations) Cannot rule
out altere explanations, and generalizability is limited
Chapter 4 Research Methods Chapter 4 Research Methods
Correlational Method Longitudinal vs Cross Sectional Study
Correlational Coefficient ranges from -1 to 1 Longitudinal: study done over many years with the same people to
see if causes are present before disorder develops
Direction Negative relationship: variables move in opposite directions
High Risk Model: include only those who are at greatest likelihood of
Positive relationship/correlation: variables move in same direction
developing a disorder – reduces the cost of longitudinal research
Constant: no relationship
Cross Sectional Design: looking at simultaneous factors, taking data
Strength (magnitude): the higher the absolute value, the stronger the at one point in time and looking at two different things, causes at
relationship effects measured at the same time.
Statistical Significance: probability less than .05% something other
than chance is happening here! Larger samples increase likelihood
that result is significant
CORRELATION DOES NOT IMPLY CAUSATION (confounding variable)

Chapter 4 Research Methods Chapter 4 Research Methods


Correlational: Epidemiological Research Correlational: Behavioral Genetics
Index cases/Probands: people who actually have the illness, a
sample of individuals with psychopathology
Study of the distribution of disorders in a population
Concordance: Co-occurencec or similarity of diagnosis (concurrent
Three features of a disorder
people have the same diagnosis)
• Prevalence: number of cases that are here long
Family studies: degree to which people are related in a family, and
• Incidence: number of new cases that occur relationship of degree of relatedness and degree of disorder
• Risk Factors: associated with higher chance of having a Twin Studies Monozygoric twins : 100% genes Dizygotic twins 50%
disorder (men vs women)
Adoptee Method: Study of adoptees who have biological parents
with psycopathology
Cross Fostering: Study of adoptees who have adoptive parents with
psychopathology

Chapter 4 Research Methods Chapter 4 Research Methods


The Experiment Analogue Experiment
Provides information about ausal relationships (does x cause y?) Experiments that aren’t possible in psychopathology (if not ethnical)
involves Independent variable, DV, Random assignment we can examine related or similar behavior in the lab… people with
a certain diagnosis may come into the lab, and then there is a
Can evaluate treatment effectiveness – most often used in
manipulation done…
psychopathology research
• Elicit symptoms
Internal validity: extent to which experimental effect is due to
independent variable (so if groups differ too much, bad thing! • Select samples with similar attributes
GOOD internal validity means that change is probably due to
• Animal research
experiment
Control Group: People that don’t receive treatment, the standard
against which treatment effectiveness is judged (placebo)
External Validity: extent to which results generalize beyond study

Chapter 4 Research Methods Chapter 4 Research Methods


Single Subject Experimental Research Integrating Findings from Multiple Studies
Examine how individual participants respond to changes in the Meta Analyses: allows us to come to some conclusion about if
independent variable hypothesis supported
Reversal ABAB Design (girl in book that was afraid of sharp foods) • Identify relevant studies
Baseline (A)  Treatment (B)  Withdrawal (A)  Reinstatement (B) • Compute effect size (transform to common scale)
• Smith et al meta analyzed 475 outcome studies and said
that psychotherapy is effective

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder


Fear vs Anxiety Anxiety Disorders
Anxiety: apprehension about a future threat Deal with atypical, maladaptive levels of anxiety. As a group are the
most common psychiatric disorders. 25% of people report anxiety at
Fear: response to an immediate threat – the present oriented mood
some point, phobias most common
state triggers the fight or flight response
Major Anxiety Disorders:
• Specific phobia or social phobia
**both can be adaptive: May save life (fear) and anxiety can
increase preparedness (improve performance) • Panic Disorder
• GAD
• OCD
• PTSD
• Acute Stress Disorder
Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder
Phobia Etiology of specific phobia
Disruptive fear of a particular object or situation that causes concern Mowrer’s Two Factor Model:
• Fear out of proportion to actual threat Step 1: Classical Conditioning: pairing of stimulus with aversive UCS
leads to fear (classical conditioning) so we are attaching fear to an
• Realization that is excessive
unconditioned stimulus based on a bad experience
• Symptoms must interfere with job or social life
UCS = dog bite (seeing, hearing about, experiencing)
Two types: specific and social
Step 2: Operant conditioning: avoidance maintained through
Animals (snake most common) negative reinforcement… avoiding what we are afraid of to ease
anxiety and feel good
Situations
Problems: many people never experience interaction with aversive
Blood, infection, injury (only parasympathetic response)
object (what if they dob’t remember?) specific types alludes to
Natural environment - Comorbid with physical disorders prepared learning (innate)

