Summary Book Abnormal Psychology Barlow Durand PDF

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Summary: book "Abnormal Psychology", Barlow &

Durand
Biopsychosocial perspectives on psychopathology (Utrecht University)
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ABNORMAL PSYCHOLOGY
CHAPTER 1: ABNORMAL BEHAVIOR IN HISTORICAL CONTEXT

A psychological disorder is a psychological dysfunction within an individual associated with
distress or impairment in functioning and a response that is not typical or culturally expected .
Psychological dysfunction
A disturbance in cognitive, emotional or behavioral functions such as extreme anxiety, hallucinations or
bizarre thinking patterns. These problems exist on a dimension or continuum ; they are with everyone
sometimes present, but with some more extreme.
Distress or impairment
Someone is extremely upset ( distress ). However, this is not necessarily abnormal (sadness at death of family)
and here too there is a dimension . If the distress is accompanied by serious disturbances of
functions, it is abnormal. Most psychological disorders are extreme expressions of
on the other hand normal emotional, cognitive and behavioral processes.
Response that is not typical or culturally expected
On the one hand it can be said that something is abnormal if it does not occur statistically (not
typical). Most pop stars are a bit strange, but that doesn't make them abnormal. A
an additional definition is that something is abnormal if the majority finds it abnormal (cultural norm).
However, this means that a political minority party is abnormal - so the definitions are incomplete.
A commonly used definition is the harmful dysfunction . Something is abnormal if the person does it too
don't want to, but can't help it. DSM-IV uses the following standard definition: behavioral,
emotional, or cognitive dysfunctions that are unexpected in their cultural context and associated with
personal distress or substantial impairment in functioning .
DSM-IV consists of prototypes of disorders. A patient does not have to meet all the characteristics
meet.
>> THE SCIENCE OF PSYCHOPATHOLOGY

Psychopathology is the study that deals with psychological disorders. It includes one
large number of trained professionals:
Clinical and counseling psychologists
Both have a Ph.D and a study of +/- 5 years. Clinical psychologists focus more
extreme disorders, while counseling psychologists focus on problems of 'healthy' people.
Psychiatrists receive an MD .
Psychiatric social workers
Usually have a master's degree in social work. They also treat, but usually within a family
and therefore not only guide the patient, but also their home situation.
Psychiatric nurses
Have masters or Ph.Ds and specialize in the treatment and care of patients with
mental problems.
Marriage / Family Therapists and Mental health counselors
Have masters and offer services at hospitals or clinics, usually under the supervision of
more trained professionals.
Current professionals use the scientific method and are scientific practioners because:
1] monitor : they monitor and apply scientific developments
2] evaluate : they evaluate their own methods and procedures to see if they work
3] research : they do research and thereby produce new information about disorders
The data flow of the research branch tries to do three things:

1] describe : an attempt is made to give a clinical description of a disorder
2] etiology : people look for causes of disorders (also called causation - what is the cause ?).
3] treatment : people are looking for treatments for disorders
This is now further discussed.
DESCRIBE
The complaints that are the reason why a patient seeks help are the presenting problem . The
describing the complaints is the first step in drafting a clinical description -
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which are the unique behaviors, thoughts and feelings of a specific disorder (e.g.
Schizophrenia).
A number of things are described:

Statistical data
The percentage of the population that has the condition ( prevalence ) and the number of people who have the
disorder increases per, for example, year ( incidence ). The percentage of men and women who
has a disorder ( sex ratio ) and the age at which it arises ( age of onset ).
Course
The individual pattern of the disorder is described. A condition can remain long-term
hang ( chronic course ) or sometimes play ( episodic course ), while others exist only briefly
( time-limited course ).
Onset
They describe differences in the development of a disorder. Some arise very quickly ( acute
onset ), while others emerge slowly ( insidious onset ). On this basis, one can
waste the future course of the disease.
Prognosis
The expected future course based on the available information about the condition.
Age
Age has a major influence on the diagnosis. One can completely diagnose children incorrectly.
These points are dealt with in DMS-IV per disorder.
The study that deals with the changes of normal behavior over time becomes
called developmental psychology , while the study deals with changes from
abnormal behavior is called developmental psychopathology . In some cases
one studies disorders for a long time, in which case one speaks of life span
developmental psychopathology .
ETIOLOGY
Etiology is the study of causes. She tries to find out what causes disorders and
includes biological, psychological and social dimensions. Chapter 2 deals extensively with this
topic.
TREATMENT
Treatment , or treatment, is important. Treatments often give hints about what the cause can be
are from a condition. However, this is not that simple, because the effect (the condition) implies
not always the cause . My headache does not itself contain an answer to what is its cause.
History has seen a large number of ways to describe and describe disorders
treat and its causes understood. This is now addressed.
>> THE PAST: HISTORICAL CONCEPTIONS OF ABNORMAL BEHAVIOUR

People have tried for centuries to understand why people exhibit abnormal behavior. There
are three major models that have existed (or still do) and see other causes:
1] supernatural model : cause is sought in God, demomes, the stars, magnetism, etc.
2] biological model : cause is sought in the functioning of the body
3] psychological model : cause is sought in the functioning of the mind
The distinction between the biological model and the psychological model is the result of the
Greek belief that mind and body are separate.
>> THE SUPERNATURAL TRADITION (1400+)

Possession by evil spirits was seen as the cause of abnormal behavior.
They tried to exorcise the spirits with excorism , which sometimes helped. Patients were seen as
mischief-makers, as evidenced by witch burnings. Mass hysteria , in which people suddenly
collectively becoming hysterical was seen as an example of possession. Nowadays they are called
this mob psychology and explained it through emotional contagion : emotions are contagious.
Another supernatural cause was found in the position of the moon and stars. The term
lunatic (crazy) comes from here. These beliefs still exist today in the form of astrology.
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At the same time, the other conviction was that abnormal behavior was natural
cause and was caused by mental or emotional stress. The treatment was
mainly rest , healthy eating , and healthy environments . Oresme , a French philosopher, was the
first to know depressive behavior from a condition instead of demons.
>> THE BIOLOGICAL TRADITION

Mental disorders are seen as caused by physical problems. The greek philosopher
Hippocrates is seen as the father of this thought. He and his followers saw
disorders such as diseases that settled in the brain and could be hereditary (modern!). The roman
Galen used the ideas of Hippcrates for his own model; the humoral model .
This model states that the functioning of the brain requires four fluids ( humors ): blood , yellow
bile , black bile and phlegm . Too much or too little of these substances leads to problems. People use
these terms still in the description of personalities:
Sanguine ( blood ): someone who is rough, happy and optimistic. Too much leads to insomnia and delerium .
Melancholic ( black bile ): a depressed personality
Phlegmatic ( phlegm ): an apatic and slow person, or someone who is calm under stress
Choleric ( yellow bile ): someone who is hot tempered .
Disbalance was often remedied by letting people rest, or letting substances come loose through it
draining blood ( bloodletting ) or vomiting ( vomitting ).
Hippocrates also came up with the term hysteria to describe what we now have somatoform disorders
to mention; physical disorders (paralysis, blindness, etc.) for which no organic cause
can be found. The Egyptians, from whom Hippocrates got the term, thought this one
disorders caused by a circulating uterus ( uterine wandering ) that are in
parts of the body went in search of conception (it is original).
The biological tradition was absent for a long time, but came back when it was discovered that syphilis
was caused by an illness. This disease is characterized in its advanced stage by
illusions and delusions. They first called this general peresis , but later discovered the connection with
syphilis. Together with Pasteur 's discoveries that diseases come from bacteria, the
thought that all diseases could be caused by bacteria.
Around 1860, Gray stated that insanity always had physical causes, and therefore had to be treated
be like a disease. This led to people focusing on rest, diet and good
room temperature and ventilation. However, the number of patients soon became too large.
The renewed interest in biological causes led to a large number of new treatments
Insulin shock therapy
Sakel noticed that a coma induced by an overdose of insulin could sometimes have a healing effect.
However, the method was too risky and was soon abandoned.
Electroconvulsive therapy
Meduna noticed that epileptics had schizophrenia less often, and that the "short circuit" in their brains
apparently healing. This caused him to shock people. This turned out to work,
and is still used now and then.
Drugs
A large number of drugs such as neuroleptics and benzodiazepines were discovered and used.
In the first instance, medicines from the bromide classes were also given, but they were found to be harmful.
Strangely enough, the interest in seeking treatment soon disappeared because people thought
that the causes lay in as yet undiscovered problems in the brain. So they focused on the
diagnosis, and Kraepelin was an important person. He was the first to order several
distinguish psychological disorders.
THE PSYCHOLOGICAL TRADITION

Plato saw the cause of problems in (1) cultural and (2) social influences, and manners
on which they are taught. This was the precursor to the psychosocial movements, which did not occur alone
focus on the individual, but also on his relationship with the environment.
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The first approach is formed by moral therapy . The core idea was to make patients so
as normal as possible, and to provide them with good role models. Treatments were
humane, and people were no longer chained. However, she disappeared for a few reasons:
Too many patients
The method worked best if there were no more than 200 patients. Around the civil war in the
US the clinics were full of people.
Dorothea Dix
Dix fought for more humane care for the sick of all classes ( mental hygiene movement ). This
however, led to a large influx to clinics that no longer had enough staff.
Ilnesses caused by brain pathology
The thought that psychological disorders are incurable because they are caused by problems in the brain
to be caused led to the elimination of attempts to cure it - that was impossible.
The tradition remained dormant after this, but came up again with psychoanalysis and then it
behaviorism .
PSYCHO ANALYSIS
Mesmer used hypnosis for his (bizarre) treatment of patients. He woke the
interest of Jean Charcot, the teacher of Freud . This one saw something in the method, and
worked with Breuer on improving the method. They discovered that people who are below
hypnosis were told about things they consciously didn't remember. They had the
unconscious mind discovered. They said it was good to hypnotize certain events
to relive the tension ( catharsis ) or to gain insight into the cause of
problems ( insight ). Breuer treated a woman, Anna O , and formed the basis for it
psychoanalytical model that Freud would later develop.
Of this model is discussed (and repeated, because this has often passed):
1] structure : the structure of the mind and the parts that make it up and which sometimes collide
2] defense : the mechanisms by which the mind protects itself against those collisions
3] development : the way in which those mechanisms, and the collisions, develop.
The mind is seen as consisting of three parts:
Id
The Id is the most primitive part of the brain that wants us to be our most primitive drives
pursue. It has no sense of reality and logical rules ( primary process thinking ) and operates
based on the pleasure principle - as long as it is tasty. If a Id need not
can be fulfilled because the object or person is not there, a fantasy is created
temporarily sufficient ( wish fulfillment ). It has two types of energy; libido (sexual energy) and
thanatos (dead energy).
Ego
The ego tries to control the pressure of Id. It holds the Id to reality and operates
according to the reality principle . The ego knows that the drifts of Id may conflict with the
reality and can postpone the fulfillment of needs until a better moment. The ego turns on
secondary process thinking - devising strategies to meet needs.
Superego
The superego is the moral knight of the mind. It internalizes the social values and rules of
a society. It would prefer to completely exclude all instincts and also knows no reality or
logical rules. The superego determines what is wrong or good and can go far beyond that.
The id, the ego and the superego are constantly in conflict. The ego wishes control to
about the situation. If conflicts ( intrapsychic conflicts ) arise, anxiety and
that can be controlled through defense mechanisms :
Repression
This is the most important form of defense. A thought is simply suppressed. Men
keeps an experience out of the conscious memory.
Denial
It is denied that a certain event has occurred at all. Daydreaming or fantasizing
a form of denial.
Displacement
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An unwanted impulse from service source is directed at someone else. A man to be by

managing director is able to express that anger at his wife. Sometimes this can happen consciously,
but displacement is purely about the unconscious form.
Rationalization
The event is rationalized by judging it. They seek a rational explanation
a result.
Reaction formation
One turns an unwanted impulse into the opposite. A woman who doesn't like her boss
can try to seduce him. The opposite behavior is usually exaggerated.
Projection
People project things that they themselves are not allowed to do on others.
Sublimation
Sublimation is the most adaptive defense and consists of transforming the energy into one
more positive form.
Freud sees the development of personality as consisting of phases in which there is always a conflict
must be solved. The children must find a way to get some form of sexual
to achieve gratification . This theory is called psychosexual stage theory . During every phase,
that are always followed in the same order, the sexual energy focuses on a specific part
from the body. If a phase is not completed properly, a fixation is created that ensures a
lower form of searching for sexual gratification. The distinguished phases are:
Oral Stage
Sexual energy focuses on the mouth. Children experience pleasure by putting things in it. The
conflict consists of finding a balance between satisfaction and dependence. Like the child
sitting at the breast, experiences the pleasure but becomes dependent on the mother. Another
conflict consists of the urge to bite and forbid the parents from biting.
Anal Stage
Children get pleasure from unloading and, when they get toilet training, from stopping the
stool. The conflict focuses on the need for Id to relieve everywhere and the desire of the
parents do not do that.
Phallic Stage
The sexual energy is focused on the genitals. Around this stage the child starts to desire sex
with the parent of the opposite sex. A boy thereby fears his father ( Oedipal conflict )
and is afraid that his father will castrate him ( castration anxiety ). The boy gives the conflict with the
Father up and identifies with him and forms his own superego . For girls this is it
called electra complex and the girl longs for a penis ( penis envy ). It wants sex
with the father so that it can have a baby that forms a kind of surrogate penis (yes .... I have it too
not made up… ..)
Latency Stage
According to Freud, nothing happens at this stage. There is a pause. Find other psychologists
precisely that a lot happened in this phase (around 6 years).
Genital Stage
This is the final phase, and one is becoming mature here. The libido is aimed at the genitalia, but in
in a more advanced way than in the phallic phase.
Freud saw all non-psychotic disorders as being caused by subconscious conflicts. He
this was called neurosis .
Followers of Freud adapted his theories to form their own movements:

Ego psychology ( Anna Freud )
Anna focused on how defense mechanisms develop and how they work. The
mechanisms are becoming increasingly sophisticated, but cause problems if they do not work properly.
Object relations ( Klein & Kernberg )
This is the study in which one focuses on how the earliest relationships of children become future relationships
to influence.
Collective unconsciousness ( Jung )
Jung rejected the sexual ideas and introduced the idea of a consciousness created by all people
is shared. Jung had a positive image of man.
Inferiority complex ( Adler )
Adler focused on the feelings of inferiority, and the pursuit of superiority. He too
saw man as a positive being.
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Theory of development ( Erikson )

Erikson made the greatest contribution with his theory of human development.
A number of techniques were used to find out more about the subconscious:
Free association
The patient is called to list what comes to mind. In fact, the censorship
mechanisms come to rest so that they filter less. The patient often calls many thousands of cases
few of which are of interest - so the therapist's job is to pick those things out.
Dreams
The censorship mechanisms are also less active during dreams. The drives and needs become
converted to symbols because, even when we sleep, many of those things are still too shocking for that
us are.
The therapist, the psychoanalyst , can experience transference , meaning the patient
Individuals from his own environment, such as his parents, project onto the therapist. The
the opposite is also possible, and is called countertransference . The therapies last
for a long time, because people do not want to trace and eradicate the causes but the causes. Nowadays
one uses the method too, but more loosely, and is called psychodynamic psychotherapy .
They use 7 tactics:
1] a focus on the emotions and expressions of the patient
2] an analysis of the patient's attempts to hinder progress or avoid subjects
3] identifying patterns in the patient's behavior
4] an emphasis on past experiences
5] a focus on the patient's interpersonal relationships
6] an emphasis on therapeutic relationships
7] and analysis of the patient's desires, dreams and fantasies.
This method is shorter and simpler (people no longer try to be personality)
reconstruct) than Freud 's method .
Freud's ideas were ultimately unscientific, and they are primarily seen as historical
important.
HUMANISTIC THEORY
The humanistic tradition states that people can fully realize themselves ( self-
actualization ) if they are given the freedom to do so. This is not always the case, and Maslow suggested one
hierarchy of needs indicating which blockades must have been overcome before self-sufficiency
actualization becomes an option. The humanistic tradition sees the individual as good, and therapies are
strongly client-centered , whereby the therapist makes as few interpretations as possible ( Rogers ).
To be important:
1] unconditional positive regard : full acceptance of the client and what he / she says
2] empathy : an understanding of what the client tells.
BEHAVIOURAL MODEL
The behaviorist or social learning model brought a more scientific method to the
psychopathology. Pavlov discovered that he could condition dogs to drool on hearing
a bell. An unconditioned stimulis leading to an unconditioned response is
replaced by a conditioned stimulus that then leads to a conditioned response.
People who receive chemotherapy often get sick when they see a sister. The
chemotherapy is the OS, the nausea that follows from it the OR. However, the sister becomes the GS and the
nausea that follows the GR. These links can also disappear ( extinction ).
The behaviorism was started by Watson . He stated that it is the only objective empirical
method and he rejected any reference to the spirit. A Watson student discovered that
you could get people rid of phobias by confronting them with the object of fear. This lead
that Wolpe started using systematic densensititzation to help people get rid of phobias.
He caused the clients to do something close to the object of fear, which did not correspond to that fear (so
he let people stay very calm) This approach is called behavior therapy .
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Skinner discovered operant conditioning . He was influenced by Thorndike 's law of effect , which states
that behavior becomes stronger or weaker depending on the chosen reinforcer . Through shaping , it
Requiring increasingly complex behavior for receiving a reinforcer, he dropped pigeons piano
play.
The behaviorist model is objective, but incomplete. She has not offered room for a long time
biology, because everything has to be determined by the environment (everything is a form of conditioning).
>> THE PRESENT: THE SCIENTIFIC METHOD AND AN INTEGRATIVE APPROACH

Every method has failed in its own way. One was too little scientific, the other
too much. An integration process started in the 90s in which the currents complement each other and not
exclude longer. This is possible because:
1] tools : the resources that science offers are becoming increasingly sophisticated
2] single influence : the realization that something is not due to 1 single cause (biology, psychology, etc.)
CHAPTER 2: AN INTEGRATIVE APPROACH TO PSYCHOPATHOLOGY

A multidimensional integrative approach approaches psychological problems as caused
through an interaction of different domains. One tries to avoid having the cause searched
is in a single area - in which case there is a one-dimensional approach. One can
do not take the various influences out of context, because all influences also influence each other in the
causing problems.
Suppose a Judy faints when seeing blood ( blood-injury-injection phobia ), how is that possible?
come ?:
Behavioral influences
Her reaction may have been caused by a certain conditioning of blood and fainting. This
However, not everyone happens, so the cause must also lie elsewhere.
Biological influences
Some people faint quickly. If excitement leads to an increased heart rate and blood pressure,
the body responds by lowering the heart rate and blood pressure. Sometimes this goes too fast, and comes
too little blood at the head ( vasovagal syncope ) leading to unconsciousness. The mechanism that
this is caused by the sinoaortic baroreflex arc that reacts too strongly in these people. This is hereditary. Yet
not everyone with this aptitude develops a phobia, and even people without develop one anyway
phobia; so there are more causes.
Emotional influences
Emotions can strengthen or weaken our physical reactions. Judy's fear can go for it
have caused her body to react even brighter to seeing blood.
Social influences
The reactions of our environment influence our behavior. If the behavior of Judy strongly disapproved
would only make her reaction stronger. It is also possible that precisely this behavior leads to
attention from the environment - and therefore occurs more often.
Developmental influences
During our development and growth we respond differently to the same stimuli. In some ages
there is a developmental critical period for the occurrence of certain problems.
Detecting the causes of problems is therefore not easy. Just a look at the
behavioral and biological side is not enough.
>> GENETIC CONTRIBUTIONS TO PSYCHOPATHOLOGY

Genes form the basis of much of what we are. In some cases it is the influence of genes
absolutely, such as with eye color or hair color. But in most cases the genes indicate inside
which area a property can vary, and the environment determines exactly how something turns out. U.S
weight for example. Some diseases, such as PKU 1 or Huntington 2, are genetically engineered, and
cannot be affected, or cured, by the environment.
Every person, except identical twins, has a unique set of genes. Every human cell has 46
chromosomes, arranged in 23 pairs. Of each pair, half comes from the mother, the other
from the father. The 23rd pair specifies the gender of the human, while the remaining 22 specifies the blueprint
1 Inability to metabolize phenylalanine - more in H12

2 A degenerative brain disorder that starts in the basal ganglia - more in H12

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of the body. In women the 23rd pair consists of two X chromosomes, in men it consists of
one Y and one X chromosome.
DNA molecules that contain genes look like a double helix , two wires that wrap around each other
wrap. Pairs of molecules are attached to each other on the wires. If errors occur, is
there are defective genes that may or may not lead to problems. This depends on dominance
of a gene. A dominant gene usually leads to problems, but a recessive gene requires one
another recessive gene to arrive at.
Most properties are polygenetic and are therefore determined by several genes. Men
therefore mainly uses statistical quantitative genetics in which people search for the
influences of pieces of genes, instead of single genes.
Research has shown that about half of most properties are determined by
the genes, and the rest through the environment. For example, 62% of IQ is genetically determined. In front of
In psychological disorders, less than half can be explained by genes. Men
has drawn a number of conclusions based on these studies and studies:
No individual genes
Disorders (as far as known) are not caused by a few genes.
No prevention
It will never be possible to completely eradicate disorders by changing genes.
Today, genes are interacting with the environment. Certain influences from the environment
can switch genes on or off. Two models have been formulated based on this:
Diathesis stress model
The genes form a basis for certain traits or behaviors ( diathesis ), that
can be activated in times of stress . So one inherits a tendency or a certain one
vulnerability that will only become active in certain situations. This model is popular, but too simple.
The reciprocal gene-environment model
This model states that genes not only create certain traits, but also behavior
that leads to stress. Depression has a genetic basis, and it seems that that
people are even more likely to look for situations in which they become depressed. Our genes affect that
to a greater extent the environment itself.
A number of studies have shown that the environment, even if its influence is small, is still large
degree of genetic influence can "override". Even animals that have a genetic predisposition to stress
were less likely to suffer if they were raised by calm mothers. This
means that one can prevent mental disorders by intervening early in life
in the area.
>> NEUROSCIENCE AND ITS CONTRIBUTIONS TO PSYCHOPATHOLOGY

Neuroscience is concerned with the nervous system, which consists of:
1] Central nervous system : the brain and spinal cord
2] Peripheral nervous system : the autonomic and somatic nervous system
CENTRAL NERVOUS SYSTEM

The CNS processes and filters all data that comes in through our senses and organizes responses. She
consists of more than 140 billion neurons, which consist of:
Dendrites : Contains many receptors that receive signals from other neurons
Axon : Makes it possible for the neuron to transmit signals to other neurons
Soma : The cell body
Between the axon of one neuron and the receptors on the dendrites of other neurons
only space, the synaptic cleft . The chemicals released by the axon and these
bridging space are neurotransmitters, referred to as
The brain consists of the forebrain , and the older and lower-lying brain voice , which itself falls into:
Hindbrain : regulates automatic functions such as heart rate and digestion
1] Medulla
2] Pons
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3] Cerrebellum: regulates motor coordination

Midbrain : coordinates movement with sensory input
1] reticular activation system (RAS): checks arousal and determines whether we sleep or wake
Top of brain voice
1] thalamus: regulates behavior and emotions and serves as a switching station between forebrain and brain voice
2] hypothalamus: regulates memory and serves as a switching station between forebrain and brain voice
The forebrain consists of:
Limbic system : regulation of emotions and expressions, inhibiting responses and basic 'drives'
1] hippocampus
2] cingulated gyrus
3] septum
4] amygdala
Basal ganglia : movement and motor skills
1] caudate nucleus: controls motor activity
Cerebral cortex
Contains more than 80% of the neurons and consists of two halves:
1] left: verbal and other cognitive processes
2] right: perceiving the world and forming mental images
The cerebral cortex consists of a number of areas with different functions:

1] frontal lobe : planning of movements, thinking, memory and aspects of emotions
2] precentral gyrus : for motor skills ( primary motor cortex )
3] central sulcus
4] postcentral gyrus : for feeling in different body areas ( primary somatosensory cortex )
5] parietal lobe : physical experiences
6] occipital lobe : vision
7] temporal lobe : hearing and advanced visual processing
PERIPHERAL NERVOUS SYSTEM

Coordinates with the backbone to determine if the body is working properly. Consists of:
Somatic nervous system : Controls muscles and muscle tension.
Autonomic nervous system : Regulation of heart and blood pressure, hormones, defense and digestion
The ANS controls and regulates the endocrine system , which consists of a number of hormone glands:
1] adrenal glands: epinephrine (adrenaline)
2] thyriod glands: thyroxine (energy metabolism and growth)
3] pituary glands: is the 'boss' of the other glands, and controls them with various hormones
4] gonadal glands: produces sex hormones such as estrogen and progesterone
The hypothalamus controls the pituary gland that can control other glands. She can do the
stimulate adrenaline glands to release adrenaline and cortisol. This is the hypothalamic pituary
adrenalcortical axis ( HPA-axis )
The ANS consists of the:

Sympathetic nervous system : for 'fight' response (blood pressure, heartbeat, immune system, etc.)
Parasympathetic nervous system : for 'rest' (digestion, storage of energy, etc.)
NEUROTRANSMITTERS
Neurotransmitters have their own paths through the brain, brain circuit , which overlap and
to influence. Medications usually act on these paths in a number of ways:
1] blocking the production of a neurotransmitter
2] blocking the receptors on which the neurotransmitter ends up
3] stimulate the release of substances that break down the neurotransmitter
4] blocking the reuptake of neurotransmitters from the cleft , allowing them to work longer
The circuits influence each other, so it is not the case that a disorder is caused by one disturbed circuit
is caused. Circuit research takes place by manipulating the neurotransmitters:
1] introduction of agonists that increase the effects of a transmitter
2] introduction of antogonists that reduce the effects of a transmitter
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3] introduction of inverse agonists that cause opposite effects
The most important neurotransmitter groups are:

Serotonin (5-hydroxytryptamine - 5HT)
Regulates our thoughts, behavior and moods. It inhibits impulsive behavior and depression
is accompanied by a low level of this transmitter. Fabrics that affect her are tricyclic
antidepressants and reuptake inhibitors (SSRIs).
GABA (gamma aminobuytic acid)
Regulates processes that deal with arousal and emotional and physical states and reduces
postsynaptic activity (reduces anxiety ). Benzodiazepines ensure that GABA binds better
receptors, which improves its functioning. ).
Norepinephrine (noradrenaline)
Is part of the endocrine system and is counted among the catecholamines . It stimulates
two groups of receptors; alpha-adrenergic and beta-adrenergic and relates to regulation
mainly heart rate, blood pressure and plays a major role in the fight response . The medicine group
of beta-blockers blocks beta-adrenergic receptors and lowers blood pressure and heart rate.
Dopamine
Also a catecholamine , and works primarily as a switch to certain
activate or deactivate brain regions. Dopamine provides stimulus-seeking and extroverted behavior while
serotonin does the opposite. Especially L-dopa is effective as a dopamine agonist.
Psychological disorders usually result from an imbalance of these substances.
For people who have obsessive-compulsive disorder (OCD), it appears that certain parts of
the brain, the frontal cortex (especially the orbital surface ), are more active. These areas contain a lot
serotonin circuits , and it appears that damage to these toads can lead to OCD. This
does not mean that this does not mean that this is also the biological cause. Maybe the activity is it
result of obsessive thinking, and not the other way around.
The environment appears to have a major influence on the functioning of the brain and body:
Obsessive compulsive disorder
Psychotherapy, called exposure and response prevention , appears to be characteristic of brain activity
for OCD - without medication or surgery!
Psychosocial dwafism
Children who are abused can experience serious growth problems (physical, emotional and
social). The pituary gland no longer transmits growth hormones. If the child is saved, it is possible
growth process suddenly go very fast. A more common variant is the failure to thrive ; a fault
in the absorption of food by certain psychosocial circumstances.
Cancer
People who have serious forms of cancer and are accompanied by psychotherapy turn out to be longer
to survive than people who do not receive it. Learning stress management and dealing with
Problems can help these people gain a sense of control over what they are going through.
Some studies show that psychosiocial factors even have a direct influence on neurotransmitter
levels. Other studies show that brain development benefits
sufficient incentive. Still other studies show that stress is in the early stages of life
can have an influence on the HPA-axis which influences the sensitivity to stress, later on.
>> BEHAVIOURAL AND COGNITIVE SCIENCE

Cognitive science is concerned with how we acquire, process, store and weather information
to pick up. A large part of these processes is unconscious, but not in the way Freud thought. There
are a large number of processes that take place unknowingly, but are extremely important:
Classical & operant conditioning
With these forms of conditioning we unconsciously establish relationships between events
environment so that we can form a working model of the world around us.
Learned helplesness
Some people may think that they have little control over what happens to them, what
can lead to depression. A wrong attribution is made by these people .
Social learning
People can learn from others. This is also called modeling or observational learning .
Prepared learning
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We learn some things more easily, such as a fear of spiders or snakes or not eating
spoiled food. Something in us determines the relationship between those stimuli and our physical response
are more important than others and can be learned in one go.
Cognitive science and the unconscious
Blind sight is a condition in which people are effectively blind, but still unknowingly able to
(they are just not aware of it). The same applies to implicit memory memories
of things that are no longer consciously present. One can often investigate this through the emotional
syrup task .
Cognitive-behavioral therapy tries to correct the incorrect attributions and / or ways of thinking of people
improve. Ellis did this through his rational-emotive therapy , which he called the irrational
beliefs that they had unconsciously shown. The purpose of all forms of this therapy type is
making aware of certain unconscious processes and lines of thought.
>> EMOTIONS
Emotions play a major role in our lives, and can promote the development of problems or
hinder. Emotions serve a purpose because they protect us. A good example is the flight or
fight response that prepares our body to fight or to flee. This response has ours
ancestors were able to survive, and we therefore still have it.
An emotion is usually defined as a tendency towards certain behavior ( action tendency ),

caused by a threat ( threat ) and some experience ( feeling state ) and usually
characteristic physiological response ( physiological response ). Emotions are usually short
expensive. Moods last longer and are more diffuse. They are usually the subject of mood disorders or
emotional disorders . Sometimes one speaks of affect , which stands for the emotional tone that ours
experience of that moment characterizes (positive or negative).
Emotions consist of three components:

Behavior
Emotions are characterized by qualitatively different behavior, but also promote the occurrence of
certain behavior (such as running away in fear).
Physiology
Emotions are characterized by specific activation patterns in the CNS ( Cannon )
Cognition
The way we evaluate our environment ( appraisal ) determines which emotions we experience
( Lazarus ).
Anger can lead to physical complaints because it reduces the functioning of the heart. This
however, does not necessarily mean that anger also causes heart problems. Elemental emotions such as anger,
grief or stress are often the subject of psychological disorders. They influence us
body, but also our thinking. A negative mood makes me see the world more negatively, while one
positive mood makes me see the world more positively.
>> CULTURAL, SOCIAL AND INTERPERSONAL FACTORS

The culture and social context in which we live also influences us. Fright comes in many cultures
disorders for, such as the Latin American susto where someone has insomnia, great anxiety and
experiencing phobias. Another example is evil eye , or voodoo death . Healthy individuals to hear that
get them cursed are dying soon. So culture determines what we fear.
Our gender also has a major influence. 90% of insect phobias exist in women. This comes
probably due to the gender roles that apply in our culture; men should not let go of their fear
see and bite through it, while that is not the case with women. Men often drown their fears
again, making them addicted. The same goes for Bulimia Nervosa, which is mainly with
women.
To have a rich social life is healthy, both physically and mentally. Even the chance
a cold is influenced by our social relationships. How is that possible? A number of options:
1] social relationships make life meaningful to live
2] social relationships facilitate healthy behavior, such as early sleep, low alcohol consumption, and so on
The effects of social relationships vary with age. The older one gets, the more social one becomes
relationships.
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Another factor that can cause problems is the social stigma towards the mentally ill. She
are considered inferior, weak and dangerous. This is in contrast to people with a
physical injury.
A form of therapy that works well with depression mainly focuses on interpersonal relationships
( interpersonal therapy ). This therapy focuses on identifying life stressors :
1] interpersonal role dispute : a fight between married couples or friends
2] death of a loved one : the death of a friend or family member
3] new relationships : new relationships by finding a job or romantic relationships
4] tracing and solving problems in social skills
>> LIFE-SPAN DEVELOPMENT

Psychologists in this branch state that we should not focus on snapshots, but on it
follow the entire life of an individual. After all, we change during our lives, and into
we run different risks every phase.
Just as a cold can arise from multiple causes, a mental disorder can continue
several different paths arise ( equifinality ). These different paths can result from
specific forms of interaction between the environment, biological predisposition, culture, etc. Men
looks not only for the causes of problems, but also for the reasons why some people do
difficult situations experienced no problems, and others did.
CHAPTER 3: CLINICAL ASSESSMENT AND DIAGNOSIS

Clinical assessment is the systematic evaluation and measurement of psychological, biological and
social factors in an individual with a presenting problem . Diagnosis is the process by which one
determines whether the presented problem meets the criteria of a DSM-IV disorder.
>> ASSESSING PSYCHOLOGICAL DISORDERS

Techniques used for assessment must meet a number of criteria:
Reliability
The results must be consistent, over time ( test-retest reliability ) and between people who have the
perform assessment ( interrater reliability ).
Validity
The results must measure what they should measure. The results can be compared with those of
a similar test ( concurrent / descriptive validity ) or determine to what extent the results
predict future problems or events ( predictive validity )
Standardization
This is the process whereby one uses a set of standards and norms to use
make a technique consistent across different situations and measurements. These standards can
apply to the testing, scoring and evaluation procedures.
Clinical assessment includes a variety of different techniques for collecting information:
1] Clinical interview
2] Physical examination
3] Behavioral assessment
4] Psychological testing
5] Neuropsychological testing
6] Neuroimaging
7] Psychophysical testing
CLINICAL INTERVIEW
The interview is intended to collect information needed for diagnosis, and it includes
information about the current situation, but also the past, attitudes, emotions and the presented
issue. This information is organized through a mental status exam . The mental status
exam is a systematic observation method of someone's behavior. It includes:
Appearance and behavior
Certain visible behavior, clothing, appearance and expressions are noted on the face.
Thought processes
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People often get a glimpse of the thought processes by listening to people. They love it
often consider the rate (speed) and the flow (fluent) of the speech, but also the content. There
are a number of things that may appear from the content and that are not normal:
Delusions of persecution : someone thinks he or she is being chased by the government, Nazis, etc.
Delusions of grandeur : someone thinks he or she is very special, powerful and strong
Delusions of reference : someone thinks that everything others do or say has to do with him or her
Hallucinations : people see, hear or feel things that are not there
Mood and affect
The mood is the dominant emotional status of an individual, and the affect is the degree to which the
feeling state that someone out matches what he or she is saying (if someone is smiling when telling about it
his father's death is the affect inappropriate ). The affect can also be flat or blunted , which means
that someone talks about emotional matters without showing any feeling, affect.
Intellectual functioning
A rough estimate is made of the intellectual capacities of the patient.
Sensorium
One determines to what extent an individual is aware of his or her environment. Certain forms of
brain damage make this difficult. People are usually asked about the person (who are you?), Place (where
are you?) and time (what time is it?). If everything goes well, the term ' oriented times' is used
three '.
In all cases it is important that the individual trusts the psychiatrist / psychologist. That what the
Patient told is therefore strictly bound by privacy legislation.
Interviews are unstructured if there is no systematic format. Interviews that completely

Being systematic are called structured , but are often more impersonal. One usually makes
use of semi-structured interviews that ask a number of specific and specially developed questions
contains, but one can easily deviate from it.
PHYSICAL EXAMINATION
If patients have not had a physical examination , the psychologist will have it taken. A lot of
Problems that resemble psychological disorders are also related to toxic states , such as it
withdrawal from drugs or alcohol or a certain medical condition. This prevents mis-diagnoses.
BEHAVIORAL OBSERVATION
Behavioral assessment goes beyond the mental status exam in observing an individual,
and uses direct observation¸ which means that the psychologist has the problem situation
visits, simulates in a role play. This is often necessary for children or patients who do not have their symptoms
can verbalize. One identifies target behaviors , trying to establish themselves
state what causes them to occur and what patterns they know.
There are two ways to observe behavior:

Informal observation : people take short notes and work them out later. (this is more subjective)
Format observation : the occurrence of specific behavior is measured (this is more objective)
In the latter case, an operational definition of the behavior in question is given, which means that
they indicate how behavior should be observed and how it should be measured .
One can also ask individueen observe their own behavior, self-monitoring or self
observation . In this way, people themselves measure how often they think about smoking if they try to quit.
A more formal and structured way is scoring; behavior rating scales .
All forms of observation can be disturbed by reactivity . The fact that a psychologist is ter
place is able to influence the behavior of an individual and make the results unreliable.
PSYCHOLOGICAL TESTING
Psychological tests consist of:
1] specific tests to measure emotional / cognitive aspects related to disorder X
2] more general tests to measure certain long-term properties, such as character or IQ
A number of forms of psychological tests are treated:

Projective testing
Page 15
Projective techniques are based on the idea that people have their own personal and
project unconscious thoughts onto ambiguous stimuli. A well-known test is the rorsarch test , where
Individuals must describe what they see in what is actually an inkblot. To make the test more objective
the comprehensive system has been developed, which describes how the cards
to be presented and how to record answers. Another test is the
thematic apperception test (TAT or CAT for children) in which an ambiguous photo is shown,
where the individual must tell a story. Both methods are controversial because they do not
be objective. The results differ from psychologist to psychologist. Yet they are often used.
Personality Inventories
Personality inventories ask questions in which they try to find patterns in the answers
that correspond to certain mental disorders. The content of the answers is not
important, but what they predict ( predictive validity is therefore more important than face validity ). The
MMPI is the most famous test, and it contains scales for all disorders and a number of others:
Lie scale (L): contains questions that cannot be true; "I'm never mad." People measure whether someone is more beautiful than he is.
Infrequency scale (F): contains questions that are rarely true and make it clear whether a person is randomly answering.
Defensiveness scale (K): contains questions that indicate whether the person has a realistic image of himself
? scale : the number of questions that the person was unable to answer
Intelligence testing
IQ tests were initially developed to indicate which students require extra attention
had from teachers. IQ tests still measure that, not how intelligent someone is. Known tests
are the WAIS-III test for adults, WISC-III for children and WPPSI-R for very young children.
The big problem is that it is not clear what intelligence actually is.
NEUROPSYCHOLOGICAL TESTING
Neuropsychological tests are intended to determine whether there is brain damage. Although
the brain itself cannot be viewed, one can determine the effects of damage. They measure
things like memory, motor skills, language, attention and concentration. A well-known tests
is the bender visual-motor gestalt test that asks children to copy certain figures. If
children have difficulty with this, there may be brain damage. Be more precise tests
provided by the luria-nebraska neuropsychological battery and the halstead-reitan neuropsychological
battery . Both test large amounts of aspects. Problems are:
False positives / False negatives
One cannot notice brain damage while it is there ( false negative ) or brain damage
while it is not there ( false positive ). However, the tests are mainly used as screening
tests , which prevents too much value being attached to it.
Time
Taking the tests takes a lot of time, usually several hours.
NEUROIMING
One can view the brain through neuroimaging . This is possible in two ways:
Images of brain structure
One looks at the structure of the brain. This can be done through normal X-ray radiation at the
computerized axial tomography (CAT / CT) or through magnetic fields and polarization of
protons in the brain in magnetic resonance imaging (MRI). MRI is more expensive and takes longer than
CAT (although the price and duration drops quickly) and the construction of the device (a tube where one
it makes people with claustrophobia undesirable.
Images of brain function
The functioning of the brain is viewed. This can be done by injecting one
radioactive tracer (fluid) that travels with the blood to active areas in positron emission
tomography (PET). However, PET is terribly expensive. A cheaper, and less precise, variant
is single photon emission computed tomography (SPECT) which involves a different kind of tracer
used. Also MRI, in this case called fMRI , can be used to control the functioning of the brain
visible. People usually measure responses to certain events, event-related fMRI .
PSYCHOPHYSIOLOGICAL ASSESSMENT
In Psychophysiological assessment, one measures the functioning of the brain and nervous system
in general. A known variant is an electroencephalogram (EEG) which involves electrodes
on the head, and measures the electrical activity in the brain. Usually the responses of
the CNS on certain stimuli, in which case it is referred to as event-related potentials (ERP) or
evoked potentials .

Page 16
A healthy brain that is calm has a regular pattern of alpha waves . They usually try
to increase the number of alpha waves in anti-stress treatments. Delta waves are not regular,
and occur during deep sleep. Large peaks and troughs during waking can indicate
seizure disorders such as epilepsy.
Other variants of psychophysiological assessment are the galvanic skin response (or
electrodermal responding ) with which one can measure the activation of the sympathetic nervous system
(because that causes sweating, and that increases the conductivity of electrical signals,
for example, the hand).
Dfy a ko [ped gjop

In many cases, the body's responses to specific stimuli are measured. That is how one can determine
whether someone has a post-traumatic stress disorder . In other cases, the results are linked
directly back to the patient, who can try to control his own body ( biofeedback ).
Disadvantages of these methods are:

1] they require a lot of technical and specific knowledge
2] results can differ greatly if small mistakes are made or the situation is different
>> DIAGNOSING PSYCHOLOGICAL DISORDERS

The purpose of the assessment is to be able to make a diagnosis . This means that that what
one has tried to classify into a categorical system. In the context of the
psychopathology this is called a nosology , and more generally a taxonomy . The nosology
consists of a set of labels and names of disorders that form it (the nomenclature ). DSM-IV
an example of a nolosogy. Based on the diagnosis one can make statements about it
future course of the disorder and the effects of treatment ( prognosis ).
One can describe the disorder of an individual in two ways:

Idiographic : the personality, culture, thoughts and circumstances of the individual are described
Nomothemic : we classify the individual into a larger group of individuals with the same problem
Classification is the basis of science. We organize and sort what we know into
categories. With psychopathology you can do this in different ways:
Classical categorical approach
This method of ordering began with the biological tradition (by Kraepelin ). Every disorder
according to this approach must have a specific unique biological cause, and there people share
on in. This means that someone has disorder [X] if he meets all the conditions, because the
conditions are unique and non-overlapping with other disorders. The disadvantage is that this method
does not take into account the complexity of the causes of disorders. It is therefore not used.
Dimensional approach
The dimensional approach sees disorders as points on dimensions from healthy to disturbed.
Because researchers cannot agree on the number of dimensions, this too will be
method not used
Prototypical approach
A prototypical description of a disorder is formulated, and this is set, for example, at four
of the criteria must be met for the disorder to be determined. Part of these criteria
need not be essential, and that leaves more room for psychologists.
Every system of classification must be reliable and valid:

Reliability
Every system must be set up in such a way that two separate psychologists come to the same diagnosis
( interrater ), but also that measuring multiple times yields the same conclusion ( test retest ). If this is not it
case are biases threats to reliable diagnoses. Within DSM-IV are the
personality disorders the least reliable (and therefore the faintest).
Validity
Every system must also be set up in such a way that it measures what it has to measure. This means that the
criteria for disorder [X] must be positive with each other, and negative with those of other disorders
correlate ( content validity ). A system must also be able to predict what will happen
Page 17
( predictive or criterion validity ). In addition, the system criteria must match what
find experts in the field ( content validity ).
The final validity is mainly determined by the extent to which the correct label is stuck on
a person with a disorder.
The first attempt at classification was made in 1900 by Kraepelin , who was the first schizophrenia
describe (he called it dementia praecox ). ICD and DSM did not enter the market until 1950, but
didn't really catch on yet. They had a large number of problems:
1] precision : they were not precise and based themselves on vague and unproven theories
2] reliability : they were not reliable at all - diagnoses differed dramatically between professionals
DSM-III was released in 1980. It had three major changes:
1] theoretical basis : theoretical explanations for causes were released
2] precision : description were much more precise, making it possible validity and reliability to
measure
3] axes : psychological disorders were measured on five dimensions
However, a number of problems remained:
1] reliability : the reliability of some categories was very low (such as in the case of personal disorders)
2] consensus : the most criteria were established on the basis of consensus, which did not work 3
Some psychologists made 'things' from the categories. They started schizophrenia as a "thing"
while it is only a description of a constellation of characteristics.
DSM-IV was released in 1993, together with ICD-10. The biggest changes were:
Distinction between biological and psychological disorders
The distinction between biological and psychological disorders was removed because people
realized that even with biological disorders many other non-biological factors play a role
played.
Changes in axes
A number of changes were made to the axes so that they became:
1] developmental disorders, motor skill disorders and communication disorders
2] personality disorders and mental retardation
3] physical disorders and symptoms
4] psychosocial and environmental problems
5] current level of functioning (degree of discomfort experienced by the disorder, from 0 to 100)
In addition, a number of optional axes have been added to include defense mechanisms, social and
include relational functioning in the diagnosis. Overall, DSM-IV holds
moreover take more account of cultural influences (Axis 4).
DSM-IV does have a number of problems / criticisms:

Comorbidity
Some categories are still somewhat vague. This means that some patients
multiple disorders. It is difficult to deal with such cases.
Reliability at expense or validity
DSM-IV focuses on reliability, and therefore sometimes loses parts of its validity
(generalizability).
Historical influences on nosology
It is possible to improve a risky system such as DSM-IV instead of constantly re-using it
to build. Terms and concepts from the past can no longer be correct, but remain
to exist.
Labeling
Categorization means that people can start to see it as things. "Christiaan is schizophrenic" while
it is actually "Christiaan is a person with schizophrenia".
Categories are usually formulated based on the opinion of multiple professionals.