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder


Social Phobia Etiology of Social Phobia
Two Factor Model
Persistent, intense fear of social situations • Avoidance and safety behaviors
• Fear of attention, scrutiny, evaluation Safety behaviors may actually make other person uncomfortable
(looking away, fidgeting) to make first person even more awkward
• 33% also diagnosed with avoidant personality disorder
• Cognitive factors
• Often beings in adolescence
Negative self evaluation
• Depends on range of situations avoided, could be
Fear of negative evaluation by others
Generalized or specific
High standards and performance in front of others

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder


Treatment of Phobias Panic Disorder
Psychological treatments that emphasize exposure procedure – fqce Marked by frequent panic attacks that are unrelated to specific
what triggers anxiety, and see that it’s not so bad situations… bouts of unexplainable anxiety
Systematic desensitization: relaxation plus imagined exposure to • Must also be worried about having attacks in the future
feared object. For social phobia, might be exposure in small group
• At least one month after the first case
setting/interaction.
Sudden intense episode of apprehension, fear, impending doom.
Also use social skills training to reduce use of safety behaviors
• Sweating, nausea, labored breathing, dizziness, heart
Cognitive Therapy: good for social phobias but not specific phobias,
palpitations,
because specific phobia people KNOW they have distorted beliefs,
and most of cognitive therapy is figuring that out. Depersonalization: feeling like out of own body
Medication: but if affect fear response system not as great because Derealization: feel like things around you aren’t real. Can be cued or
we don’t get symptoms when exposed to what we fear. uncued

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder


Etiology of Panic Treatment of Panic and Agoraphobia
Neurobiological Factors LC (norepenephrine) PCT (panic control therapy)
Genetic predisposition (identical twins: 30% chance) • Exposure to somatic sensations with relaxation and
hierarchy
Interoceptive conditioning: classical conditioning response to
somatic symptoms Cognitive Behavioral Therapy: Increase awareness of thoughts about
physical sensations, patients learns to challenge maladaptive beliefs
Cognitive Factors: fear of bodily changes and fear of fear hypothesis
Exoectations about negative consequences of attack in public

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder


War Article Symptoms of Anxiety Disorders
Greater Risk: those with greater threat of loss or actual loss Somatic, emotional, cognitive, and behavioral
Those with fewer coping resources
Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder
Generalized Anxiety Disorder (GAD) Obsessive Compulsive Disorder (OCD)
Trademark symptom: constant worry, lasts at least 6 months Obsessions: intrusive, recurring and uncontrollable thoughts or urges
that are experienced as irrational. Most common are
• Restlessness, fatigue, interferes with daily life, often begins
contamination, sexual, and aggressive
in adolescence
Compulsions: impulse to repeat certain behaviors or mental acts.
Etiology of GAD: GABA deficits
Extremely difficult to resist the impulse, may involve elaborate ritual
Borkovec’s cognitive model: worry is reinforcing because it distracts
Etiology: Hyperactive regions of the brain (Anterior cingulate,
from negative emotions and images that may be more painful for a
orbitofrontal cortex, Caudate nucleus). Operant reinforcement:
person to confront – worry is tolerable compared to this. There is no
compulsions are negatively reinforced by reduction of anxiety.
exposure, so anxiety never distinguishes.
Person wants to engage in compulsion to get rid of anxiety
Treatment: cognitive behavioral models, challenge and modify generated by obsessions.
negative thoughts, increase ability to tolerate uncertainty, worry only
during scheduled times
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Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder
Treatment of OCD PTSD (Post traumatic stress disorder)
Exposure plus response prevention (ERP): most widely used treatment Extreme response to severe stressor, event leads to intense fear of
– enduce something to cause to perform compulsion, then NOT let helplessness, for diagnosis symptoms must be present for at least a
them do that, then gradually expose t anxiety, and extinguish month
compulsion.
Symptoms
Cognitive Therapy: challenge beliefs about anticipated
1) Reexperiencing the traumatic event
consequences of not engaging in compulsion
2) Avoidance of stimuli (avoid situations or numbing)
Medication
3) Increased arousal (startle response, hypervigilance)