Teams of scientists then try to determine the characteristics of the new ones
category are truly unique and do not belong to another category. In addition, one must take into account
take into account the amount of people who would fall into it - after all, they will receive benefits and
other government support. It is not intended to cause a headache due to stress as a DSM-IV disorder
to take. The book describes how two new categories, mixed anxiety depression and
3 someone had a panic disorder if he had four attacks in four weeks. why four attacks? is it okay with three?
Page 18
premenstrual dysphoric disorder after repeated examination have not been included in DSM-IV itself.
They are, however, included in the appendix in order to stimulate research into these disorders.
DSM-V probably gets a much stronger dimensional character, which means that disorders
be seen as points on a continuum from healthy to disturbed.
CHAPTER 4: RESEARCH METHODS

The elementary components of each study are:
Hypothesis
The hypothesis is the 'educated guess' about what we can expect based on certain facts
Research design
The plan that is used to test the hypothesis and that is adapted to what we want
knowledge and practical / ethical aspects.
Dependant variable
A variable that is measured and (hopefully) changed as a result of changes in the
independent variable.
Independent variable
The variable that is being manipulated and must lead to changes in the dependent variable.
Internal validity
The extent to which the fluctuations in the dependent variable can be explained by
the independent variable.
External validity
The extent to which the results of the study can be generalized to other areas.
The testability of a hypothesis is important. We may wonder if God exists, but there
is no way to test that - so this is not a scientific hypothesis. The same does not apply
for whether more coffee leads to more heart problems.
Confounds can occur within a study . These reduce the internal validity because they are the
make results uninterpretable. There are a number of ways to prevent this:
Control groups
A group is introduced that goes through the same as the test group, but is not exposed
to the independent variable (or the variable of the same level).
Randomization
It is ensured that participants are randomly assigned to groups, to prevent it from happening
biases occur during selection, or that participants organize themselves. If one is investigating or a
Certain long-term treatment helps against depression, and people are allowed to choose whether they are there
participate or go on a waiting list, then patients who are severely depressed, and so
be less motivated, probably less likely to participate in long-term therapy.
Analog models
One creates in a controlled environment, artificially, the phenomenon being investigated. One can
In this way involve multiple types of participants and prevent confounds.
Internal and external validity often have an inverse relationship. If the internal validity increases, then
the generalizability (external validity) often becomes smaller.
People value effects that are statistically significant . A problem is that as something
is statistically significant, it does not have to be clinically significant . If one has a medication
developed that people let themselves be significantly less injured, that is not immediately clinical
significant - because the problem is not solved. Moreover, 'less self-injury' does not mean
automatically that that's better, because maybe people injure themselves a few times
injure themselves much more seriously. To prevent this, focus on the effect size that one
calculated by calculating the progress or decay of each individual in the group. A
another option is social validity , or the extent to which the environment sees progress.
A problem is the patient uniformity myth . Scientists tend groups

view participants as homogeneous. Although a group might have improved significantly on one
characteristic, individuals in the group can decline considerably.
>> STUDYING INDIVIDUAL CASES

One way to investigate a new syndrome is the case study method , where one or
more individuals who closely follow the syndrome. This method is not:
Page 19
1] scientific
2] interested in internal or external validity
3] free from confounds or other problems
We can use her to start a new field, but she is not safe enough to
to base whole theories on.
>> RESEARCH BY CORRELATION

A correlation is a statistical relationship between two variables. The correlation is positive as the one
variable increases and the other also, and the correlation is negative if one variable falls while the
another is rising. Correlations are expressed through a correlation coefficient ranging from –1 to
+1, where both extremes represent perfect negative or positive correlations.
Correlations have two problems:

Directionality : people don't know which variable is the cause and which is the effect
Third-variable : the effect of both variables can also be caused by an unknown third
variable
A form of correlational research is used in epidemiology . They determine the

incidence , prevalence and distribution of certain problems or properties within
groups of people hoping to find out more about the causes. One compares for example
the number of new schizophrenia cases in a community of refugees with a village
community.
>> RESEARCH BY EXPERIMENT

The experimental research concerns the manipulation of an independent variable and the measurement
of a dependent variable. People usually use it within psychopathology
research groups undergoing treatment, and control groups not receiving treatment
undergo. In some cases, the controls receive so-called placebos , or fake medicines
to make
what them believe
is tested, there isthat they too are control
a double-blind being treated. If thethis
, and with researchers themselves
one can prevent that do not know either
researchers accidentally confirm their own hypotheses (even if they are incorrect); the allegiance
effect .
One can also give groups of different types of treatments, instead of one or none
therapy. This is comparative treatment research . There are two forms (which one often does
combines):
Process : Process research focuses on why something works
Outcome : Outcome research focuses on whether something works
>> SINGLE-CASE EXPERIMENTAL DESIGNS

With single-case designs , one or more individuals are investigated. She knows a few methods
Repeated measures
One takes one person, and exposes it to all levels of the independent variable and measures
frequently before and after changing. One does this to establish the following of what one is
wants to measure:
1] level : the extent to which the property changes after changing the independent variable
2] variability : the extent to which the value of the property fluctuates
3] trend : the trend, direction or direction of the value of a property (descending, ascending, etc.)
Withdrawal designs
One is given a certain treatment, and suddenly stops to see if the dependent variable
(for example, the degree of stress) increases again. If the degree of stress decreases with being present
of treatment, and rises again if treatment is not applied, the method works. She
has some problems:
1] ethics : it is not always ethically justified to suddenly stop a treatment
2] unlearning : sometimes the treatment is learning a certain skill. One cannot suddenly learn this
Multiple baselines
One recognizes several locations where the individual goes, and treatment begins at one of the
locations and then spread it to others. One can find those locations where the treatment is not
takes place compared to the location where it already happens. One can also have several individuals
suits that will be treated at different locations. (see page 102).
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>> STUDYING GENETICS

Genetic researchers distinguish the phenotype , the observable properties of a
individual, and the genotype , the unique hereditary code of an individual. The human genome project
attempts to map the complete genotype of humans. One can through a few ways
Investigate the extent to which genes and the environment play a role in a certain trait:
Family studies
One determines which family member has a property (the proband ). If there is genetic influence, then
first-degree family members must have the same characteristic more often than further-degree members. The
Problem is that these people do live with each other, and a trait can also be caused by one
shared influence from the environment.
Twin studies
One determines whether a trait is more shared by monozygous twins than by dizygote
twins, in which case the trait is at least partly genetically determined. Is a problem
that one does not know whether dizygote twins do not experience entirely different things than monozygote
twins, who are also treated more like twins by their parents.
Adoption studies
Genetic and environmental influences are split. One detects twins that are different
families are raised, and determines whether the siblings have a particular condition more often
than with a chance.
However, these studies cannot indicate which genes cause the problems.
This is possible through two methods:

Genetic linkage analysis
One examines, together with the condition, a number of other traits of which the
know the genetic location ( genetic markers ). If a certain marker often occurs with a
disorder, then the disorder can be caused by the same chromosome.
Association studies
People here compare people with a disorder and without a disorder and look at certain markers
more common in people with the disorder. In that case it is assumed that the disorder
is caused by the marker genes or something that is nearby.
>> STUDYING BEHAVIOUR ACROSS TIME

Sometimes people want to know how a disorder develops over time. The reasons for this are:
1] We then know if it is necessary to treat those people
2] we can set up treatments to prevent the disorders ( prevention research )
Two types of methods are generally used:

Cross-sectional designs
One compares age groups ( cohorts ) on a trait. A confound is that different
cohorts have had different upbringing and experiences and can therefore react differently
( cohort effects ). Nevertheless, this method is simpler than a longitudinal design. One can
just not answering how disorders arise; This requires longitudinal research.
Longitudinal designs
A number of individuals are followed during part of their lives. You can now make statements
about the occurrence of certain disorders. The method is expensive and takes a lot of time, moreover one can
sometimes difficult to generalize results to other age groups ( cross-generational effect ).
Sometimes a combination is used, called the sequential design . One follows cohorts about this
time. This is less expensive and time-consuming than longitudinal design and does not have the problems of cross-
sectional designs
>> STUDYING BEHAVIOUR ACROSS CULTURE

Where we have to take into account the influence of age on psychopathology, we must also
take into account the culture. Some researchers see the culture as the independent
variable, and the elimination of a particular disorder as the dependent trait. However, this is difficult
to investigate because:
1] we cannot classify random babies into different cultures and see how they do it
2] The symptoms of disorders are often very different in cultures
3] the tolerance of disorders varies greatly per culture (difficult with regard to incidence and prevalence )
4] cultures have different treatment methods, which makes comparing very difficult
Page 21
>> THE POWER OF A PROGRAM OF RESEARCH

None of the above methods is better than the others. They complement each other and often become
combined or followed up in long-term programs or research . By combining methods you can
people say more about the cause, treatment and course of a disorder.
However, replication is important for all programs. Only when one can replicate the results is
assumed something as "proof."
>> RESEARCH ETHICS

Ethics is important when doing research. One must determine when the interests of the
Patients exceeded the interests of the study, in which case an informed consent was given
must be by the patient: "yes, I want to cooperate and you can do this with me". Getting such
consent is not very simple, because a person must fully understand what he agrees with.
Moreover, it has always been difficult with children. To prevent this, there are International Review Boards
checking research methods.
People who participate in research must be protected from physical and psychological
damage. The welfare of the participants is given priority over the design and the research results. At
Children are subject to special rules, which also require that parents or guardians consent
to give.
CHAPTER 5: ANXIETY DISORDERS

Anxiety is a negative mood that is characterized by physical symptoms such as
tension and fear of the future. It is not easy to investigate in humans, so aim
people usually rely on animals - do they only experience the same thing? Anxiety is healthy for us. It takes care
make sure we prepare for an exam, date or application. It becomes pathological as we
The anxiety can not turn off, and know that there is no reason anxious to be.
Fear is a stronger response to imminent danger, also called the fight / flight response called Mount
to flee, and consists of fear of the present. Both are psychological and physical
different, and are discussed in this chapter. A panic attack , or panic , is a form of fear
where there is no real danger. The term panic comes from the Greek God Pan that travelers
once in a while until dying to left scare with a shout.
Three types of panic attacks can be distinguished :

1] situationally bound : fear of / at a specific location (is phobia, will not be treated here)
2] unexpected : unexpected attacks
3] situationally unbound : fear of / on location, but is not bound by it and often
unexpectedly
What causes these strong emotional responses?
>> CAUSES (BIOLOGICAL)

There is a genetic basis for both anxiety and panic .
The main cause of anxiety seems to lie in the corticotropin releasing factor (CRF) that the
HPA axis activates and exerts effects on large parts of the brain, including mainly the:
1] hippocampus (limbic system)
2] amygdala (limbic system)
3] locus ceruleus
4] prefrontal cortex
5] dopaminergic neurotransmitter system
6] GABA benzodiazepine system (lowers the amount of GABA, which indirectly causes problems)
Gray discovered the behavioral inhibition system ( BIS ), a circuit that is located in the limbic
system, and that is triggered by sudden danger, such as changes in the body, that
indicate a hazard. This system appears to be related to anxiety .
Page 22
For panic , Gray discovered another system, the fight / flight system ( FFS ), which starts in the
brain stem and travels through various structures, including the amygdala and the hypothalamus. At
activation it causes a panic response. A lack of serotonin appears to activate this system.
Factors in the environment can influence sensitivity. Smoking increases the risk of anxiety
disorders.
>> CAUSES (PSYCHOLOGICAL)

Youth experiences influence anxiety . Parents who do everything for their children, and little for them
release, do not give the opportunity to develop a healthy sense of control . It may or may not
the presence of this feeling influences the chance of developing an anxiety disorder.
A cause for panic lies in conditioning . A strong emotional response is the first time
justified because there is real danger. However, it is linked to internal and external cues
who later evoke that feeling, even though she is no longer justified. The cues are often unconscious.
This is called learned alarms compared to true alarms .
>> CAUSES (SOCIAL CONTRIBUTIONS)

The way we deal with stress seems hereditary and influences the chance of developing
an anxiety disorder. Certain stressors can activate biological sensitivity.
>> CAUSES (AN INTEGRATED MODEL)

So there seems to be a generic biological predisposition to anxiety disorders. However, this is only one
vulnerability . Anxiety and panic are strongly related. The comorbidity (degree of joint
occurrence) is high in anxiety disorders. The characteristics are largely the same, only the
focus of the anxiety and the pattern of the panic . 55 to 76% of individuals have several
disorders side by side.
The following is a discussion of the specific disorders:

1] Generalized anxiety disorder
2] Panic disorder with and without agoraphobia
3] Specific phobia
4] Social phobia
5] Posttraumatic Stress Disorder
6] Obsessive Compulsive Disorders
>> GENERALIZED ANXIETY DISORDER

GAD (this disorder is not related to panic ) is characterized by:
1] excessive care that occurs during most days for at least 6 months
2] difficulty focusing attention
3] at least three of the symptoms below (in children only one)
1] restlessness
2] tired quickly
3] difficulty with concentration
4] irritated
5] muscle tension
6] trouble sleeping
4] the focus of the fear is not specifically focused on 1 object or 1 situation
5] the anxiety causes clinically significant disruption of functioning
6] not caused by medication or drugs, or a medical condition
In fact, GAD is worrying about things without being able to turn it off and knowing it
It is pointless to keep worrying about it.
STATISTICS
GAD occurs in 4% of the population, and in the west mainly (66%) among women (outside of it)
especially with men). The onset is mainly gradual, but with some more direct due to one
great life stressor . Once developed, GAD is chronic and does not disappear quickly. GAD comes primarily
common among the elderly (7%) because they develop a feeling of lack of control over them
life.
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CAUSES
What causes GAD? There seems to be a genetic contribution. Strangely enough, people score with
GAD on almost all physiological tests lower than people without GAD (lower heart rate, blood pressure, etc.).
They are therefore called autonomic restrictors . They only score higher on muscle tension - they
are chronically tense. They focus much faster, often unconsciously, on potential threats. This
appears with emotional stroop tasks (see research practical 2003). What is the link between these
mental processes and the restriction of the autonomic nervous system? Borkovec states that people with
GAD worry about things without forming mental images of it - they do
to prevent more anxiety. As a result, they never confront the source of their fears and adaptation
will not occur (just like people with social anxiety, who will avoid social contact). Figure 5.4
page 121 shows this story schematically. Smoking, alcohol use and in particular
use of most drugs, worsen the symptoms or even produce it.
TREATMENT
The treatment is relatively weak:
Biological treatment
It is often prescribed tranquilizers such as benzodiazepines . These hinder cognitive functioning
however, and that can have other consequences (for example, on school performance). Medication intended
to treat depression seem to work better.
Psychological treatment
Psychological treatment works just as well as medication. People try to stimulate the
visualize and confront fear or accept fear instead of avoiding it. Especially with children
this seems to help very well. The disorder disappears at 95%.
>> PANIC DISORDER WITH AND WITHOUT AGORAPHOBIA

Panic disorder with agoraphobia (PDA) is a panic disorder in which people experience severe panic
(because one thinks to die or something) and moreover all situations in which one feels that it is not safe with
to avoid such an attack ( agoraphobia ).
CLINICAL DESCRIPTION
The clinical description (including agoraphobia) contains the following characteristics:
1] Recurring unexpected panic attacks
2] At least one attack must have been followed for 1 month by concerns about the cause and consequences
3] The presence of fear of square (or agoraphobia)
4] The panic attacks are not caused by drugs, drugs, or medical conditions
5] The panic attacks are not caused by other disorders, such as a social phobia .
In PDA, anxiety (for example, the causes and consequences of the panic attack) and panic are together
connected. In addition, phobic avoidance also comes in the form of agoraphobia .
Most people with a panic disorder develop agoraphobia. Agora is the Greek term for
marketplace. t is a complication of serious unexpected panic attacks and serves as a coping
method to deal with the panic. Usually people are more comfortable with people, op
locations where they feel 'safe', but they avoid all situations that do not apply. Op den
For a long time, agoraphobia becomes quite detached from the panic attacks themselves, which may never even happen again
occur after the first time. Another way to deal with the panic is drink and drugs or
enduring the enormous fear caused by the agoraphobia. Most patients experience it too
interoceptive avoidance . They avoid all situations where physical reactions resemble those of
a panic attack, such as watching horror, sex or exercising.
STATISTICS
PD , with or without agoraphobia, occurs in 3.5% of the population. With 5.3% of the population
agoraphobia. 75% of people with agoraphobia are women, because men usually go there
otherwise deal with it (they become addicted to alcohol). PDA is usually PDA . The onset is
often between 25 and 29, but very rarely occurs in children. There is a different form for the elderly
which often arises later as a result of a specific event.
The culture does not influence the expression form very much. Only in third-world cultures do complaints become
usually flavored.
Page 24
Many patients experience nocturnal panic ; a great fear from which they wake up. This happens
usually a few hours after bedtime, when delta waves and slow waves occur. The panic starts
usually when sinking into the deeper delta sleep , and it looks like that physical sensation of that
"sinking" caused the panic. It is certainly not due to:
1] nightmares : because they do not yet occur in the phase in which the panic arises
2] sleep apnea : this has a specific rhythm of waking up and sleeping again - no panic
There are two related phenomena:

1] Night terrors : Especially with children who have the feeling that someone is present in the room.
2] Isolated sleep paralysis : a phenomenon where your muscles are already asleep, so that you are paralyzed.
A large proportion of patients, 20%, seemed to attempt suicide . This appeared after correction
not too bad, but it is still possible that such a link exists.
CAUSES
A panic disorder occurs as a result of incorrect attribution of physical reactions.
People with PD constantly pay attention to how their body reacts, and this may be a psychological one
vulnerability that already exists. The vulnerability is therefore a predisposition.
A psychodynamic explanation states that the loss of the primary caregiver in early childhood
( object relations theory ) can cause later panic attacks.
TREATMENT
There are two groups of treatment:
Medication
Klein discovered that tricyclic drugs (imipramine) prevented panic, and that benzodiazepines
anxiety occurred. This was an indication to him that both problems had different causes
had. Although this is still the way it is, the differences are between the effects of the medication
not large, because tricyclic drugs, and in particular the specific reuptake inhibitors (SSRIs), which
working with depression is also used to combat panic attacks . There are side effects:
Benzodiazepines : impair cognitive functioning
Tricyclic anti-depressants : have many side effects
SSRIs : few side effects, but malfunction in sexual functioning in 75% of the cases
If the medication is stopped, a large proportion (up to 90%) falls back.
Psychological intervention
One confronts the person with the subject of fear, for example by deliberately determined
induce physical reactions ( panic control treatment ). Agoraphobia is often treated by the
patient search for places that he actually wants to avoid.
Research shows that the latter, PCT , works best because the effect stays longer. Combination of
medication and psychological treatment does not work better, and even worse in the long run
just pct .
>> SPECIFIC PHOBIA

A specific phobia is an irrational fear of an object or situation that is clearly functioning
of the person. That's where the similarities end, because there are hundreds of variations. Men
usually distinguishes a number of classes:
Blood-injection injury phobia
This phobia is characterized by the characteristic that people faint when they see blood or
something that has to do with that. This is partly hereditary (see Chapter 1 why).
Situational phobia
At first it was thought that this was PDA . The big difference is that these people do not experience panic in it
situations outside the context of what they fear. This phobia is also hereditary. Born around the age of 20.
Natural environment phobia
Fear of natural phenomena is healthy (fear of a tornado is not very natural), only can
they break. This usually happens around the age of seven.
Animal phobia
These fears are also common, only they are called phobia if they function too strongly
are going to bother. They also originate around the seventh year of life.
Other phobias
Page 25
Some people are afraid of contracting illnesses ( illness phobia ), while others are afraid of
choke when swallowing ( choking phobia ).
Seperation anxiety disorder
This disorder is specific to children and consists of the unrealistic and chronic worries of one
child for overcoming suffering with his parents. This is also normal to a limited extent. The process of
The separation here the important person is the subject of fear.
STATISTICS
Specific fears are common. With 11% of the population in the form of a phobia , again
predominantly with women (which is probably culturally determined, because men are not allowed to fear)
show). The most phobias are chronic . One must bear in mind that many fears are on
certain ages are quite normal, such as fear of loud noise in babies, monsters in children,
etc.
CAUSES
There are four ways in which a phobia can arise:
1] direct experience : you experience a frightening event yourself and you become afraid of it
2] observation : you see someone getting scared of something, and you get scared of it yourself
3] false alarm : you get a panic attack, and you attribute the fear (wrongly) to a location or
object
4] information transmission : someone tells you about danger, and you get scared of it
Just experiencing such an event is not enough. There must also be a degree of anxiety to that
fear of experiencing again later with that object.
So there are two steps:

1] conditioning : a direct or indirect traumatic event (1, 2, 3 or 4)
2] anxiety : an innate vulnerability to be afraid of an object
Phobias are often present in families in almost all cases. Whether this is due to genes or modeling is
still unclear, but it seems that the genes are responsible.
The culture plays a big role. In many cultures men are not allowed to make their fears known,
and so they just tolerate them.
TREATMENT
The treatment is easy. It requires exposure techniques in which the patient is exposed
to the subject of fear. With blood-injury phobias, even the exaggerated disappears
vasovagal reaction of the body. Most treatments can be done within one-day treatments
take place.
>> SOCIAL PHOBIA

A social phobia is more than exaggerated embarrassment and is characterized by:
1] fear of evaluation : a great fear of evaluation by others
2] anxiety or panic : exposure to the dreaded social situation must lead to anxiety or panic
3] irrational : the person recognizes that the fear is unreasonable
4] avoidance : the dreaded social situations are avoided
5] dysfunction : avoiding or fearing the situations leads to dysfunction
6] duration : for individuals under 18, this must last at least 6 months
7] other cause : the fear is not the result of medication, drugs or any other disorder or illness
8] comorbidity : in the case of another disorder or illness, the anxiety must be caused by
1]
STATISTICS
13.3% of the population sometimes suffers from social phobia. Men in this case slightly more often than
women, possibly because men complain more about it because it functions on business or
relational area. The onset is on average around fifteenth, at the start of the
adolescence and is more prevalent in young people.
Page 26
CAUSES
There are several possible explanations:
Evolutionary explanation
It may be useful to fear and avoid negative evaluation , and individuals have it
that in the past did live longer and propagated more - so an evolutionary "benefit."
Temperament or trait of shyness / inhibition
It is possible that it is a trait that becomes visible in children after four months ( Kagan ). There are
evidence that individuals with excessive behavioral inhibition are at increased risk.
There are three paths through which development can take place:
Due to biological weakness
One has an innate vulnerability to be socially inhibited, which only manifests itself in the performance
of a certain event.
Due to false alarm
People experience a panic attack that is unexpected, and the cause is attributed to the social environment,
by which you condition yourself to fear the social environment.
Due to true alarm
People experience a real trauma and condition themselves to fear a situation.
However, this requires an individual to fear social evaluation in advance. Parents who clear this
can transfer this to their children. See page 140, figure 5.10 for an overview.
TREATMENT
With CGBT (cognitive behavioral group therapy), people play the situations they fear in role-playing
after. At the same time, the therapist searches for unconscious thought processes that sustain phobia
to hold. This method appears to work best, even in the longer term. Studies show that
especially the exposure part does its job. Also medicines such as tricyclic antidepressants and MAO
inhibitors and SSRIs work, but people usually relapse when treatment stops.
>> POSTTRAUMATIC STRESS DISORDER

The emotional disorder that follows a trauma is called post-traumatic stress disorer :
1] severe trauma : person is exposed to a severe trauma that was caused by great anxiety
2] flashbacks : the traumatic event is revived time and time again (flashbacks or the like)
3] avoidance : people avoid stimuli related to the trauma
4] arousal : continuous arousal that was not present before the traumatic event
5] duration : duration of at least more than one month
6] distress : the disorder causes significant clinical stress
There are in fact three forms of PTSD :

Acute onset PTSD : the disorder follows immediately after the trauma (diagnosis between 1 and 3 months)
Chronic onset PTSD : no problems at first, but PTSD develops completely later
Acute stress disorder : the disorder that occurs in the first month due to the heavy stress
The latter is accompanied by amnesia of the event, emotional insensitivity and
derealization and has been added to entitle people who experience that disorder after a trauma to
medical care and insurance reimbursement.
STATISTICS
The prevalence of PTSD varies per study. In WW2 only a fraction of PTSD increased and increased
rapes more than 10%. It seems that in the last group, people were suffering
encountered. Yet that cannot be the whole story, because many of those people develop
no PTSD.
CAUSES
The etiology is clear; people experience a trauma and develop a disorder . However, this happens
not with everyone, so other factors play a major role:
Heredity
There is at least a slight degree of heredity.
Character
Certain traits, whether or not hereditary, determine how to deal with trauma.
Page 27
Early experiences
Experiences from early childhood where one has no control over what happened can be a child
make it vulnerable to a later development of PTSD.
Social and cultural factors
People with a large group of people to develop PTSD less quickly.
In any case, the development of PTSD only involves neurobiological systems. Extreme stress
seems to cause damage to parts of the brain, in particular the hippocampus (memory). In PTSD is
so the intimate alarm response is justified, but can be so powerful that it leads to a perm
chronic reaction. And whether this happens depends on our vulnerability.
TREATMENT
Patients must confront the trauma . Sometimes people have subconsciously suppressed memories,
and releasing those memories can be very hard.
>> OBSESSIVE-COMPULSIVE DISORDER

OCD is the most destructive expression of an anxiety disorder . They usually make all others
disorders. Where the event that evokes anxiety in the other disorders is often external, there is
in this case it is the thought itself that evokes fear. Other features:
1] obessions or compulsions
2] excessive : the person must realize somewhere that this is no longer possible
3] distress : the obsessions and compulsions led to significant clinical stress
4] comorbidity : the obsessions should not only concern, for example, social anxiety
phobia)
5] other cause : the obsessions must not be the result of alcohol, drugs or diseases.
Obsessions are, generally, illogical thoughts themselves impose . Compulsions are the
thoughts and actions used to suppress the obsessions - they are usually
illogical, and more a form of magic.
STATISTICS
OCD occurs in around 2.6% of the population. Many people sometimes have obsessions or
compulsions, but never as bad as with OCD. Most people just ignore those thoughts while
people who develop OCD see them as evil , extraterrestrial or intrusive . The onset is from the
early adolescence until mid-20, but peak slightly earlier in men (13-15) than in women (20-
24). When it develops it remains chronic . OCD looks about the same about cultures
from.
CAUSES
Again, the anxiety about getting a certain thought back is decisive for this
the development of OCD, and that is mostly biological . It seems that people
has been taught to find certain thoughts unacceptable, and to do everything to dispel them. See
figure 5.13 page 150 for a schematic overview.
TREATMENT
There are three approaches:
Medicines
In particular, agents that block the serotonin reuptake appear to help, such as SSRIs. The profit is
however moderate.
However, the best treatment is exposure to the thought that one is trying to avoid and it
prevent the rituals.
Psychosurgery
In extreme cases one can damage the cingulate nucleus in a procedure that one
cingulotomy . In 30% of the cases this helps, but it is a last resort.
Page 28
CHAPTER 7: MOOD DISORDERS

Mood disorders are characterized by large deviations in mood. There are two states :
Depression
Characteristic of the most common disorder; major depressive episode , and is characterized
due to a lack of energy, loss of pleasure in life ( anhedonia ) and disturbed physical
processes such as digestion and sleep / wake rhythm. This must take at least two weeks .
Mania
A mania is the opposite, and manifests itself in an exaggerated enthusiasm and experience of
extreme pleasure every day. People become hyperactive and think so fast that their speech is underneath
leads ( flight of ideas ). The state often leads to destructive behavior, because people think they can handle everything.
This must take at least a week . A less extreme form of mania is the hypomanic episode
which is not usually treated and does not cause serious disturbances.
The characteristics of a major depressive disorder :

1] symptoms : a depressed mood or loss of interest for at least 2 weeks
2] no mixed episode : there is no question of a mixed episode
3] distress : the symptoms cause clinically significant distress
4] drugs : the effects are not the result of medication, alcohol or drugs
5] complaint : the symptoms are not caused by (normal) raw
The characteristics of a manic episode :

1] elation : at least a week of overly cheerful, irritated mood
2] symptoms : high self-confidence, more sleep, more talkative, seeking pleasure and fun
3] no mixed episode : there is no question of a mixed episode
4] impairment : the episode is heavy enough to cause serious disruption of functions
5] drugs : the effects are not caused by medication, alcohol or drugs
>> THE STRUCTURE OF MOOD DISORDERS

There are two types:
Unipolar disorders
In unipolar disorders there is depression or mania.
Bipolar disorders
In bipolar disorders, depression and mania alternate. Mania and depression
are not exactly the opposite, because sometimes people also experience depression during or over the
own mania ( dysphoric manic or mixed episode ).
>> DEPRESSIVE DISORDERS

Major depressive disorders are most common, and there are two types:
1] single episode : one experiences a single episode. However, 85% receive more than one
2] recurrent : one experiences two or more episodes, separated by at least 2 months
In the case of recurrent depression, other family members also tend to experience depression.
Because most depressions keep recurring, it is a chronic condition. Most
people experience four episodes, and some even six.
Another form is the dysthymic disorder . She is milder, but often remains present for 20/30 years:
1] mood : a negative mood during the day and during most days
2] symptoms : loss of weight, insomnia, low self-confidence, low energy, etc.
3] duration : for two years, no two months or more have had 1] and 2]
4] mde : in the first two years there was no major depressive disorder
5] no mania : there has never been mania or a mixed episode
6] other : there is no other chronic disorder, such as schizophrenia
7] drugs : the effects are not the result of medication, alcohol or drugs
8] distress : the symptoms cause clinically significant distress .
Most people who have this disorder eventually experience a major depressive disorder .
Sometimes there is both a major depressive disorder and a dysthymic disorder , and then
one speaks of a double depression . The dysthymic disorder develops earlier, after which
depression follows. People often heal from depression, but not from dysthymic disorder.
Page 29
Major depressive disorders occur around the 25th or 29th. The prevalence of depression in the
population is currently increasing. Episodes last from two weeks to nine months. The chance of
however, healing is great. If a depression occurs at the age of 25, it is often
more serious, chronic and genetically engineered. With dysthymic disorders, half usually falls back
treatment and commit suicide faster than people with depression. Children often heal.
Raw is a short-term and natural depression that is not treated unless it is longer than one
years or extreme symptoms. People sometimes develop a pathological complaint
reaction or an impacted grievance reaction , which means that people always think of the lost and
tries to avoid any memory or confrontation. The treatment often consists of confrontation.
>> BIPOLAR DISORDERS

Characteristic is a change between depression and mania . There are some forms:
Bipolar I disorder : Depression is alternated with manic episodes (most severe)
Bipolar II disorder : Depression is alternated with hypomanic episodes (slightly less strong)
Cyclothemic disorder : A milder form in which depression and mania more dysthymic his
People with a cyclothemic disorder run an increased risk of moving on to the lake
extreme disorders.
The characteristics of a bipolar II disorder :

1] mde : presence of one or more major depressive episodes
2] manic : presence of one or more hypmomanic episodes
3] no mania : there have been no manic or mixed episodes
4] distress : there is clinically significant distress
The characteristics of a cyclothemic disorder :

1] episodes : a large number of weak hypomanic or depressive episodes
2] duration : one has not been without symptoms for more than 2 months within 2 years
3] first years : there have been no depressive, manic or mixed episodes
4] other : the symptoms in 1] are not caused by another disorder
5] drugs : the effects are not caused by drugs, drugs or drink
4] distress : there is clinically significant distress
The average onset for a bipolar 1 disorder is 18, and for a bipolar 2 disorder 22. They
begin more acutely than depression. The more serious disorders often start with
fluctuations that are sometimes cyclothemic in nature. After 40, the disorder rarely occurs,
but if it happens she is also chronic and cannot be cured. Many people think of or commit
suicide. Cyclothemic disorders often last a lifetime and the onset is often earlier, around 12
to 14.
There are additional specifiers , or symptoms that determine sub-types. There are two types of specifiers:
1] specifiers of most recent mood
2] specifiers of course of mood
The six distinguished specifiers for the most recent vote are:
Atypical features ( major major depressive episodes only )
They often sleep too long, eat more and arrive and can also experience some pleasure. They experience it
also more anxiety . It is possible that this is a first phase in the development of more extreme ones
disorders.
Melancholic features ( major major depressive episodes only )
Refers to extreme somatic changes such as loss of weight, appetite, libido and sleep. She is
reasonably treatable with medication or other physical interventions, such as ECT. Comes with the elderly
more common.
Chronic features ( major major depressive episodes only )
Covers only major depressive disorders that are continuously present for at least two
year.
Catatonic features (all types of episodes)
Covers all types of episodes, and involves extreme somatic complaints involving muscles
work less or completely freeze ( catalepsy ) and do not move at all or at all.
Page 30
Psychotic features ( major depressive or manic episodes )

Covers psychotic experiences, such as seeing or hearing things that are not there
( hallucinations ) or having unrealistic thoughts ( delusions ). Sometimes these are
Symptoms directly related to the state, in which case they are mood congruent , but it is also possible
that someone who is depressed still thinks he is the king of the world ( mood incongruent ).
Treatment with drugs that tackle the whole often works well.
Postpartum onset features ( major depressive or manic episodes )
Some mothers develop complete depression after birth. It is not strange that one
feel a little less after birth ( postpartum blues ), but this is rarely a cause for concern.
The three additional specifiers for the mood pattern are:

Longitudinal course
Was there any previous dysthymia or cyclothymia ? To what extent is the patient among the
to cure and recover from episodes?
Rapid cycling ( bipolar I or bipolar II)
If someone experiences four or more manic episodes within a year, this is specified
spoken. This is a serious form that does not respond well to medication. Tricyclic drugs
make her even more serious (or let her arise)! The speed often increases, but this form
usually lasts no longer than 5 years.
Seasonal pattern
Sometimes bipolar disorder is tied to the season, people are manic in the summer and depressed
in the winter ( seasonal affective disorder ). This may have to do with an over-production of
melatonin which develops in dark environments and can make people more sensitive to it
mood changes. They are often treated here with exposure to bright light.
>> PREVALENCE OF MOOD DISORDERS

The prevalence of mood disorders is high, 7% to 19%. Women walk three times as high
risk of dysthymic or major depressive disorders, while bipolar disorders are equally distributed:
In children and adolescents
Children experience fewer depressions than adults, but adolescents experience more. At
Children usually have dysthymia . Just as with adults, women are most at risk.
Bipolar disorders are rare, but are often seen as ADHD. Depressions at
children who express themselves in aggression and irritation are often diagnosed incorrectly.
In the elderly
Elderly people in nursing homes have many depressive disorders (18-20%). Because getting older
is associated with physical ailments, the depression is often blamed on that (or does not even notice it).
The prevalence is slightly lower in the entire elderly population, possibly because people are less stressful
events. However, the elderly become increasingly depressed once they start.
The prevalence becomes the same for both sexes around the age of 65.
Across cultures
In many cultures, depression is expressed as somatic complaints. Moreover, they say in collective
cultures are not that one is depressed, but that the group is depressed. The prevalence is between
cultures are equal, but does have peaks in cultures where individual stress is very high.
Among the creative
People who are extremely creative (or genius in any area) know considerably more
bipolar disorders. In times of mania, people are much more creative and successful. Possibly there is one
underlying variable that causes both; so creativity and bipolar disorder.
>> ANXIETY AND DEPRESSION

Depressions usually follow anxiety , and it seems that both have similar causes.
Almost all depressed patients experience anxiety, but not all patients with anxiety disorders
experienced depression. So depression comes on top with these additional symptoms:
1] helplesness
2] depressed mood
3] loss of interest and lack of pleasure
4] suicidal ideation
Page 31
>> CAUSES
There are many causes that lead to the same result; depression ( equifinality ). You identify:
1] biological causes
2] psychological causes
3] social and cultural causes
The biological causes fall into a number of groups:

Familial and genetic influences
A genetic influence of 40% is estimated in women and a lower influence in men. The
The genetic influence for bipolar disorders is somewhat higher. 60-80% is therefore due to the environment.
Studies also show that there appears to be a generic vulnerability to anxiety and mood
disorders , and that the other factors determine which disorder exactly arises.
Neurotransmitter systems
A lack of serotonin is seen as an important cause, because it regulates our emotions. Others
neurotransmitters can move more freely if there is not enough serotonin ( permissive
hypothesis ). One does not see one transmitter as the cause, but as the most important in it
story. In mania, dopamine is seen as an important cause.
The endocrine system
The cortisol level is higher in depressed individuals . A test has been developed from this, the
deaxmetahasone suppression test ( DST ). Deaxmetahasone suppresses the amount of cortisol, but
this works less well with depressed individuals because it secretes the cortisol much more
than normal. Now it appears that other disorders also have this effect. People focus now
neurohormones , substances that influence the HPA axis.
Sleep and circadian rhythms
Depressed individuals enter faster and have a more intense REM sleep. They have
therefore less slow-wave sleep (the sleep in which you rest). Possibly there is one
underlying generic biological disruption that also disrupts the biological clock. People with
bipolar disorders are also more sensitive to light in that melatonin suppresses them more strongly
when exposed to light.
Brain assymetry
Individuals with depression show stronger activation of the back of the right
hemisphere. This also continues to exist after the depression, and may be a biological vulnerability.
The psychological causes fall into a number of groups:

Stressful life events
Mood disorders are often preceded by stressful events. Not everyone developed
however, depression, and one often examines the context of the event and the meaning for it
the person. A disadvantage is that the memory is often influenced by the depression (bias). The
reciprocal gene-environment model says that a genetic basis can take care of it and that one can
develops depression, but also seeks out situations that promote it (unstable relationships). First
episodes are caused by events, further episodes often arise 'just like that'.
Learned helplesness
The learned helplesness theory of depression states that people who make an attribution do not
have control over their lives quickly become depressed. The depressive style has 3 characteristics:
1] internal : the individual sees himself as the cause of everything that goes wrong
2] stable : the individual thinks that bad things will always happen
3] global : the individual thinks bad things will happen everywhere
This negative style itself does not cause depression, but with sufficient negative experiences
people are developing more and more negative styles, which makes children more vulnerable. The sense
or hopelesness is most crucial in the development of depression.
Negative cognitive styles
Beck sees depression caused by negative thought patterns. Two are important:
1 ] overgeneralizing : one generalizes failure to all other areas ('one here, one everywhere')
2] unjustified inference : one makes inferences that are incorrect ('she does not call back - I am a dick')
These patterns relate to three components ( depressive cognitive triad ):
1] themselves: the own person
2] immediate world: the own world
3] future: one's own future
One can try to change these wrong thought patterns during treatment
Depressions always seem to be accompanied by a pessimistic way of thinking. It seems that such
styles pose a vulnerability to the development of mood disorders.
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The social / cultural causes fall into a number of groups:

Marital relations
Men have an increased risk of depression after a divorce. Especially if the marital conflict
was high, and the marital support was low. Depressions also affect relationships (logically) negatively.
Mood disorders in women
More depression occurs in women. Possibly because they sooner have a sense of lack
have control over men, with whom this is encouraged in their upbringing. Moreover
women appear to think more about what is wrong with their lives, while men think about it
ignore thoughts. Women who have a full-time job have as few mood disorders as they do
men who work. Men have more with other types of disorders ( eg substance abuse )
complaints.
Social support
Social support helps prevent mood disorders, but also makes recovery easier. This has
led to a new form of therapy; the interpersonal psychotherapy .
In summary, people have biological vulnerabilities that put them at risk
walk on mood disorders . There is also a psychological vulnerability , such as one
pessimistic way of thinking that originated in early childhood. For stressful events , if
Due to the vulnerabilities, the first episode emerged. Possibly because stress causes activation
of certain genes and excessive release of neurohormones that cause damage in the brain.
This is therefore reminiscent of a diathesis stress model , where a vulnerability exists and
becomes visible after a certain amount of stress. Which disorder is being developed, seems to be declining
depend on the unique set of factors that each individual has on top of the genetic predisposition. See page 219
for a schematic representation.
>> TREATMENT
There are a number of possible types of treatments for mood disorders :
1] medications
2] electro-convulsive shock therapy
2] psychosocial treatment
3] combined treatment
>> TREATMENT (MEDICATIONS)

Medications includes the administration of medicines. With depression these are:
Tricyclic antidepressants
Best known are imipramine (Tofranil) and amitriptyline (Elavil). How exactly they work is not clear,
but they block the reuptake of certain transmitters and ensure that less of them are free
comes ( down regulation ). This mainly relates to norepinephrine and also to serotonin .
It takes a while before it works, and side effects are strong, but then they decrease. It's working
in 50% of patients, and 40% quit because of the side effects. This substance is fatal if it is too large
doses, and should therefore not be administered to people who are suicidial.
MAO inhibitors
Block monoamine oxidase (MAO) that breaks down norepinephrine and serotine after release. The effect
so looks like Tricylics, but has slightly fewer side effects. There are two major problems:
1] tyramine : in combination with tyramine (in many foods) it leads to hypertension or even death
2] medications : usually leads to serious side effects in combination with other medicines
Selective Serotonergic Reuptake Inhibitors (SSRIs)
Block the presynaptic reuptake of serotonin, allowing it to act longer. Is known
fluoxetine (Prozac). Prozac has quite a few side effects, but they are less serious than those of
tricyclics. Sleep is often disturbed by these drugs.
Two new medicines are currently being tested. Venlafaxine looks like a tricyclic, but has
less serious side effects. Nefazodone is similar to an SSRI, but it regulates sleep better. Nature offers
also an alternative, in the form of hypericum (st john's wort) which has none of the side effects and just
seems to work so well (yay! for mother earth).
Medications that work with the elderly do not automatically work with children. Tricyclides resemble
to lead children to death. The purpose of the medication is not so much the people
cured, but especially to prevent them from relapse.
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In bipolar disorder one uses lithium . This salt must be administered to the correct degree, because
she is toxic in overdose. People often experience less energy, and that often causes many people
stop taking the drug. The manic state associated with this disorder is often found
pleasant. It is unclear how lithium works. It is possible that it causes more sodium and potassium
is available. Administration of lithium after the depression prevents relapse in 66%. Therapy and
guidance to continue to use the medication helps here well.
>> TREATMENT (ELECTRO CONVULSIVE THERAPY)

Controversial. A shock is delivered to an individual, and this shock apparently leads to a positive one
changes. In many cases, symptoms decrease. However, the treatment is stressful, and
is therefore used as a last resort. There are few side effects (at most some temporary ones)
amnesia). A recent method called transcranial magnetic stimulation , eventually turned out
not working; after the first positive results.
>> TREATMENT (PSYCHOSOCIAL TREATMENT)

There are two primary forms of psychosocial therapy:
Cognitive therapy
Beck developed this method, and the goal is to get maladaptive thinking patterns, and ultimately
to detect and disable negative schedules . The therapist and the client do this as a team ,
and often the client gives up homework; for example, to determine if the expectations that
follow from the way of thinking is correct ( hypothesis testing ). They also try to activate the client again
by sending him to social events. This alone appears to be helpful.
Interpersonal psychotherapy
The focus is on relational problems, which often (in 50% of the cases) lead to depression.
Attention is paid to conflicts in four possible areas:
1] role disputes : dealing with interpersonal role disputes (such as conflicts between married couples)
2] loss of relationship : adjusting to the loss of a relationship
3] new relationship : acquiring new relationships
4] deficits in social skills : identifying and correcting deficits in social skills
People identify and define interpersonal conflicts, and try to resolve them. This is what they do
by determining together with the client what phase the conflict is in:
1] negotiation : there is negotiation
2] impasse : there is no development, but a weak displeasure with each other
3] resolution : a solution is being sought by both partners
>> TREATMENT (COMBINED TREATMENT)