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder


Etiology of PTSD Treatment of PTSD
Nature of trauma: highest risk most severe trauma) • Exposure to memories and reminders of original trauma
Neurobiological: Smaller hippocampal volume, increases receptor Either direct (in vivo) or imaginal, treatment may originally
activity to cortisol INCREASE symptoms
Behavioral: two factor model Cognitive Therapy: enhance beliefs about coping abilities
Psychological Medications:
Perception of control Treatment of ASD may prevent PTSD
Avoidance coping, dissociation, memory suppression

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder


Acute Stress Disorder Comorbidity Anxiety Disorder
Symptoms of ASD are similar to PTSD ¾ with anxiety disorder have another disorder
Duration is what is different (short term reaction) 60% meet criteria for major depression
Experienced by 90% of rape victims ½ individuals with anxiety disorder meet criteria for another one
More than 2/3 with ASD develop PTSD General and Sociocultural Factors
Genetics; twin studies suggest heritability for phobias
Neurobiological: overactive fear circuit (and amygdale)
NT: serotonin, gaba, NP

Chapter 5: Anxiety Disorder Chapter 6: Somatoform Disorders


Risk Factors Anxiety Disorder Somatoform Disorders
Cognitive: perceived control (those who believe have little control Pain Disorder
are more vulnerable) and attention to threat (pay more attention)
Body dysmorphic disorder
Social: negative life events often precede disorder onset
Hypochondriasis, Somatization disorder
Conversion Disorder
Psychosomatic Disorders: Physical illness present, psychological
factors contribute to illness
Malingering: Deliberate faking of physical symptoms to avoid
unpleasant situations
Factitous Disorder: Deliberate faking of physical symptoms to gain
medical attention
Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders
Pain Disorder Body Dysmorphic Disorder
Person experiencing severe, prolonged pain Some sort of defect with the body focus
Cannot be accounted for by organic pathology Preoccupation with and extreme distress over imagined or
exaggerated defect in appearance
Is caused or intensified by psychological factors like stress
Attempt to camoflague or hide defect
Individual is unaware of psychological origins
½ have suicidal thoughts, onset is adolescence, sluightly more
Diagnosis is challenging
common in women than men, prevalence less than 1%
High levels of comorbidity:
Some think BDD and OCD are the same thing

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders


Hypochondriasis Somatization Disorder
Preoccupation with fears of having a serious disease, despite Someone with physical symptoms (with no apparent cause) that
medical assurance, lasting at least six months would warrant medical attention, but are calm, accepting, stoic
about it.
Usually critically of medical professionals
Maybe people feel that distress is more appropriately expressed through
Onset is typically early adulthood, and is comorbid with anxiety and physical symptoms?
eating disorders

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders


Etiology of Conversion Disorder Conversion Disorder
Psychoanalyic perspective: Individual experiences distressing Lose functioning in different parts of the body
event, and unable to express emotional distress, so memory of
event pushed into unconscious Sensory or motor function impaired but no known neurological cause
In women linked to electra complex
Vision impairment, seizures, coordination problems, Anesthesia,
No empirical support Aphonia, Anosmia, La Belle Indifference
Social and Cultural Factors: Decrease in incidence since first half of
19th century, does it have to do with more repressed sexuality?
• More prevalent in rural areas and lower SES, and in non Onset: usually occurs after significant stressor
western cultures
Cormorbid with substance abuse, personality disorder, BDD,
Cognitive Behavioral Model: preoccupation with body or physical
health, gross misinterpretation of symptoms/feelings, negative prevalence less than 1%
thoughts exacerbate symptoms
Somatization disorder has symptoms in several areas of body,
conversion is localized to sensory and motor function