Psychosocial and medicinal treatment are equally effective, but medicines work earlier, and
psychosocial treatments often prevent future problems. So a combination works
often used. Relapse, relapse , can also be prevented by a combination ( maintenance
treatment ). It is best to start with psychosocial treatment and only to take medication
administer if that does not work or hardly works. In some cases, psychosocial therapy helps better, such as
in people with a higher level of MPHG . This makes the effect of medication on them
less, and seems to have to do with learned helplesness .
>> SUICIDE
Suicide is the eighth leading cause of death in adults and the third in young people (in the US).
Recently, the number of suicides has increased sharply. Men commit four to five times as much
suicide than men. However, this is rather because men are more successful (questionable honor ...)
then women, who try to commit suicide three times as often (!) as men. One must therefore
make a distinction between successful suicides , suicide attempts and the thoughts on it
suicide; suicide ideation .
Little is known about the causes. The sociologist Durkheim distinguishes 4 reasons (causes):
Altruistic suicide : people commit suicide because that is the accepted solution to this problem
Egoistic suicide : people commit suicide because they have lost social support
Anomic suicide : people commit suicide because of an important event (dismissal)
Fatalistic suicide : people commit suicide because they no longer have any hope
Freud saw it as anger that had to be directed at others, but directed at the self.
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There are risk factors (which come about through interviews with surviving relatives: psychological autopsy )
Family history
If a family member commits suicide, there is a greater chance that someone else will. Possibly because
impulsiveness, what is needed, is genetically determined, but it can also be the way the family are
solves problems (it is of course effective, but not very useful).
Neurobiology
Possibly there is a too low level of serotonin, which can cause people
overreact or become too impulsive.
Existing disorders
Disorders already present, such as depression or a borderline personality, can lead to
issues.
Stressful live events
A stressful event can affect existing weaknesses and encourage the person to
commit suicide.
Sometimes it seems like suicide is contagious . If a famous person commits suicide (such as Kurt
Cobain), then others often follow. Possibly this is because suicide is glorified in the press, and
is seen as a heroic act. Of course it isn't.
The treatment of people who want to commit suicide is difficult because it is virtually impossible for them
to identify. Sometimes they conclude a no-suicide contract , and if they refuse, there is reason to go
assume that suicide is on the agenda. Cognitive therapies where one is more constructive
teaches techniques to deal with problems as well.
CHAPTER 8A: EATING DISORDERS

Eating and sleeping disorders are discussed in this chapter . First become the three most
common eating disorders, and in part 8B sleep disorders are treated.
1] bulimia nervosa
2] anorexia nervosa
3] binge eating disorder
>> BULIMIA NERVOSA

The characteristics of bulimia nervosa are:
Binge eating
Individuals eat large quantities, and usually in short periods ( binge eating ). They have this
the feeling of being out of control and unable to control food intake.
Compensating for eating
One compensates for taking in large amounts of food by applying
purging techniques ( vomiting the stomach) by vomiting , laxatives or diuretics .
Self-image and self-image
Self-confidence is very much influenced by the image of one's own body.
Two subtypes can be distinguished :

Purging type : individuals use purging techniques to empty the stomach
Nonpurging type : individuals use other techniques, such as training or fasting
The purging type is more serious and has more incidental psychological problems such as anxiety - or
mood disorder .
Bulimia with purging often has major physical consequences. Teeth are damaged by the acid,
glands erect and there is a risk of an imbalance in the sodium and potassium levels
in the body ( electrolyte imbalance ). When using laxatives, the kidneys and the
intestines often damage.
The risk of anxiety and mood disorders is greater in people with bulimia. At 75% there is
anxiety disorders as social phobias. Depressions seem to follow from bulimia (not the other way around, like
long thought). Also, substance abuse is common in this individiueen.
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>> ANOREXIA NERVOSA

The biggest difference between bulimia and anorexia nervosa is that individuals in the latter case (extremely)
be successful in losing weight. They are proud of the extent to which they lose weight and the degree of control
they have about themselves. People with bulimia are ashamed of the weight and the lack of it
own check. The clinical features are:
Low body weight
Individuals have a body weight that is less than 85% than what can be expected.
Fear of gaining weight
Individuals are extremely scared to arrive and prefer to see constant weight reduction
Disturbances in self-image
One has a strongly disturbed image of one's own body, and continues to see it as fat.
Absence of at least three menstrual cycles
There is amenorrhea , which means that they have at least three consecutive menstrual cycles
have missed.
The problem is that these people often do not seek help because they do not see what condition they are in
are in trouble. Moreover, they are often good at saying what people want to hear ("yes, I am a bit thin."
and something must arrive ').
The most serious physical consequence is amenorrhea . But there are other characteristics:
1] dry skin, nails and hair
2] black thin hair on the cheeks and arms ( lanugo ).
3] cardiovascular problems due to the lack of nutrients
Associated disorders are mainly mood disorders and mainly obsessive

compulsive disorders .
>> BINGE-EATING DISORDER

This condition is characterized by binge eating , but the need to purge does not exist,
or they are not followed (so there is no question of fasting, training or vomiting). Currently this is
disorder still mentioned in the DSM attachments, but it seems to be a separate disorder. One finds this
people mainly in waste groups or groups that help people who over-eat . Binging often finds
place to get rid of a nasty mood ('eat when you feel bad').
>> COMBINED STATISTICS

90-95% of people with bulimia are women, more than half of men are gay or
bisexual. The age of onset is usually early, and is between 16-19 years old. The lifetime prevalence is
1.1 to 4% for women and 0.1% for men. As women get older, the chance also falls,
because bulimia mainly occurs in young women.
The same distribution applies to anorexia , as 90-95% are women. It is rarer that bulimia , but
is starting to occur more often, especially in Western cultures.
Eating disorders occur mainly in women in a medium to high social class who are white
origin. People of dark descent rarely suffer from these disorders, and that comes
probably because people attach much less importance to what the body looks like.
Anorexia occurs rarely in children under 11, and is often more dangerous there because
children also stop drinking.
>> CAUSES
Again, a number of classes of influences are recognized
1] social influences
2] biological influences
3] psychological influences
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The following social influences are distinguished:

Cultural standard
The cultural norm for what is beautiful currently expects unrealistic thin figures from women
(and to a lesser extent in men, where muscularity is especially important). See these standards
practically impossible to achieve, and moreover lead to an increase in diet and exercise
to fall. Women systematically find themselves more important than their ideal or what they want
expect men to like it. Men, however, do not prefer that women give them
attribute. The same also happens with men and their desire for muscularity.
Specific pressures
In some fields, such as dance, there is great social pressure to lose weight. Eating disorders occur
considerably more often.
Familial influences
The mothers of girls with eating disorders are often perfectionist , often doing various activities themselves
and are concerned about possibly being overweight with their daughter.
The following biological influences are distinguished:

Genetic influences
Studies on heredity seem to point to a genetic vulnerability. Probably this is
not specifically for eating disorders, but more generally for the way people with stress
deals with or has control over one's own impulses. These studies have yet to be confirmed.
Hypothalamus
Various neurotransmitters appear to be less common in people with eating disorders (such as one
lower level of serotonin , which inhibits impulsivity). However, it is not known whether this is the cause, because
it is more a consequence of the disorder than vica versa.
The following psychological influences are distinguished

Distorted body image
Individuals with eating disorders often have a serious disturbed image of their own body.
People find themselves too fat, while they are not.
Anxiety relief by purging
Emptying the stomach after a period of binging air on, and thereby strengthening itself. Chance
that people start to use it more often then increases.
An integration of these influences places particular emphasis on social factors. Become individuals
possibly born with genetic or psychological vulnerabilities, but develop eating
disorders mainly due to cultural norms and the resulting pressure. On page 251 this is
schematically shown.
>> TREATMENT
The treatment of eating disorders rarely benefits from the use of medication . They can
short-term help, but those effects are also usually short-lived. The best treatments
consist of psychosocial treatments:
Bulimia Nervosa
The best treatment is cognitive-behavioral therapy (CBT), where one tries on attitudes about it
taking away weight and food and changing eating patterns. Another effective treatment is
the inter-personal psychotherapy (IPT), which is improved interpersonal functioning. CBT
works faster than IPT, but after a longer period (> 1 year) the effects are about the same. The
administering additional drugs (such as SSRIs and tricyclics) can support the process.
Anorexia Nervosa
One starts with a physical treatment, in which one tries to regain the body weight somewhat
make normal. Thereafter, treatments such as CBT and IPT can be used. People focus
but also to the families of the patients, and tries to achieve two things there:
1] communication : people try to eliminate negative and dysfunctional communication about food
2] Attitudes : Attitudes about weight, food and appearance are discussed
Binge eating disorder
CBT and IPT also work here. However, it appears that self-help also works. You will receive one at home
self-help guide and first get started. One can at least start with this.
The main treatment consists of the prevention of the disorder. People are encouraged to do this
on those that belong to a risk group, and treats them with a method that involves normality
of the body weight and the physical damage of the disorders (and the purgen ).
Page 37
There are also some other eating disorders:

Rumination disorder
An individual chewed what he ate, by getting it back from the stomach (how you do that
is a mystery to me). The treatment is usually easy to combine with chewing
a nasty stimulus (such as spraying lemon juice in the mouth). It can also occur in people
with bulimia, and in these cases regular psychosocial treatment such as CBT or IPT helps.
Pica disorder
People eat things that are not edible, such as stones, iron or wood. This mainly occurs in people
that are mentally less developed, and is of course dangerous. Maybe these people are putting this on
to pass the time. In any case, operant conditioning also helps here.
Feeding disorder
Children absorb too few nutrients, and therefore experience a failure to thrive . This means
that they do not grow quickly and often have serious problems. Common with chaotic
family circumstances.
CHAPTER 8B: SLEEPING DISORDERS

The study of sleep has been taking place since the beginning of psychology. Sleep disorders are coming
common with people with other disorders (such as mood and anxiety ). Possibly because it is limbic
system , which is also important with these disorders, is also important with the REM trail ; the period of
the night we dream. Sleep disorders are divided into two categories:
1] dysomnias : sleeping is not easy, and people experience many problems with sleeping
2] parasomnias : abnormal behavior or events while sleeping, such as sleep walking.
The best representation of the sleeping pattern is given by a polysomnographic evaluation ,

whereby a patient is put to sleep in a lab and observes and monitors aspects of sleep there:
1] electroencephalograph : brain activity
2] electrooculograph : eye movements
3] electromyograph : muscle movements
4] electrocardiogram : heart activity
Because this is rather cumbersome, two other, simpler methods are often used:
Actigraph : a kind of watch that measures body activity while sleeping
Sleep efficiency : you determine how long someone is in bed and how long they actually sleep
>> DYSOMNIAS
Dysomnias fall into a number of groups:
1] Primary insomnia : people experience problems falling asleep or holding on to sleep
2] Primary hyperinsomnia : people sleep 'too' too much and also fall asleep during the day
3] Narcolepsy : people suddenly fall asleep during the day
4] Breating-related disorders : people experience sleeping problems due to problems with breathing
5] Circadian rhythm sleep disorders : people have a disturbed sleep rhythm
PRIMARY INSOMNIA
A primary insomnia is not related to other psychological or physical disorders:
1] difficulty sleeping : people have difficulty falling asleep / staying asleep for more than 1
month
2] distress : people experience significant stress as a result of sleeping problems
3] other : the problems do not occur exclusively during other sleep disorders
4] mental disorders : the problems do not occur exclusively during other mental disorders
5] drugs : the problems are not the result of the use of drugs or drugs
Insomnia in its most extreme form (complete sleeplessness) can be fatal ( fatal familial)
insomnia ). Even in very poor sleep compensates the body microsleeps , wherein
falls asleep for a few seconds.
It occurs in a third of the population, and twice as often in women (probably there)
pay more attention or seek help for it sooner). A large part comes from the elderly, but that's it
often normal because they usually need 6 hours of sleep (but still lie in bed for 9 hours).
Page 38
The influences fall into the usual three-part:

Sometimes the temperature rhythm of the body is disturbed, and the body does not become less hot
before they go to sleep. In other cases, the use of medication or sleeping in one
troubled environment cause problems.
Psychological influences
Psychological stress for certain events (driving test, exams, etc.) can lead to
trouble sleeping. Often people with sleeping problems experience aniety when they don't fall asleep,
because they have unrealistic attitudes about sleep ("I get trouble without sleep," "I have to respect eight."
hours of sleep ', and so on).
Social influences
The culture in which one lives has a major influence. In many other cultures, children sleep by the
parents in bed, and problems with sleep are less common there.
Again, there is an integrative model , involving certain biological vulnerabilities
interact with sleep stress (various non-biological factors that negatively influence sleep). Also
the way one responds to sleeping problems can make it worse. The use of medicines
often helps temporarily, but when one stops, one experiences rebound insomnia , and quickly grabs again
pills. Taking a nap during the day can also cause problems.
PRIMARY HYPOSOMNIA
People sleep too much with primary hyposomnia . The characteristics are:
1] excessive sleepiness : people fall asleep during the day for more than 1 month
2] distress : falling asleep during the day leads to significant stress for the individual
3] other : it is not caused by disorders that make sleep difficult (eg insomnia)
4] mental disorders : it does not occur exclusively during certain other mental disorders
5] drugs : it is not the result of the use of drugs or medicines
Little else is known about it (which saves our learning work again)
NARCOLEPSY
With narcolepsy there is hyposomnia and cataplexy - a more extreme variant:
1] attacks of sleep : one is suddenly attacked by sleep for at least three months
2] cataplexy : you lose muscle tension spontaneously (to a slight or severe extent)
3] REM : REM sleep occurs spontaneously during the day, without the previous nREM phases
4] drugs : the problems are not the result of drugs or medication
People often experience hypnagogic hallucinations during spontaneous REM sleep ; experiences
that are extremely realistic (such as kidnapping by aliens). There is little left
known, but the disorder appears to be partly genetically engineered and is rare in the population.
BREATHING SLEEP RELATED DISORDERS

Some people are sleepy during the day because they do not sleep well at night due to physical problems:
1] sleep disruption : a disruption of sleep that leads to daytime fatigue
2] other : the disturbance cannot be better explained by other disorders or medicines
In most people, breathing is slightly blocked ( hypoventilation ) while in others
briefly blocks completely ( sleep apnea ). There are three forms of this:
1] obstructive sleep apnea : the supply of oxygen is blocked even when breathing is still working
2] central sleep apnea : breathing stops completely for certain periods
3] mixed sleep apnea : this is a combination of the above variants.
CIRCADIAN SLEEP RHYTHM DISORDERS

If sleep is disturbed because the biological clock cannot adapt to it
new rhythm, there is circadian sleep rhythm disorder :
1] schedule mismatch : drowsiness caused by an asynchronous sleep and life rhythm
2] distress : the disorder leads to significant stress in the individual
3] other : the disorder does not occur exclusively during other disorders
4] drugs : the disorder is not caused by drugs or drugs
A distinction is made between three types:
1] delayed sleep phase : one wakes up late and goes to sleep late, and can hardly change that
2] advanced sleep phase type : reverse of the above
3] jet lag type : sleepiness and vigilance occur at the wrong times of the day
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4] shift work type : insomnia during sleep periods and sleep during work periods due to work schedule
Our sleep pattern is set by the suprachiasmatic nucleus , which is the biological clock
always equals the periods of light and dark. The melatonin substance is released when it is dark
and makes us feel sleepy. The release rhythm is often disturbed in this disorder.
TREATMENT OF DYSOMNIAS
The treatments fall into a number of groups:
Medical treatment
People often use sleeping pills ( benzodiazepines ) such as triazolam or flurazepam .
Some work only briefly, others longer. However, they have three disadvantages:
1] excessive sleep : they can cause an extreme need for sleep, even if they no longer want to
2] addictive : they are addictive
3] short treatment : treatment is not intended for more than four weeks
People with
Problems onehypersomnia
can often usereceive stimulants
to reduce as ritalin
muscle tension in .the
Bythroat
breathing
or surgery.
Environmental treatment
With circadian sleep rhytm disorders one can often use ligh-exposure techniques ,
exposing people to light. You can reprogram sleep patterns with this.
This treatment can be divided into a number of types:
1] cognitive : people try to eliminate unrealistic attitudes about sleep
2] cognitive relaxation : people are taught to relax themselves before going to sleep
3] graduated extinction : (for children). Parents often read and check, but they do not do so as often
4] paradoxical intention : people with sleeping problems are tried to stay as awake as possible
5] progressive relaxation : people are taught to systematically relax muscles to get tired
However, prevention is equally important, and people try to sleep healthy people ( sleep
hygiene ).
>> PARASOMNIAS
Parasomnias are abnormal events during sleep. There are two kinds:
1] parasomnias occuring during REM-sleep
2] parasomnias occuring before or after REM sleep
The first group includes:

1] nightmares : anxiety dreams that wake you up (are fairly normal)
2] night terrors : especially with children, extremely anxious and realistic dreams
The second group includes sleep walking , in which people become active and go to sleep
walking, eating, etc. Little is known about it, but it is not dangerous to wake these people up in any way
while walking around. 6% of the population with sleeping problems sometimes show nocturnal
eating syndrome , where people eat at night (I think this is typically American).
CHAPTER 9: PHYSICAL DISORDERS AND HEALTH PSYCHOLOGY

Research into the causes of physical disorders, with a clear physical cause ,
has led to the conclusion that they are also influenced by psychological and behavorial factors.
Stress, for example, can greatly aggravate a disease, but a lack of social support can also.
It used to be called the field that this factors investigated psychosomatic medicine , which meant
that psychological factors influenced somatic complaints. This term is no longer used
because it suggests that mental disorders, as discussed further, have no physical basis.
Two fields have now developed:

Behavioral medicine
Knowledge from the behavioral field is applied to prevent diseases and combat symptoms
to speed up the treatment. In this field doctors work together with psychologists.
Health psychology
In this field, where only psychologists work and what a sub-field of behavioral medicine is
looked at psychological factors that are important for the promotion and maintenance of the
health. People are also looking for how to prevent diseases; prevent acquisition .
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>> PSYCHOLOGICAL AND SOCIAL FACTORS THAT INFLUENCE THE BODY

Stress is the factor that gets the most attention. It not only influences the development of
mental disorders, but also those of some physical disorders (such as AIDS).
Selye discovered that certain environmental factors in rats caused health problems. He
this was called stress . His theory describes three phases in which the body responds to stress:
Alarm internship : the body reacts to a certain danger or threat
Resistance stage : the stress continues, and the body uses resources to carry it
Exhaustion stage : the stress continues and the body sustains permanent damage
This is called the general adaptation syndrome (GAS). Stress is then defined as the
physiological response of the body to a stressor .
The endocrine system is activated in response to stress according to this step-by-step plan:
1] hypothalamus : secretes corticotropin release factor ( CRF )
2] pituary gland : in response to CRF, secretes a substance that instructs the adrenal glands
3] adrenal glands : secrete cortisol (the stress hormone) that ends up with the
hippocampus
4] hippocampus : switches, in response to cortisol, the stress response from weather
This is the HPA axis (see first letters). The final step, switching off the stress response, is possible
however, become problematic if the amount of cortisol is too high. Then the hippocampus runs
damage, and is less able to brake. This creates chronic stress that reinforces itself.
Sapolsky investigated baboon stress and discovered that males at the bottom of the
chain found to have a continuous higher base level of cortisol in their blood. Moreover it worked
the immune system with them less well. How is this possible? Sapolsky distinguished two factors:
Predictability
The feeling that people know what is coming is reassuring and reduces stress.
Controllability
This is the most important factor. Males at the bottom of the chain had no control, males
literally all control at the top. This also includes the ability to stress to their own control .
Our responses to stress depend on our sense of control over stress:
Excitement : a lot of control
Stress : little control
Anxiety : almost no control (imagined or not)
Depression : every form of control has been specified
There appears to be a strong relationship between emotional and physical disorders. Vaillant discovered
that students who developed emotional problems died earlier.
>> THE IMMUNE SYSTEM AND PHYSICAL DISORDERS

Stress increases the chance that we, for example, get a cold. Indeed, stress influences
the functioning of the immune system . Having a sense of control can stress
prevent or decrease, and is therefore good for the functioning of the immune system
Antigens are intruders in the body. Viruses, bacteria, but also cells of your own body
must be broken down. The immune system has cells that protect the body:
Leukocytes
Macrophagen, the best-known leukocyte, is the first line of defense. They identify and
surround antigens and destroy them and called lymphocytes on
Lymphocytes
Lymphocytes consist of B and T cells.
And B and T cells again consist of all other types (See also scheme 9.5, page 284):
B Cells
Are part of the humoral part of the immune system and release molecules that otherwise
detect and neutralize. They also release immunoglobulins that destroy antigens. After one
antigen has been destroyed, split a B cell into another B cell and a memory B cell . This last one
'remembers' the configuration of the antigen so that the immune system responds faster next time
on the same kind of intruder.
T Cells
Are part of the cellular part of the immune system and attack antigens directly. A
the killer T cells are an example . Memory T cells also arise here if antigens are destroyed. There
Page 41
are also helper T cells (T4) that strengthen the immune system and surpressor T cells that it
to suppress.
People should have twice as many T4 cells as surpressor T cells. If there are too many T4 cells,
does the immune system attack the body itself; an autoimmune disease , such as rhematoid arthritis .
With too many surpressor cells, the body is susceptible to diseases. It appears to be possible to feed animals and
to condition people to weaken or strengthen their immune system. The study that this
investigates is called psychoneuroimmunology and looks for psychological influences
the functioning of the immune system.
AIDS
AIDS starts with HIV , simply carrying a virus (that still 'sleeps'). If small
health problems arise, there is AIDS-related complex (ARC). A diagnosis of
AIDS occurs when the symptoms get worse. Studies show that treatments to stress
reduce and control well help to develop HIV or AIDS (just established or already
developed).
CANCER
Also cancer is influenced or even caused by psychological factors. The study that this
investigates is called psychoncology . Here too it appears that studies that help people cope with stress
start stagnating the development of the disease. People who experience great stress as a result of the
disease, or taking care of someone with the disease, often have a reduced immune system.
>> CARDIOVASCULAR PROBLEMS

The cardiovascular system includes hard, blood vessels and the control mechanisms that control hair
regulate. A lot can go wrong, and that leads to cardiovascular diseases such as strokes or, more
general, cerebral vascular accidents .
HYPERTENSION
High blood pressure, hypertension , is harmful to the body. It is caused by the narrowing of
blood vessels, which means that it must beat harder (and wear more). Usually the cause is not
known and essential hypertension is mentioned . Too high a blood pressure is 160 over 95,
with values representing and occurring in more than 20% of people between 25 and 74:
Systolic pressure : 160; the pressure as the heart pumps
Diastolic pressure : 95; the pressure if the heart is not pumping
High blood pressure occurs in 20% of people 25-74 and twice as often in black people
have a higher basic blood pressure. It is partly hereditary, and there are two causes:
Autonomic nervous system activity
Upon activation of the sympathetic part of the ANS, the blood vessels narrow. Blood pressure rises.
The SNS is strongly influenced by the degree of stress that someone experiences.
Sodium regulation in the kidneys
Holding on too much salt, which happens through the kidneys, leads to thicker blood and requires a higher one
blood pressure. People with high blood pressure must therefore not absorb much salt.
Stress, personality style and dealing with anger are major influences.
CORONARY HEART DISEASE
In coronary heart disease , the heart receives too little or no blood due to a blockage of the main
veins. There are many types:
Angina pectoris : chest pain due to a partial blockage of a heart vein
Atherosclerosis : the build-up of plaque in a heart vein and the gradual blockade as a result
Ischemia : a lack of blood in a body part due to narrow vessels or plaque
Myocardial infarction ( heart attack ): death of heart tissue due to lack of blood
Sensitivity to CHD is hereditary, but there are also psychological, cultures and social influences.
A distinction is made between two types of people who are more and less susceptible to CHD :
Type A
People who are in a hurry, get irritated quickly, are very competitive and have a lot of energy. This one
people are two to three times as likely to have heart problems.
Type B
People who are not what A is; relaxed and calm
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There are strong cultural differences. Hardly any type A people are found in Japan. With the Type A
personality is primarily the degree of anger that people experience. It reduces the efficiency of
the heart. More generally, the negative effect , including depression, anxiety, etc., appears to be problematic.
>> CHRONIC PAIN

There are two types of pain:
Acute pain : pain that follows an injury and disappears after treatment or rest
Chronic pain : pain that follows an injury (or something) and does not disappear
The latter type is mainly influenced by psychological and social factors. One makes
a distinction between a number of related terms (this is the emotion triad):
Pain : the subjective sensation
Pain behaviors : the behavior that results from pain
Suffering : the emotional component of pain
However, the severity of the pain does not seem to affect people's response. Some people experience it
extreme pain, and functioning normally, while others become completely disabled as a result of the pain.
There are a number of psychological factors:

Sense of control : There is less stress and pain if you have a positive view of the future.
Attitudes towards pain: People who experience pain as terrible also experience more pain.
Experience of pain : People who focus on pain also experience more pain
There are also social factors:

Operator control
If the environment suddenly gives a lot of attention to an individual, the pain can get worse. Men
here, as it were, the pain behaviors , because they lead to attention.
Social support
Strong social support leads to faster reintegration with society. One reduces the
degree of stress that an individual experiences.
There are a number of additional biological explanations for pain:

Gate control theory
Various pain nerves occur in the body. A delta for short and sharp pain ( small
fibers ), C-fibers for dull pain and A-beta (or large fibers ) to inhibit the pain. An area in it
brain, the dorsal horns or the spinal column serve as a gateway to the rest of the brain, and determine
how much pain can go through. Small fibers open the gate, large fibers close the gate and the brain can
also determine the position.
Endogenous opioids
There are two opiates ( endogenous opioids ) in the body that inhibit pain; endorphines and
single-legged . The brain uses them to inhibit pain, even with serious damage. People with a
Higher levels of self-efficacy have higher pain tolerance and produce more endorphins
response to pain.
There are also differences between men and women. In men, the endogenous opioid system appears
stronger, where women have an additional system that runs synchronously with the estrogen
level and has been developed to withstand that pain.
>> CHRONIC FATIGUE SYNDROME
In the old days, a feeling of tiredness was called neurasthenia ; weak nerves.
Nowadays this is called chronic fatigue syndrome (CFS) and is spreading rapidly:
1] fatigue : a fatigue with no physical cause of at least 6 months
2] symptoms : at least four symptoms that indicate pain, fatigue or dysfunction of the body
At first it was thought that it was caused by physical things, such as a virus. This is not
impossible, but it seems that psychological factors are more important.
Sharpe states that people live purposefully (and perhaps a sense of worthlessness)
especially vulnerable. They undergo a period of stress or illness and attribute the longer term
symptoms, as tiredness, as caused by the disease. They expect taking rest
it corrects the problem, while it actually makes it worse (because that way you lose condition, and so on).
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Medications don't work, but a Sharpe method that tries to increase the activity of participants
increase them, teach them a good sleep rhythm and teach them how to deal with stress, is proving extremely good
to work.
>> PSYCHOSOCIAL TREATMENT OF PHYSICAL DISORDERS

Besides that pain is annoying, it also seems to increase the chance of more problems. Possibly because of pain
reduces the number of natural killer cells in the immune system. The administration of pain medication, or
better yet, administering pain treatment seems a good solution. A number of methods:
Biofeedback
With biofeedback, the patient is made aware of a number of bodily functions, and let them try
to influence that. People appear to be able to indicate what the status of their ANS is, but are
no longer used to that skill.
Relaxation and meditation
People are allowed to relax with special techniques, such as deep muscle relaxation , where the
focus focuses on muscle tension. With transcendental meditation , attention is focused on it
repeating a mantra. A more simplified variant is the relaxation response , where one
simple word, as 'one', repeated in the head.
Stress and pain reduction program
People first learn to determine their own level of stress. Then they learn relaxation techniques
systematically relax muscle groups. Moreover, people try unrealistic attitudes
away from stress and one's own life. People are also developing ways of dealing
with stress and planning your own time. The effectiveness of these programs becomes less than
people make chronic use of anti-pain or anti-stress agents.
Denial , denying problems, is often seen as a negative influence. Still it is possible

help, because it makes it easier for people to take the first shock, such as an AIDS
diagnosis, and appears to reduce the level of stress. Denial can help, but on
specific moments.
At the beginning it appeared that psychological and social factors can directly be biological factors
but that this can also be indirectly influenced by lifestyle. Unhealthy food, smoking and lack of
Movement are the three greatest risk-increasing styles. There are a number of interesting areas:
Injury control
The number one cause of death, especially among children, is injury. Moreover, the loss of
Productivity is often much greater. Attention is therefore paid to educating children
how to prevent injuries of various kinds.
AIDS prevention
The only strategy currently to combat AIDS is to prevent it. People are trying to
groups, such as homosexuals and prostitutes, as much as possible.
Smoking in China
Smoking is a big problem in China, and one uses the strong family ties to
convince children not to smoke.
Stanford Three Community Study
A study within three comparable municipalities in the US showed that large media attention works,
but that individual counseling and information work much better.
Page 306-307 contains a schematic representation of what has been discussed in this chapter.
CHAPTER 10: SEXUAL OR GENDER DISORDERS

One has to wonder here if sexual behavior is abnormal (a disorder). They handle it
criterion that sexual behavior must lead to clinically significant stress. There are then three groups:
1] gender identity disorders : people are dissatisfied with their own biological sex
2] sexual dysfunction : people experience problems with having sex
3] Paraphilia : there is a strong deviating sexual preference
>> WHAT IS NORMAL?

Studies have shown that the vast majority of men only at heterosexual sex does
(97%) and that 2.3% were bisexual and 1.1% homosexual . The use of condoms is
increased to still moderate 41% (of 17%) and risky sexual behavior, such as oral or
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anal sex or many sexual partners occur regularly. As people get older
sexual activity, but not as strong as people sometimes suspect. Only around the age of 80 does
50% of men and 36% of women still have sex.
There are a number of gender differences :

Masturbation
Men masturbate more often per week than women, and men masturbate more often (75 against
45%). Possibly because women associate sex with romance and men with physical
satisfaction, for which masturbation is suitable. Possibly also because men can be easier
masturbate than women.
Casual premarital sex
Men are milder compared to sex before marriage than women.
Studies show that women still (despite the sexual revolution ) have a more negative schedule
have sex. They are conservative in their views and are ashamed of it. Men are there
more open, aggressive and progressive. However, the double standard for women has disappeared, because
women no longer have to meet unrealistic sexual norms and values, but the
negative schemes still exist.
There are also cultural differences , in which there is a completely different view of what is seen sexually
is normal. The age at which sex is allowed, for example, or the opinion about homosexuality. About
homosexuality , by the way, has a lot to say. Studies show that there is a genetic influence,
but just like with disorders, this seems more like a biological predisposition (I don't want it to be 'vulnerability')
in this context). Bem drew up the exotic becomes erotic model, in which he states that
boys who separate themselves early from other boys and play with girls attracted
start to feel that group they don't belong to (in this case the boys). With boys who do with the
boys group, interest in girls arises.
>> GENDER IDENTITY DISORDERS

There is a gender identity disorder and the physical sex of an individual emotionally
does not match your own gender identity . The characteristics are:
1] cross-gender : strong identification with the opposite sex (that gender whatever one feels)
2] discomfort : people feel uncomfortable with their own body
3] no intersex : the individual is not a hermaphrodite (naturally has both biological sexes)
4] distress : the disorder causes clinically significant stress
One must also distinguish it from transsexualism , where one is (usually) excited
of dressing in women's clothes (or men's clothes). This is a paraphilic disorder .
Little is known about the causes :

The male fetus may be exposed to too many female hormones (and vice versa at
a female fetus).
Social influences
Possibly excessive attention and physical contact of the mother play a role,
Three treatments are possible:

Sex reassignment surgery
The physical gender is changed during an operation. This is not a simple procedure, and
is furthermore preceded by a trial period, in which the individual already has the desired one
takes on identity and determines whether he or she likes it. 7% nevertheless regret the
operation, which is difficult since it is not reversible.
Psychosocial treatment
Psychological treatment cannot change the physical gender, but one can change the gender
try to change identity . That's how they succeeded a boy who felt like a woman
to make oneself feel man again and to be attracted to women.
With hermaphrodites (who are born with ambiguous genitals) was often immediately after the
operation removes one of the sets, so that the gender identity was established. These days it will be
reconsidered its position, since it does not seem to be the most meaningful approach.
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>> SEXUAL DYSFUNCTIONS
Sexual dysfunctions expressed themselves in difficulty with sex, albeit through pain or other problems. They have
relate to the three phases of sex:
1] desire
2] arousal
3] orgasm
Furthermore, disorders are classified on the basis of three dimensions:
Lifelong - acquired
The disorder is either chronic or has occurred after a period of normal functioning ( acquired )
Generalized - situational
The disorder occurs in every situation, with every partner ( generalized ), or in a specific situation or
with a specific partner ( situational ).
Psychological factors - combined factors
The disorder is the result of only psychological factors or a combination of psychological and
physical factors.
SEXUAL DESIRE DISORDERS

A distinction is made between two disorders that relate to the lack of sexual desire:
Hypoactive sexual desire disorder
An individual has little or no interest in sex. They don't masturbate, don't think about it and do it
not on. Decreases with age in women, and increases in men (and is more common in women).
Sexual aversion disorder
An individual experiences a panic attack when thinking or experiencing sex. A quarter classifies for
real anxiety disorders, and usually they are the result of past nasty experiences with sex.
SEXUAL AROUSAL DISORDERS

One has no difficulty here with the generation of desire , but with the generation of arousal (or
an erection or a moist vagina). Formerly also called impotence . Everyone has here sometimes
but it classifies as disorder if it occurs consistently. For men this disorder is the
most common, but less common in women. Possibly because it's for women
it is more difficult to determine whether or not they have experienced orgasm.
ORGASM DISORDERS
There is no problem here with generating desire or arousal , but with getting one
an orgasm . A distinction is made between two types:
Inhibited orgasms / Male orgasmic disorder / Female orgasmic disorder
It is difficult for them to cum, or it is going too fast ( premature ejaculation ). This is coming a lot
more common in men than in women. Note that everyone sometimes has this, but that diagnosis
occurs if the problem occurs consistently. There are two other rarer variants:
1] retarded ejaculation : a man arrives late
2] retrograde ejaculation : the seed does not come out of the penis, but goes back into the bladder (ouch?)
Sexual pain disorders
If one experiences pain during intercourse, there is a sexual pain disorder . If the pain is like that
is serious that the sex must be stopped, there is dyspareunia , and is more common
women. The less serious variant vaganism occurs only in women, and consists of light
pain during sex.
>> ASSESSING SEXUAL BEHAVIOR
The assessment of sexual disorders includes three aspects:
Interviews
People ask questions to the individual, paying particular attention to language (not too difficult) and it
conveying the idea that the psychiatrist / psychologist is at ease when talking about sex.
Because people do not always want to talk about everything, it is also possible that people enter surveys or questionnaires
let fill.
Medical examination
One examines the individual. It is determined whether certain drugs or recent operations for that
cause problems. They also monitor heart function and hormonal levels.
Psychophysiological assessment
One checks, in a number of ways, whether an individual can become aroused :
1] penil strain gauge: as soon as the pennis swells, it is registered on a polygraph
2] vaginal photoplethysmograph: a kind of tampon that enters the vagina and measures excitement
Page 46
3] nocturnal penile tumescence: the penis is tied at night. at an erection she shoots loose. This is rarely used.
Usually one shows the individual a porn movie, during which the responses are measured.
>> CAUSES OF SEXUAL DYSFUNCTION

There are again a number of influences, which are subdivided into a few groups:
1] biological influences
2] psychological influences
3] social and cultural influences
A distinction is made between the following biological influences:

Medical conditions
Many
can getmedical
excited.conditions
As: and various neurological disorders influence the extent to which someone
1] diabetes : diabetes
2] arterial insufficiency : blood vessels are narrowed, making it difficult for blood to reach the penis
3] venous leakage : the blood runs out of the penis quickly
4] chronic illness : people with a heart attack, for example, are often afraid of the effort that comes with sex.
Medications and other substances
Various drugs, including anti-depressants but also alcohol and drugs often suppress it
autonomic nervous system. This system is needed to get excited.
A distinction is made between the following psychological influences :

Arousal
People with sexual disorders expect the worst when they have sex. Arousal takes care of it
that people focus more on sex, but people with a disorder start focusing more on sex
negative thoughts ( negative affect ), making problems more serious. Then will
these people try to avoid sex , so that problems only get worse.
A distinction is made between the following social and cultural influences:

Early traumatic sexual experiences
People who have experienced traumatic sexual events, such as rape
more sexual problems later.
Script theory
In many cultures there are certain attitudes (and myths) with regard to sex. To yourself
read the table on page 331. These attitudes can occur later, if people experience stress
cause problems. An extremely negative set of attitudes to sex is called erotophobia .
In summary, socially transmitted negative attitudes can interact with relational problems
that someone is already experiencing. This can ultimately lead to problems.
>> TREATMENT OF SEXUAL DYSFUNCTION

A number of possible treatments are possible in the following areas:
1] psychosocial treatments
2] medicinal treatments
The following psychosocial treatments are distinguished:

Education
Simple education about sex and the sexual cycle can often solve many problems.
Sensate focus and nondemand pleasure
This program, which focuses on couples, teaches couples in a number of steps to healthy sex
so that problems with one member often disappear on their own. One starts with very quiet
nongenital pleasuring where people kiss and caress each other, but stay away from the sexual areas.
This is gradually built up over the course to complete sexual intercourse.
Squeeze technique
To prevent a man from coming too quickly, the woman squeezes the point in the penis where the
jerk starts. In this way an erection quickly disappears (may I just say 'AUW!', Because that is almost necessary).
Masturbation
In some cases, such as in women with orgasmic disorders, it can teach masturbation
techniques (such as with a vibrator) help.
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The following medicinal treatments are distinguished:

Oral medication
The drug viagra is well known, but appears to be less successful than the media shows. There are often
many side effects (severe headache) and the pleasure one experiences is less. Although the penis is
becomes stiff, sexual intercourse itself is not pleasant for many.
Injection of vasoactive substances
These substances, papaverine and prostaglandin , must be injected into the penis before one
sex wants. As a result, blood vessels expand and lead to an erection.
Surgery
One places a inflatable penis inside the actual penis (or one that is filled with fluid)
can become). This method is often used as a last resort.
Vacuum device therapy
A device is placed around the penis that creates a vacuum. Blood is sucked into the
penis and then stays there. However, it is fairly artificial, and therefore is not very fun
found by people. Yet it works extremely well (70-100%).
>> PARAPHILIA
Some people get excited about non-normal objects. Their arousal pattern is abnormal:
Fetishism
There are thousands of species, but it covers:
1] inanimate object : a non-living object
2] tactile stimulation : a substance that triggers a certain physical sensation (such as rubber)
3] partialism : refers to parts of the body (feet for example)
Voyeurism and exhitibitionism
One observes unsuspecting individuals who undress or are naked ( voyeurism ) or let the
seeing one's own genitals to get excited ( exhihibitionism ). Both mostly turn around
anxiety caused by the risk of being caught. This makes it exciting and therefore interesting.
Transvestic fetishism
People get excited about dressing in women's clothes.
Sexual sadism and masochism
People get excited about harassing or abusing others ( sadism ) or undergoing
harassment and abuse by others ( masochism ). Sometimes this is expressed by hypoxiphilia , where one
ties itself up and suffocates half - making the orgasm stronger. The most serious variant is
sadistic rape , where the raping itself excites people.
Pedophilea and incest
Children get excited ( pedophilia ), which can sometimes relate to their own
children ( incest ). Pedophiles usually only get excited by children, while people get them
incest companies get excited of a maturing body.
It occurs, as expected, mainly in men. Most people who have a paraphilia
often find themselves extremely nasty and dirty, but cannot brake themselves.
>> CAUSES OR PARAPHILIA
There are two possible explanations for paraphilia :
First experiences
We often see the first sexual experiences later. Wrong sexual experiences in the early
childhood can lead to wrong associations about what sex is and when to get excited.
Reinforced fantasies
Early fantasies that one has while masturbating can be created by the orgasm itself
be reinforced. A pedophile can therefore fantasize thousands of times and masturbate about sex with
children, and thereby conditioning themselves. This also explains why paraphilia is almost alone with
men, with whom masturbation is easier than with women.
Strong sex drive
People with paraphilia often have a strong sex drive. Possibly this is an expression of an OCD,
where masturbation forms the obsession, and people try to avoid it. Is problematic
that avoiding often leads to more problems.
>> ASSESSING AND TREATING PARAPHILIA

People often do not know of themselves what the source of their paraphilia is when they seek help.
People often want to get rid of paraphilia rather than be rich, and people themselves are most likely to suffer.
Page 48
There are a number of psychosocial treatments:

Covert desensitization
People are allowed to combine their own source of excitement (in their own fantasy) with the serious
consequence of that source of excitement (being caught by your wife for example). This is extremely possible
to be successful.
Orgasmic reconditioning
People are asked to take more normal subjects for masturbation. This repeat
conditioning eventually leads to more healthy arousal patterns.
Just as with addictions, the chance of relapse is high, so relapse prevention is important. The
The above treatments work for most people.
One can also perform a chemical castration , in which someone swallows pills (such as cyproterone)
acetate) which reduces testorone levels. The injection is more powerful
medroxyprogrestrone acetate. As soon as the treatment is stopped, the paraphilia usually comes again
back.
CHAPTER 11: SUBSTANCE RELATED DISORDERS

Substance-related disorders are associated with taking mind-expanding agents, such as
drugs or alcohol. There is then talk of psychoactive substances , and one is talking about one
four levels of involvement :
Substance Use
Simply using psychoactive substances happens regularly. Caffeine and nicotine
also belong to that.
Substance Intoxication
Our physiological response to the substance ingested. The extent to which this happens depends on the
person and the drug being used. Usually this is a worse one
judgment, changes in mood and reduced motor activity.
Substance Abuse
DSM-IV states that there is abuse if the amount of drugs seriously affects daily functioning
disturbed. Losing work, a relationship or running a major danger because of drugs is therefore abuse .
Substance Dependance (addiction)
There is a physiological or psychological dependence
A definition of substance dependance is difficult, and can be divided into two definitions:
Physical dependance
There is physical dependence when the body builds tolerance to the drugs, and
symptoms of withdrawal shown if the drug is withheld. This happens, for example, in the absence
to coffee, or to remember alcohol in addiction.
Psychological dependance
There is psychological dependence when users have an urge for more and
exhibit allerie behavior to get more.
However, the combination of the above definitions, used in DSM-IV, also means that
more normal things, like sex, are counted as addictions. There is, therefore, often also in the assessment
there is a 'feeling' about the drug.
In earlier versions of DSM, sociopathic personality disturbance was mentioned . Abuse

of drugs was not a disorder in itself, but a symptom of the aforementioned disorder.
Although the abuse of drugs has now 'given' its own disorder, it is still true that the
characteristics can be caused by other mental disorders. Patients no longer
taking medication for depression, can also show withdrawal symptoms. In that case
no diagnosis for drug abuse.
A number of types of drugs are now being discussed:

1] depressants : substances that lead to suppression of behavior and mood
2] stimulants : substances that make us more active and alert, such as cocaine, caffeine, etc.
3] opiates : substances that reduce pain and induce euphoria
4] hallucinogens : substances that change sensory perception and can induce dillusions (etc)
5] other drugs : other substances that do not belong in the other four.
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>> DEPRESSANTS
These substances reduce the activity of the CNS and lead to less stress and tension:
1] alcohol
2] sedative, hypnotic & anxiolytic drugs
ALCOHOL USE DISORDERS

Abuse of alcohol leads to alcohol use disorders . Alcohol is produced in one
fermentation process in which yeast reacts with sugar and leads to alcohol. The effect of alcohol on the brain
is more complex than that of other drugs. It only inhibits the inhibition centers in small doses
brain, but with larger doses, other parts of the brain are also suppressed.
The path that alcohol goes through upon ingestion is as follows:

1] stomach : it enters the stomach through the throat where parts are absorbed
2] intestines : a part enters the kidneys, where it is easy to get into the blood
3] lungs : a part goes to the lunge and is exhaled there (the basis for bladder tests ).
4] liver : it is broken down in the liver.
The use of alcohol has a few consequences:

Effects on GABA
GABA is an inhibiting transmitter and is released with alcohol. It ensures communication
between neurons is more difficult. Because GABA is also related to anxiety , it seems likely
that the anti-anxiety effects of alcohol also have to do with GABA.
Effects on Glutamate
Glutamate is an exciting transmitter. It helps to fire neurons, and is primarily related and
learning and memory. The blackouts that sometimes come with alcohol use may come from here.
Withdrawal effects
Abstinence from alcohol usually leads to serious physical problems, including shaking hands and
nausea. The most serious is the withdrawal delirium or the delirium tremens , involving people
experience terrifying hallucinations.
Organic damage
Alcohol leads, in the long term, to serious damage to the blood vessels, liver and brain. Or
neurons actually die, the question is, because studies show that rather the connections between
neurons die off - and they can come back if you stop drinking. Alcohol use
however, can lead to some form of dementia or damage to wernicke's area , leading to
intelligent speech, confusion and difficult muscle coordination. Possibly this is because alcohol is the
uptake of thiamine , a building material of the brain.
Fetal alcohol syndrome
Mothers who drink run the risk that the fetus will be affected. Possibly there is one
certain predisposition in babies, by having the enzyme 3ADH ( 3-alcohol dehyrdogenase ).
The use of alcohol is currently decreasing slightly. Use is still highest among whites, and is
especially higher the higher the education is. Men drink more and drink more than women
often heavier than women. There seems to be a correlation between the amount of beer you have
drinks a week, and the numbers you get. About 10% seem to have problems with alcohol,
where men are the most vulnerable. The number of addicts is very high, especially among homeless people
is because alcohol helps them deal with the disappointment and hopelessness of the situation.
It was thought that as soon as problems arose with drinking, they would also become more and more serious
nothing is done about it. Jellinek discovered these four phases of development based on
returned surveys of 89 individuals from a population of 1,600 drinkers surveyed
addicts:
1] prealcoholic stage : people drink regularly, but there are no problems
2] prodromal stage : people drink heavily, but there are few visible problems
3] crucial internship : there is a loss of control and people 'drink'
4] chronic stage : primary activity in one day is ... drinking beer (like the wanderer 50m here
from)
The study turned out to be wrong. The group was too small, and the conclusions were not justified. Although
it is still believed that the development of alcohol dependance is progressive (the
dependence increases with continuous use), people no longer agree that alcohol abuse
Page 50
also progressively increases. Although alcohol can lead to more aggressive behavior, alcohol should not be used
come to see it as the cause of rape, abuse, and so on. That is just a correlation.
SEDATIVE, HYPNOTIC OR ANXIOLYTIC SUBSTANCE USE