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders


Etiology of Conversion Disorder Treatment Somatoform Disorder
Psychoanalyic perspective: Individual experiences distressing Pain Disorder: antidepressants and psychotherapy (validate pain,
event, and unable to express emotional distress, so memory of teach relaxation, and coping strategies)
event pushed into unconscious
BDD: Antidepressants and CBT (also for hypochondriosis and
In women linked to electra complex somatization disorder)
No empirical support Somatization Disorder: validate physical complaints, minimize use
of tests and medicine, avoid prolonging attention, treat underlying
Social and Cultural Factors: Decrease in incidence since first half of depression and anxiety
19th century, does it have to do with more repressed sexuality?
Conversion Disorder: Reinforcement of high functioning behavior
• More prevalent in rural areas and lower SES, and in non may help
western cultures

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders


Dissociative Disorders Dissosicate identity Disorder (DID)
Disruption of consciousness, but more severe in disorders Used to be multiple personality disorder
Defining feature is disruption in consciousness, memory, or identity
Each with unique behaviors, relationships, and memories
All experience dissociation at some level, like zoning out :P lala…
Memory gaps are common when alters are in control

Dissociative amnesia Rare disorder! Symptoms: headache, hallucination, self harm suicide
attempts
Dissociate fugue
Depersonalization disorder Comorbid with: PTSD, depression, borderline personality disorder,
substance abuse, phobias
Dissociative Identity Disorder DID
More common in women than men
** best way to study is with case study
Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders
Epidemiology DID Treatment of DID
Major increase in diagnosis since 1970s because of media attention Mainstays of most treatments:
DSM III (1980) made more explicit diagnostic criteria to address this Empathetic support of therapist REALLY important
surge
Integration of alters into one fully functioning individual
Etiology of DID, Two major theories
Improved coping skills
Posttraumatic model: results from sever psychological and or sexual
Psychoanalytic approach adds Re-experience the traumatic event
abuse as child
thought to underly the disorder (hypnosis)
Sociocognitive model Is a form of roleplay in suggestible individuals
Can be done by hypnotized students
Only partial memory deficit in DID patients
Differs by clinicians, few clinicians diagnose, after therapy starts
gnose the majority of cases
Chapter 6: Somatoform Disorders Chapter 7: Stress and Health
Summary of Somatoform Disorders Defintiions
Features somatoform disorders: physical problems without organic
cause Coping: how people try to deal with problems
Features dissociative disorders: extreme distortions in perception, Social Support
memory, or identity Structural: person’s basic network of social relationships (marital
status and friends)
Functional: quality of a person’s relationships
BOTH rare but we have quote few movies because they are Stress: Body’s alarm reaction  Resistance  Exaustion
interesting
Allostatic load: price body pays in response to stress and high levels
of cortisol, becomes more susceptible to disease

Chapter 7: Stress and Health Chapter 7: Stress and Health


Psychophysiological Disorder Cardiovascular Disease
Include hypertension and coronary heart disease
Physical diseases produced or influenced in part by psychological
factors of stress, social support, and negative emotions Etiiology: tendency to respond to stress with increases in blood
pressure or heart rate Anger, hostility, cynicism, anxiety, are linked to
• Life stress is relevant to all disorder, so appears on Axis III
these conditions
Etiology diathesis: stress in nature, but stress described in
psychological or biological terms
Biological diathesis: emphasize effects of allostatic load or changes
in the immune system caused by stress
Psychological diathesis: emphasize focus on how emotional states,
personality traits, cognitive appraisals, and specific types of coping
with stress

Most successful accounts of etiology are those that integrate both

Chapter 7: Stress and Health Chapter 7: Stress and Health


Asthma AIDS
Respiratory systems overresond to allergies or have been weakened Arises from behavior that appears irrational and generally is
by prior infection preventable by psychological means

Focus of prevention is to change people’s behavior - to promote


Psychological factors are anger, anxiety, depression, stressful life safer sex and discourage sharing of needles
events, and family conflict

Chapter 7: Stress and Health


Treatment Psychophysiological Disorder
Physical dysfunction is valid – so medication used
Primary aim is to reduce stress, anxiety, depression, or anger
Focus is on changing unhealthy behavior, encouraging breast self
exam, intervention, adhering to medical treatment intervention
Stress Management Intervention: help people without diagnosable
problems avail themselves of techniques that allow them to cope
with the inevitable stress of everyday life and ameloriate toll of stress
on body.