Sedatives calm us down, hypnotics help us to fall asleep and anxiolytics prevent anxiety.
There are two known drugs that belong to these classes:
Barbiturates (Amytal, Seconal, Nembutal)
A hypnotic that helped people sleep. It was the first medicine of this kind, but it turned out
quickly become highly addictive.
Benzodiazepines (Valium, Rohypnol, Halcion)
An anxiolytic that takes away fear. It was also the first medicine of this kind, and also
this turned out to be highly addictive. It is less dangerous than barbiturates. Rohypnol is also standing
known as the date rape drug .
The effects of both drugs are similar to those of alcohol (GABA). The criteria for disorders
Related to these drugs is no different. Combination of alcohol with these medicines
is very dangerous because the effect is doubled.
>> STIMULANTS
The most commonly used drugs are stimulants , substances that stimulate us. This includes:
1] amphetamines
2] cocaine
3] nicotine
4] caffeine
AMPHETAMINES ABUSE DISORDER

Amphetamines give a good feeling, but then lead to a crash . They occur in many
regular medicines such as ritalin (for ADHD). Designer drugs , such as XTC, are variants. At
excessive use of amphetamine abuse disorder . Diagnostic criteria are:
1] significant behavioral symptoms (mood, emotions, etc.)
2] significant physiological symptoms (blood pressure, sweating, weight loss)
Amphetamines influence the activity of dopamine and norepinephrine by promoting production
and re-uptake. Too much can lead to hallucinations and dillusions.
COCAINE ABUSE DISORDER

Cocaine increases alertness and leads to a euphoric feeling. Blood pressure and heart rate are increased
and increase pupils. This only lasts a short time, and is often followed by severe paranoia . There are
indications that cocaine can affect the fetus, but that is not yet certain. The effects are
roughly like that of amphetamines, as cocaine mainly blocks the dopamine re-uptake. The
high is caused by stimulation of dopamine neurons in the pleasure pathway of it
brain.
Addiction often builds up slowly, usually over several years. Rehab is difficult because
people feel bad and dull when they are not using and quickly grab cocaine again.
NICOTINE ABUSE DISORDER

Nicotine is a colorless liquid that is extremely addictive. Half of the students ever have
smoked. DSM-IV does not describe an intoxication pattern , but indicates the symptoms of withdrawal ,
including insomnia, irritability and an increase in weight. There are indications that
Nicotine is harmful to the fetus, or at least leads to some kind of addiction in the baby.
Nicotine enters through the lungs and reaches the brain within 7 to 19 seconds. It works in on
nicotinic acetylcholine receptors in the midbrain and the pleasure pathway .
CAFFEINE ABUSE DISORDER

Tjah. Coffee, cola and tea. The least harmful of them all, but just as addictive. It is a
stimulant, and leads to moderate withdrawal effects. Caffeine seems to be the re-uptake of
adenosine , and to a lesser extent serotonin . Why this effect is still unclear.
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>> OPIOIDS
Opium refers to the natural variant that is extracted from poppy-bulbs. However, it includes
also the synthetic variants (methadone & pethidicin) and the natural opiates of the body
(endorphins, enkephalins and dynorphines). Most opiates (heroin, morphine, etc.) activate this
natural system and thereby relieve pain ( analgesics ) and make us sleepy and calm. They do this
by inhibiting GABA transmitters that inhibit dopamine neurons.
Withdrawal of opiates is extremely difficult, but simpler than alcohol or barbiturates. In a

week, physical effects disappeared. The life of opiate users is usually hopeless, and
one runs additional risks because the drugs must be injected (HIV).
>> HALLUCINOGENS
These fabrics change the way we see the world. Sight, hearing and even taste can
be changed, and in large- scale use there is hallucinogenic use disorder . Best known:
Marijuana
Marijuana causes a slightly disturbed perception, but paranoia and dizziness can occur with large doses
performance. Long-term use can lead to a form of apathy that is amotivational
syndrome . Rehab is usually easy. The substance tetrahydrocannabols ( THC ) it seems
active ingredient. The body itself produces a type of THC with the name anadamine .
LSD
LSD is a synthetic drug. It leads to heavy hallucinations. Other species from this group:
1] psilocybin : is found in some mushrooms (mushrooms)
2] dimethytryptamine : is found in the bark of the virola tree
3] mescaline : is found in the peyote cactus plant
4] phenecyclidine : is produced synthetically (PCP)
The criteria for LSD are the same as for marijuana; strong perceptual changes and physical
symptoms such as increased heart rate and blood pressure and dilated pupils. Tolerance builds up quickly,
and within a few days it no longer works (with large consumption). There is no withdrawal -
securities. A big risk are frightening bad trips and so-called flashbacks , where
someone who has not used LSD for a while suddenly gets another trip.
>> OTHER DRUGS

A number of other drugs that do not belong to the above classes are recognized:
Inhalants
This includes all substances that are inhaled and lead to a high, such as glue or paint
thinner. Prolonged use can lead to damage to the bone marrow, brain and liver.
Anabolic androgenic steroids
This drug is used to increase your own muscle mass. It therefore does not lead to a high.
The addiction is therefore mainly psychological, because people want to be in a certain form
stay or reach it. Mood disorders are common, and regular use leads to
damage to the body.
Designer drugs
Designer drugs are means that are "professionally" developed. All variants are addictive and
dangerous with too regular use.
>> CAUSES
Again there are a large number of different causes:
1] biological causes
2] psychological causes
4] social causes
5] cultural causes
The following biological causes are distinguished:

Genetic influences
There is a weak genetic vulnerability to drugs. They seem to determine if someone is one
drug is pleasant or unpleasant.
Neurobiological influences
There is a pleasure pathway in the brain that is believed to be the opioid releasing system
contains and reacts to dopamine . All drugs stimulate, directly or indirectly, this path. Some through
stimulate dopamine directly, others by inhibiting GABA (which inhibits dopamine). There are however
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also drugs that do the opposite; they take away annoying things (such as pain killers). How
that works is still unclear. In children with alcoholic parents, it appears that they are less sensitive
for the effects. They do experience the high, but not the adverse consequences. It was thought for a time that one
so-called P300 peak was present in alcoholics ( encephalogram ), but now it appears that one
such a peak during measurements also occurs in people with other types of disorders.
The following psychological causes are distinguished:

Positive reinforcement
Drugs provide a pleasant experience, but tolerance usually increases. This means that
ever increasing doses must be used to achieve the same kick.
Negative reinforcement
Drugs can also serve to keep annoying feelings away. But why do these stop?
people not because they experience a crash after the high? The oponnent-process theory states that after the
high follows a crash (or vice versa), and that these become increasingly intensive as tolerance increases.
The only way that addicts see the more intense crash is to use more drugs.
Expectancy effect
The use of drugs is motivated if one has a certain positive expectation of the
effects, such as that alcohol facilitates social interaction. Expectations can be the high
make it stronger if you expect that (people even get drunk from alcohol-free beer
if she is told that there is alcohol in it). In people who drink a lot, alcohol myopia occurs
on, a condition that makes them less able to think and assess, and often stay that way
drink.
The social causes lie primarily in our environment and upbringing. That which our parents give
determines how we see drugs. The friends we interact with increase or decrease the chance that we
start using drugs. It is important to give a correct picture of drug addictions, because
nowadays there are two primary visions:
1] moral weakness : addicts are weak and have little self-control
2] disease model : addicts have a physical illness
Both models of course tell half the story, and don't even do it well.
The cultural causes lie mainly in the cultural beliefs in relation to the use of
certain drugs.
>> AN INTEGRATIVE MODEL

Each statement must ultimately be able to explain why some people, and others don't,
build up addiction. Figure 11.1 on page 377 shows such a model. All the factors discussed come
together here. The concept of equivinality , which has many causes for these disorders, is particularly important
substance-related disorders .
>> TREATMENT
The first step is to recognize that someone is addicted. Only then can someone motivated to
something to change, and if motivation is lacking treatment is almost impossible. There are many
treatments possible, but complete abstinination is often achieved with enormous difficulty.
The biological approaches are the following:

Agonist substitution
A similar drug is offered that is less addictive or leads to fewer problems, such as
methadone with heroin or nicotine patches with cigarettes . However, psychological counseling is then
of vital importance.
Antagonist treatment
Drugs are administered that hinder the functioning of the drug. Naltrexone in opiates
for instance. It also works with alcohol. However, one must be very motivated, because this one
substances ensure that the high is not, but the crash is experienced.
Aversive treatment
One associates an extremely annoying feeling with a drug, such as smoking a cigarette where you have one
gets a bad taste in your mouth by adding silver nitrate . Antabuse , for example, occurs
the breakdown of a toxic alcohol waste and make people extremely ill. Needless to say
one then always take that pill, and that sometimes causes problems.
Other procedures
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People usually treat the symptoms that occur with withdrawal . One often serves sedatives
to.
The psychological approaches are the following:

Inpatient facilities
Addicts are 'locked up' voluntarily in a home. This approach is often extremely expensive and often
just as effective as the 90% cheaper outpatient care .
Alcoholics anonymous and its variations
This is based on the disease model , and sees addiction as something larger than the individual and the
requires the strength of many. People often seek faith in spirituality. People who attend the meetings
good followuse
Controlled usually appears to be 'cured'. A large part, however, stops fairly quickly.
Instead of the total abstinence that the AA preaches, it is assumed that a gradual withdrawal
is better, and one does not necessarily have to stop definitively. As long as the use is no longer as abuse
can be classified, people are generally satisfied. However, the effectiveness is just as high or low as the AA,
and also does not work for many patients (70-80%).
Component treatment
With component therapy, different components are used interchangeably:
1] aversion therapy : one combines the substance with an annoying stimulus
2] covers sensitization : addicts are allowed to combine imagined annoying things with the drug
3] contingency management : you reward addicts with, for example, CDs when they reach certain stages
4] community reinforcement : people learn social skills and involve friends and family
Relapse prevention
If people relapse, they are apparently not entirely convinced of the disadvantages of the drug. In
these methods examine those attitudes and remove them.
Prevention has shifted from educating children to laws to reduce use.

The strongest prevention is a change of cultural values compared to forms of
drugs. If people no longer allow others to smoke, it will stop automatically.
CHAPTER 12: PERSONALITY DISORDERS

A personality disorder is defined as an enduring pattern or perceiving, related to and
thinking about the environment and oneself, that are exhibited in a wide range of social and personal
contexts and that are inflexible and mapadative and cause significant functional impairment or
subjective distress .
In short, a rigid and difficult to change thinking pattern that causes significant disruption
functioning or significant stress. It is not always the individual who experiences stress, it can also be
or its environment. In this chapter 10 disorders are discussed that are all diagnosed
are on Axis II in DSM-IV-TR, because they are a single group and other disorders can be on Axis I.
aggravate or influence. The disorders are divided into three clusters:
1] odd / eccentric : paranoid / schizoid / schizotypal
2] dramatic / emotional / erratic : antisocial / borderline / histrionic / narcissistic
3] anxious / fearful : avoidant / dependent / obsessive-compulsive
It is not clear yet if one should see personality disorders as:

Categories : the traits are clearly different from the way normal people do
Dimensions : the traits are only extremes of the ways in which normal people do that
Most professionals see disorders as dimensions, yet they are treated as in DSM-IV
categories. There are therefore votes to combine both forms, and that has three advantages:
1] retain : more information about the individual is retained when using different dimensions
2] flexible : one can make both categorical or dimensional differentiation possible
3] not arbitrary : there is no longer a clear line between 'yes, has disorder' or 'no, doesn't have it'
Support for the dimensional approach comes from the Big Five which shows that traits on five
axes can be defined.
Personality disorders occur in 2-5% of the population. There is little about the development
known because people in the early stages of the disorder rarely seek help. Some
Disorders, such as histrionic disorder , are more common in women. Possibly because there really is one
difference, but possible because there are certain biases :
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Criterion bias
The criteria for a histrionic personality are clearly feminine. There is no one anywhere
male variant described.
Assessment bias
The way in which the diagnosis is established can be biased .
Many people have multiple personality disorders ( comorbidity ). Whether that is really the case is
the question. The categories that have been distinguished may not be correct.
>> CLUSTER A DISORDERS (ECCENTRIC)

This cluster includes:
1] paranoid personality
2] schizoid personality
3] schizotypal personality
PARANOID PERSONALITY DISORDER

People with a paranoid personality disorder don't trust anything or anyone:
1] distrust : one does not trust others, without there being any real basis for it
2] other : the disorder does not occur exclusively during another mental disorder or medication
The lack of trust in others almost always leads to complete social isolation.
Little is known about the causes. There seems to be a genetic influence, but possible
people with this disorder have three wrong thought patterns:
1] deceptive : people are mean and unreliable
2] attack : they attack you or abuse you if they can
3] vigilance : you can only live if you are constantly on guard
Children may already receive these attitudes from the parents (albeit in a less extreme form).
Treatment is also difficult, because these people often do not seek help or the counselor either
trust. A tiny minority of therapists believe that people can do this
help out.
SCHIZOID PERSONALITY DISORDER

People with a schizoid personality disorder do not need social relationships:
1] detachment : a clear distance from social relationships and lack of emotions in social situations
They regard themselves as 'observers' of the world rather than 'participants'. They look like
people with a paranoid personality, only they have only the negative symptoms and not the
strange thoughts of the paranoid person.
Little is known about the cause, but people realize that there is a possible link with autism .
There may be a joint biological influence. A low level of dopamine,
for instance. These people rarely ask for help; usually only after major problems. The treatment
usually consists of learning social skills . Nevertheless, the prospect is not good.
SCHIZOTYPAL PERSONALITY DISORDER

People with a schizotypal personality disorder are also lonely, just like the other two. They
Moreover, behave strangely and have strange thoughts:
1] social interpersonal deficits : inadequate ability to enter into social relationships
2] cognitive distortions : cognitive and perceptual disturbances (dillusions & hallucinations)
A strong link is suspected between schizophrenia and this disorder (as the name suggests).
Some suspect that this disorder is just another expression ( phenotype ) of the same
underlying problem ( genotype ), only less serious. Many people with a schizotypal
personality later develop schizophrenia . Almost a third also has a mood
disorder .
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Treatment is again difficult. Usually it consists of learning social skills or it

deal with the consequences. In this case, medicinal treatment is also possible, involving medication
which are also used for schizophrenia.
>> CLUSTER A DISORDERS (ERRATIC)

1] antisocial personality
2] borderline personality
3] histrionic personality
4] narcissitic personality
ANTISOCIAL PERSONALITY DISORDER

Someone with an antisocial personality disorder does things that are totally unacceptable to others
like stealing from family and friends. The clinical characteristics are therefore:
1] disregard : a complete lack of interest in the rights and welfare of others
2] age : the individual is at least 18 years old
3] conduct disorder : there is a conduct disorder for the fifteenth year of life
4] other : the disorder does not only occur during schizophrenia or a manic episode
There are a number of disorders that are related to the antisocial personality:
Conduct disorder
The conduct disorder is often a precursor to the antisocial personality, and it becomes
established in children under 18 who had the same symptoms.
Psychopathy
Related to the antisocial personality is the psychopath (or psychopathy ). This is not exact
the same (they are not always criminal or antisocial), but these people do have some similarity:
1] charm : they come across as charment (or smooth)
2] Self-worth : they have a huge amount of self-confidence
3] boredom : they are easily bored
4] lying : constant lying (even if there is no real reason for that)
5] manipulative : inclined to manipulate others
6] remorse : a total lack of regret
Dyssocial psychopathy
These are not psychopaths, but people with an antisocial personality. Usually members of
culturally separated groups, as gangs in ghettos or the mafia.
Not all of these people come into contact with justice. A higher IQ usually protects people.
A number of biological influences can be distinguished :

Genetic influences
There is a genetic influence, because adopted children of criminal parents walk a lot
greater chance of an antisocial personality. There is also a gene environment
interaction , because the genetic influences all become visible when the environment encourages them
gives. Children who experience a lot of stress in their youth (for example due to an impending divorce) walk a
much greater chance.
A number of neurological influences can be distinguished :

Underarousal theory
This theory states that people with an antisocial personality have too low a cortisol level ,
making them look for excitement and adventure. So they are constantly bored and that shows in one
lower heart rhythm and lower skin conductance . There are also more theta waves in the brain, that one
be a sign of multiplicity or sleepiness.
Cortical immaturity hypothesis
This theory does not expect the brain of people with an antisocial personality to grow
is, and has remained stuck during development (hence the sometimes childish behavior of this
people). The cerebral cortex is not fully developed in these people, while it plays a major role in
inhibition and control of impulses.
Fearlessness theory
This theory states that people with an antisocial personality are less likely to be frightened than
other people. They are unable to properly interpret cues as signs of danger or threat.
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BIS / REW
The B ehavioral I nhibition S ystem inhibits undesirable behavior. The Re ward S ystem reward behavior. The
BIS is possibly located in the septo-hippocampal area and the REW is associated with it
dopamine system (pleasure pathway). The BIS is for people with an antisocial personality
weakly developed.
A number of psychological and social dimensions are also distinguished :

Reward goals
Psychopaths do not give up, even if reaching the goal has become impossible. This results in
that they do stupid things.
Coercive family process
Parents of some aggressive children solve a fight by walking away. This solves it
problem temporarily, but the child learns that if he perseveres, the parent automatically agrees. This reaction
pattern can become increasingly serious.
Neighborhood
Neighborhoods in which people are less willing to social control, the chance of problems is greater.
Stress
People who are exposed to extreme stress are more likely to come into contact with justice
rather aggressive, and so on.
Strangely enough, antisocial behavior in people with this disorder usually disappears around the 40th
year of life, while criminal behavior continues to exist in people without this disorder.
Again, there is a highly integrated model , with biological vulnerability

interacts with the environment in which one grows up. The treatment is difficult. These people search
never help themselves, and if they do, the chance of success is small. Parent teaching helps with children
usually good, where the parents are taught how to handle the child. Prevention seems
more successful, in which problem cases are identified early and the parents are taught how to
deal with that.
BORDERLINE PERSONALITY DISORDER

People with a borderline personality lead a turbulent life, involving relationships and moods
extremely unstable. The characteristics are:
1] instability : a serious degree of instability in relationships, self-image and emotions
2] impulsibity : extremely impulsive
3] Adulthood : starts when one becomes an adult
4] emptiness : people usually feel empty
5] substance abuse : the chance of abuse of alcohol and drugs is high
People often improve after the 30th / 40th year of life. But it rarely disappears completely. Suicide
occurs at 6%.
There are a number of different influences that have been distinguished:

Genetic influences
There is a genetic influence, and there is also a link with mood disorders. However, it seems that
only a few elementary traits (such as impulsiveness) are inherited.
Cognitive influences
There seems to be a memory bias in which negative things are remembered longer than necessary
is.
Early trauma
People with this personality report considerably more trauma during childhood (91-92%)
has experienced severe trauma). This may also have to do with the memory bias . Possible seems
this personality at the PTSD .
Only one treatment is known that seems to work; dialectical behavior therapy . Here one learns
people deal with the stressful events in their lives. This treatment reduces
suicide attempts, but the disorder itself cannot be remedied.
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HISTRIONIC PERSONALITY DISORDER

People with a histrionic personality disorder are overly dramatic and always seem to be
acting (the meaning of histrionic ). The characteristics are:
1] excessive emotionality : they are overly dramatic
2] attention seeking : they constantly seek the attention of others
3] influential : are easily influenced by the opinion of others
4] impressionistic : they often think and speak superficially with a lack of detail
5] manipulative : they manipulate others (usually through the use of emotions)
There may be a bias with respect to women in this description.
Little is known about the influences. There seems to be a link between the antisocial personality and
the histrionic personality . Possibly the histrionic personality is the feminine expression of one
antisocial disorder (or vice versa).
Little is also known about the treatment. They often teach these people what the consequences are of what
they do or try to learn correct attitudes towards others; like the consequences
in the long term of manipulation.
NARCISSITIC PERSONALITY DISORDER

People with a narcistic personality disorder find themselves very special:
1] grandioseness : they find themselves extremely important and have power fantasies
2] attention : they think (therefore) that they should get a lot of attention from others
3] lack of compassion : they have no interest in what others think (lack of empathy)
4] arrogant / jealous : when confronted with other successful people they are jealous
5] exploitative : they exploit others to feel better
A possible explanation is a lack of examples of empathy by the parents. In our

culture this personality comes more and more to the fore, this is also called the 'me
culture '. Little is known about treatments, but the great fantasies are often tried
replaced by more realistic objectives.
>> CLUSTER C DISORDERS (ANXIOUS)

1] avoidant personality
2] dependent personality
3] anxious personality
AVOIDANT PERSONALITY DISORDER

Someone with an avoidant personality is extremely sensitive to the opinions of others, and
therefore avoids most relationships. The characteristics are:
1] social inhibition : they are strongly inhibited socially
2] anxious : they are always afraid of being rejected by others
3] low self-esteem : have extremely low self-confidence
It is possible that these people are born as children with a difficult temperament, which means they are not
receive unconditional love from their parents. This can cause them through their parents
be rejected. Because this personality resembles a social phobia , people usually use it
(with reasonable success) the same treatments. Systematic desensitization is also used , where
one confronts an individual with humiliating events, or behavioral rehearsal , where
one plays after fearful situations in role play.
DEPENDANT PERSONALITY DISORDER

People with a dependent personality depend on others and are extremely afraid of being abandoned
to become. The other characteristics are:
1] reassurance / advice : requires a lot of advice and insurance from others in their own decisions
2] disagreement : has great difficulty in stating that someone else is wrong
3] alone : cannot be alone, and searches (almost hopelessly) for others who look after him / her
4] fear of abandonment : is unrealistically afraid of being abandoned by others
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Possible concerns disturbances in early bonding process with parent problems. Children
then become afraid of losing people who are important. Little is known about the treatment, but
is difficult because they always agree with the therapist (even if they are not in reality). There is
a big risk that the patient becomes dependent on the therapist.
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

People with an obsessive compulsive personality disorder have a strong urge for it
perfection. They are extremely systematic and organized. Characteristics:
1] details : constantly worries about the details (they must be perfect)
2] perfectionism : cannot complete something if the details are not perfect
3] devoted to work : is focused on work, at the expense of other areas (friends, relationships, etc.)
4] inflexible : is not flexible in terms of morality, ethics, etc.
There is a weak genetic influence that determines the extent to which people value orderliness
and perfection. The degree of reinforcement by the parents, and the own cleanliness, however, determines whether this
personality.
>> PERSONALITY DISORDERS UNDER STUDY

In addition to the described personalities, two other groups are also being investigated. The
depressive personality is extremely critical of himself and others, and feels
constantly guilty. The negativistic personality is characterized by passive aggression towards
others and the rules they impose and is an extension of an older class; the passive
aggressive personality and can be a subtype of the narcissistic personality.
CHAPTER 13: SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

Schizophrenia is characterized by a broad spectrum of cognitive and emotional
dysfynctions, including delusions and hallucinations, disorganized speech and behavior and
inappropriate emotions. Psychotic behavior is part of schizophrenia , but there are also
psychotic disorders that are not schizophrenia.
Over time, people have given schizofrence , or things that look like it, various names. Haslam
called it a form of insanity , Pinel called it demence (loss of mind). Kreapelin gave it the name
dementia preacox and thereby combined the previously isolated disorders under one name:
Paranoia : dillusions of grandeur or pursuit
Hebephrenia : strange and immature emotionality
Catatonia : varying immobility and agitation of muscles
In addition, Kreapelin distinguished schizophrenia from bipolar disorders because the onset and
outcome of the second being different (schizophrenia occurs early and usually ends badly). The term
schizophrenia was given by Bleuler , who wanted to make it clear that the disorder according to
it arose through associative splitting ; breaking the natural ties between various
psychological and biological functions (schizophrenia means 'split mind').
>> CLINICAL DESCRIPTION

The symptoms of schizophrenia are extremely heterogeneous. One starts by distinguishing from
typing:
1] Positive symptoms : the active manifestation of strange behavior. Something is added
2] Negative symptoms : the lack of certain behavior. Something stays away
3] Disorganized symptoms : behavior is disturbed. That which is there is partly disturbed.
There are a number of positive symptoms that can be distinguished:

Delusions
There is a disorder of thought content . People have unrealistic thoughts. One can
think to be powerful, known or special ( delusion or grandeur ) or have the feeling that they are always
to be pursued ( delusion or persecution ). Two syndromes are found in this category:
1] capgras syndrome : a family member has been replaced by a body double
2] Cotard's Syndrome : a body part has been replaced or changed in an impossible way
Perhaps these dillusions serve an adaptive function, because people who have experienced them
less stress and depression than people who have schizophrenic and do not have them.
Hallucinations
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One hears, most frequently, things that are not there ( auditory hallucination ) or sees things that are there
not be. Broca's area appears to be more active in auditory hallucinations , which indicates that people are
'hear' their own thoughts, but do not recognize that they are themselves.
There are a number of negative symptoms that can be distinguished:

Avolition
Avolition is the inability to choose or start (also called apathy ). People maintain themselves
for example bad or not and has little interest in daily worries.
Alogia
People have difficulty communicating because words are missing or are coming too slowly.
Anhedonia
People no longer experience pleasure in life, such as with food, sex or social interactions.
Affective flattening
There is talk of flat affect , which means that it is difficult to show emotions on the face. Men
by the way, still experiences those emotions, but has difficulty expressing them.
There are a number of disorganized symptoms that can be distinguished:

Disorganized speech
People have difficulty speaking, which results in not answering questions or incorrectly
( intangentiality ) or the constantly changing subject ( loose association of derailment ).
Inappropriate affect
Sometimes people smile when that is not appropriate at all (or there is no reason to do so), or when they show up
bizarre behavior such as the collection of certain objects (you see, stamp collectors have)
a screw) or the strange behavior in public places. Catatonic immobility is one of these
example of - people freeze their attitude.
There are a large number of subtypes within schizophrenia :
Paranoid type
There are delusions and hallucinations , but cognitive functions are fine. Both have
usually a common theme, such as grandeur . The prognosis is the best of all subtypes.
Disorganized type
There is a clear disturbance of speech, behavior and affect. If there are delusions
or halucinations , then they have no central theme. Problems usually arise quickly and are
chronic in nature. Relapse is common, and this is one of the more serious variants.
Catatonic type
Strange motor activity (from frozen to very busy) and strange facial expressions. Repeat them
of words ( echolalia ) or movements ( echopraxia ) of others.
Undifferentiated type
People who cannot be classified in the above groups end up here.
Residual type
People who no longer suffer from the greatest symptoms and who are no longer in an episode,
can still experience certain problems (left-over problems).
In addition to schizophrenia , there are also a number of other forms of psychotic behavior :
Schizophreniform disorder
This is a form of schizophrenia that lasts no more than a few months and then disappears.
Recovery is usually almost complete.
Schizoaffective disorder
A mix between a mood disorder and schizophrenia . There must therefore be a vote
disorder, but also from dillusions or hallucinations for more than 2 weeks (apart from the mood disorder)
Delusional disorder
These people experience delusions , but the content is more realistic. Where the dillusions of
Schizophrenics cannot even, those of these people can theoretically. It relates to:
1] erotomanic: people think that a certain star likes him or her (like with fan-stalkers)
2] grandiose: people think they are special
3] persecutory: people think they are being followed
4] somatic: people think they are sick or have a physical disorder
This disorder often arises around mid-life and may be partly hereditary.
Letter psychotic disorder
There are positive symptoms during a few days, which then suddenly disappear.
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Shared psychotic disorder

An individual develops dillusions because he or she lives in the vicinity of someone who also has dillusions.
There are also a number of other classification systems:

Process / Reactive schizophrenia
Schizophrenia occurs as a result of a slow development ( process ) or as a result of a
sudden dramatic event ( reactive ). Of course a too simple approach, and moreover
the divorce is not actually present.
Poor premorbid / Good premorbid
The degree of social functioning is determined just before the onset of schizophrenia. Also too
simple, and is therefore no longer used.
Type I / Type II
With Type I there are positive symptoms, a good prognosis, and many possibilities
treatments and no cognitive disturbances. With Type II there are negative symptoms, where
treatment is difficult and the prognosis is (therefore) poor.
The prevalence of schizophrenia is not high, 0.2 to 1.5% within a lifetime. For men
the chance of aging diminishes, with women it increases. It seems that people do that
later develop schizophrenia, as a child were already different. They show less positive affect and more
negative affect. It is possible that there is slight brain damage that will only really occur later
from. Moreover, it seems that positive symptoms are diminishing in the elderly.
It is sometimes said that schizophrenia exists only in the minds of the therapists, and that it does
is actually a departure from the cultural norm. The fact that in all cultures enormous is being suffered by
patients and bystanders, clearly shows that it is not that simple. Schizophrenia is coming
this is more common in certain groups, but that can be due to a bias during diagnosis .
>> CAUSES
Finding the causes of schizophrenia is extremely difficult. A few streets are distinguished:
1] genetic influences : the genetic influence that plays a role
2] neurobiological influences : influences due to problems in the brain or with neurotransmitters
3] psychological and social influences : psychological and social influences
GENETIC INFLUENCES
With regard to genetic influences , the following has become known from various studies:
Family studies
These studies show that the closer you are in the chain of genetic inheritance to someone who is
schizophrenic, the more likely you are to develop a shape.
Twin studies
These studies show even twins who both have the same genetic predisposition, yet different
can develop forms of schizophrenia. The environment therefore enters that, and in this case those parts
of the environment that is not shared ( unshared environment ).
Adoption studies
Children with a biological mother who has schizophrenia are at an increased risk
schizophrenia, even if they have been adopted by other families. This comparison is called the
adoptees study method . In another form, the adoptees relatives method , one determines who
has schizophrenia, and then compares it with people who have been adopted but none
have schizophrenia.
So there is a genetic component. However, even people who have parents can live without it
schizophrenia does develop it themselves. It seems that there are genes that make you vulnerable
( predisposition ) for schizophrenia, but that do not always have to become active.
An attempt has been made to determine which genes are responsible for schizophrenia
genetic linkage studies (see chapter 4). Chromosomes 6 and 11 are suspects in this case.
Chromosome 10 has long been suspected, but the evidence could not be replicated. In the search of
markers (see Chapter 4), it has been discovered that schizophrenics more often lack smooth-pursuit eye
movement , which means that they have difficulty in following a movement with the
eyes. The gene that causes schizophrenia may be close to the genes that cause it.
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In any case, it seems plausible that there are several genes that play a role, which also occur
different locations.
NEUROBIOLOGICAL INFLUENCES
A large part of the research focuses on disturbances in the brain. This research is
correlational , so one does not know about the relationship between schizophrenia and certain transmitters:
1] or schizophrenia causes the imbalance
2] whether the imbalance causes schizophrenia
3] or a third variable causes both.
Antipsychotic drugs that suppress the dopamine system ( antagonists )

the effects. Medications that stimulate this system ( agonists ) can cause schizophrenic symptoms
induce. Dopamine therefore plays a major role. However, there are a number of problems:
1] response : not all people with schizophrenia respond to dopamine antagonists
2] duration : although the drugs work, they often do so slowly and briefly
3] negative symptoms : the medication helps to alleviate the negative symptoms
4] D2 receptor : the D2 receptor may occur to the same extent in all people
A hypersensitive, or too many, D2 receptors were seen as a cause of schizophrenia.
Another problem is that clozapine is a medicine that works well. Yet it is the least effective in it
inhibiting the dopamine system. It seems that the interaction between serotonin and
dopamine is important. So it depends on the combination of both, and clozapine has there
influence on.
People are also interested in the brain itself:

Size of the ventricles & hippocampus
With schizophrenics, the ventricles, spaces in the brain filled with fluid, are larger. The back of the
hippocampus is smaller. This does not occur in people (or members of an x-ling) who do not have schizophrenia
to have. Whether it is the cause is unclear, but it is possible that certain brain damage will build up,
due to a lack of certain substances, and schizophrenia manifests itself.
Frontal lobes
With schizophrenics, the frontal lobes are less active ( hypofrontality ). This relates to the
dorsolateral prefrontal cortex ( DLFPC ). Important dopamine streets are running in this part, and possibly
activates inactivation here deeper dopamine streets in the brain. The outer streets (which are less active
are) cause the negative symptoms, and the deeper paths (which are more activated) for
the positive symptoms.
Viral infection
Some say that a virus in the womb causes damage to the brain, which causes later
for schizophrenia.
These characteristics are not found in all schizophrenics.
PSYCHOLOGICAL AND SOCIAL INFLUENCES

That one member of twins does develop schizophrenia and the other does not say that the
environment is important. The factors that are recognized:
Stress
It is difficult to determine whether a difficult event led to schizophrenia, because this is the case
retrospective investigation . In the few prospective studies, it appears that stressful events
can indeed cause a relapse (and possibly the occurrence), but that they do not explain everything.
Families and relapse
It used to be thought that the family atmosphere, or the form of communication, the development of
could promote schizophrenia in others, such as a cold and cold mother ( schzophrenogenic ) or
a communication style in which conflicting messages are given ( double bind ).
Nowadays people focus more on whether the interactions contribute to a possible relapse.
It turns out that a specific communicative style called expression can cause emotion problems
promote. People speak with a lot of emotions. What is special is that this effect is specific to ours
culture is.
In all cases, hostile and stressful environments aggravate and cause it
possibly even.
Page 62
>> TREATMENT
In the old days people cut pieces of the brain that caused problems ( lobotomies ).
Today, people mainly use medication in combination with psycho-therapy for use
promoting medicines.
ORGANIC INTERVENTION
Neuroleptics are drugs that help against, mainly, positive symptoms. They are usually
dopamine antagonists. Approximately 60% of individuals benefit from such medicines.
The only problem is that many people stop treatment because the side effects are annoying:
Blurred vision & dry mouth
People experience reduced vision and a dry mouth.
Extrapyramidal symptoms
The more serious side effects belong to this group. Akinesia ensures that there is no emotional
expression is more that speech becomes monotonous and motor activity becomes slower. Is more serious
tardive dyskinesia , in which someone starts shaking and shaking (type of parkinson).
It is possible that transcranial magnetic stimulation , a new technique with magnets, can be used
make treatment more portable. However, it is unclear whether this actually works.
PSYCHOLOGICAL INTERVENTION
Sometimes people try to cure schizophrenia through psychotherapy or analysis. However, this works
rarely, and usually symptoms get worse. Such therapy is currently primarily focused on
encouraging people to use the medication. There is one therapy that works, and she
focuses on learning social skills. A token economy is set up in an institution,
where people receive receipts if they display certain desirable behavior that they can trade in
against food or certain luxury goods.
Because schizophrenia also has major social consequences for people who suffer from it (even though
they can live with the condition itself), social training is also extremely important.
Also the guidance of the families and learning to deal with a schizophrenic can be the treatment
spuds. These forms of treatment help the primary biological treatments.
Prevention is also a spearhead. They try to reduce stress in children who
be vulnerable.
CHAPTER 14: DEVELOPMENTAL DISORDERS
Disorders that become clinically significant during the development of a child are the
focus of this chapter. Childhood is a vulnerable phase, because various processes are here
completed sequentially. Problems may arise in the event of interruption or disruption. The disruptions that
covered in this chapter are:
1] attention deficit / hyperactivity disorder
2] learning disorders
3] autism
>> ATTENTION DEFICIT / HYPERACTIVITY DISORDER

ADHD has a number of specific clusters of characteristics:
1] inattention : one cannot constantly focus the attention for at least 6 months
2] impulsivitity / hyperactivity : one is hyperactive , without thinking it becomes a maladaptive
level
These characteristics cause problems outside the disorder, such as with regard to school or social issues
relationships. It occurs in 4-12% of children aged 6-12, and four times as often in boys. The
symptoms often get stronger during the school years. Although the hyperactivity / impulsivity is strong
decreases, patients always have problems with inattention . The disorder comes in the west
more common, but that is possible because behavior in other cultures is seen as 'normal'.

1] chromosome 20 : ADHD is more common in some families, and appears to be on chrom 20
2] D 4 receptor : The dopamine D4 receptor is more common in children with ADHD (genetic
determined)
Page 63
3] less brain activity : the basal ganglia and the frontal cortex are less active (cause or effect?)
4] additives : colorants in food may cause hyperactivity (although evidence is lacking)
5] maternal smoking : smoking mothers are three times as likely to have a child with ADHD
The following psychological influences are distinguished:

1] negative responses : ADHD children are often punished; that is bad for self-confidence
The treatment is two-fold:

Biological treatment
The focus is on suppressing the two clusters of ADHD; inattention and
hyperactivity. Administration of stimulating (paradoxical?) Drugs, such as methylphenidate ( ritalin )
helps in 70% of cases. Anti-depression agents such as imipramine and clonidine may help
also. They reduce disruptive behavior, but do not improve academic skills or
learning abilities. Most medicines lead to insomnia, laziness or irritability.
Psychosocial treatment
They focus on improving academic skills and reducing disruptions
behaviour. This can be done through operant conditioning or helping the parents and teachers
to deal with ADHD.
A large study showed that a combined treatment is superior to a specific one
treatment, but those results are still disputed.
>> LEARNING DISORDERS

Learning disorders are characterized by a substantially lower performance than what one is allowed to do
expected given someone's IQ and age, and relates to:
Reading disorder : Under-average reading performance, not due to sensory problems.
Mathematics disorder : Under-average performance when calculating.
Disorder of written expression : Under-average writing performance
The prevalence of reading disorders is highest, 5-15% and is followed by mathematical
disorders with 6%. Little is known about writing disorders . Of the children with problems, it stops
32% with the training, which of course leads to major personal problems. Also the chance of a job
is extremely small.

1] genes : certain forms are strongly genetically engineered (chromosome
2] brain damage : brain damage may lead to problems
3] processing : the brain does not pick up the difference between some sounds in read / write disorders
The biological influences do not occur in everyone. Psychological effects such as
motivation and self-confidence give people the courage to bite through and persevere.
Treatment usually focuses on operational support in a number of areas:

1] direct : direct treatment of the underlying cognitive processes (reading skills learning)
2] cognitive : generic training to improve listening, comprehension and memory
3] behavioral : learning behavioral skills that are needed to deal with, for example, reading problems
There are also a number of related disorders:
Stuttering
Disruption of fluent speech. Begins early, and more often with boys. Most of it disappears
naturally. There are genetic influences, and the restlessness to stutter also leads to stuttering.
Treatment usually consists of the regulated-breathing method or the administration of anti-anxiety
medicines (although the side effects here are more extreme than the problem they want to solve)
Expressive language disorder
Limited speech in all situations, but full understanding of what is being said. Again, especially with
boys are ahead, and causes may be in ear infections or parents who have too little against them
to talk. This usually disappears by itself, and treatment is rarely necessary.
Selective mutism
Limited speech in very specific situations. This time especially with girls, and anxiety becomes like the
possible cause. Building self-confidence is therefore the treatment of choice.
Tic Disorders
Page 64
Involuntary movements with head or voice. Gilles de la Tourette is also part of this. 12-24% of the day
children have problems with this. Possibly genetically engineered by dominant genes and
Treatment is usually psychological through relaxation exercises or pharmacologically through it
administration of relaxing agents such as haliperidol .
>> PERVASIVE DEVELOPMENTAL DISORDERS

Pervasive developmental disorders lead to serious problems with language, socialization and cognition.
The following disorders from this group are extensively treated:
1] autistic disorder
2] asperger's disorder
Other disorders within the group are:

Rett's disorder
This disorder, which mainly occurs in girls, only manifests itself after normal development. The
mental decline is progressing steadily from that point. It is rare and likely
caused by a gene on an X chromosome.
Childhood disintegrative disorder
Concerns extreme deterioration in language, motor skills and behavior after a 2-4 year old healthy person
development. Abnormal brain activity is seen as the cause.
Pervasive developmental disorder, not otherwise specified
Serious disruptions, but not enough to be diagnosed as autism. The
neurobiological disturbances that occur with autism also occur here.
AUTISTIC DISORDER
Autistic disorder is a disorder that is characterized by three groups of symptoms:
Impairment in social interactions
One does not develop the social relationships that are normal for age. They do have the same
relationships, but people with autism seem to attach little importance to relationships.
Impairment in communication
Communication is usually severely disrupted. Echolalia , the saying of words and sentences, is coming
often for. However, this is not exclusive for people with autism. Those who can speak have there
often do not feel like or are unable to.
Restricted behavior, interests and activities
People with autism often have an intense preference for keeping the situation the same
( maintenance of Sameness ). They often spend hours on the same kind of simple behavior, and
can be completely absorbed in it (such as looking at the hand, moving a car forwards and backwards)
The disorder is fairly rare, and is more common in women with a lower IQ and with a higher IQ
more with men. The symptoms usually occur in the first 3 years, and most develop one
below-average IQ. The higher the IQ, the better the prognosis.
The following psychological influences are recognized:

Parenting style
For a long time it was thought that cold, cold and dominant parents would have autists. Nowadays
It is believed that upbringing does not affect autism and cannot cause it.
No self-awareness
It was thought that autists may not have self-awareness. However, they appear to have this.
The following biological influences , which are much more important, are recognized:
Genetic influences
Autism is more common in families, it has a hereditary component (at least with some types).
Neurobiological influences
Many autists also have a mild form of dementia, which indicates mild brain damage. More
it has recently been discovered that some autists have a smaller cerrebellum .
ASPERGER'S DISORDER
Asperger is a milder form of autism that does not cause severe cognitive impairment.
People with asparagus often have an extreme interest in remembering small details about it
Page 65
people and speak extremely formally, and that's why the little professor is sometimes spoken of
syndrome .
The disorder is still relatively unknown, and many individuals do not get the diagnosis that they would
have to get. Almost nothing is known about the causes, except that there is a genetic component
is.
The treatment for autism and asparagus , but also for the other syndromes mentioned in this
group of disorders is the same, and is primarily of a psychological nature:
Communication
Children are taught to communicate. A problem with autists is that they do not want to imitate, and that is
important when learning a language. They usually use operant techniques such as
shaping and discrimination training to get children to imitate.
Socialization
The unusual reactions of people with autism in particular lead to many social problems. People are
have not yet succeeded in teaching these people the subtleties of social interactions.
An important aspect appears to be the timing and settings for treatment . If communication and
learns socialization skills intensively and early, later problems are smaller. Moreover
it appears that children who are admitted ( inclusion ) perform better in normal school classes. There
are not biological treatments that are effective.
>> MENTAL RETARDATION

Mental retardation is a disorder that becomes visible in childhood and is significantly lower
shows intellectual capacity and leads to significantly lower adaptive functioning. She is in DSM-IV
placed on the second axis because:
1] chronic : it is chronic in nature
2] influence : it can exert influence on disorders that occur on axis-1
DSM-IV distinguishes three characteristics that must be met:

Significantly sub-average intellectual functioning
There must be a significantly lower IQ than can be expected on average. One pulls the
limit usually at an IQ of 70.
Competitor deficits or impairments in adaptive functioning
In addition to a low IQ, an individual must experience at least significant problems in at least two
areas of his life, including communication, work, school, health, self-reliance, etc.
Age of onset
The above symptoms must occur before the 18th year. This is for people with
brain damage that later occurred to be excluded from a diagnosis as mentally retarded .
People with this disorder differ in severity. A number of classes can be distinguished:
1] mild : an IQ between 50/55 and 70
2] moderate : an IQ between 35/40 and 50/55
3] severe : an IQ between 20/25 and 35/40
3] profound : an IQ below 20/25
Another scale division ( AAMR ) divides into the degree of help that one needs:
1] intermittent
2] limited
3] extensive
4] pervasive
These levels correspond to those of DSM. Another system, the educational system ,
distinguishes three classes that descend into the chance that they have the chance to succeed at school. This implies
that people in the lower class therefore also have no chance.
There are a number of biological influences (and in this case also causes):
Fetal alcohol syndrome
Heavy alcohol use during pregnancy can lead to severe brain damage in children
so mental retardation .
Genetic influences
A number of diseases that are genetically transmitted can cause mental retardation, such as
tuberous sclerosis or PKU (phenylketonuria). In the latter, the body cannot do phenylalanine properly
Page 66
break down (a substitute for sugar, for example in light products) and that comes in the brain and
blocks all kinds of important channels there and leads to brain damage.
Lesch Nyhan syndrome
This disorder is on the X chromosome and only affects men. It leads to spastic behavior.
Down syndrome
Down syndrome is caused by a third copy (instead of 2) of the 21st chromosome. They have
a clearly different face and usually get dementia after their 40th (like my own uncle, who too
this syndrome)
Fragile X syndrome
This syndrome manifests itself in men in severe retardation and in women in learning difficulties.
Men are also hyperactive, have a short attention span and difficult speech.
With a method called amniocentesis , one can determine before birth whether there is one
chromosomal disorder. This is, in Dutch, a amniotic fluid puncture.
There are also some psychological influences , because not all people have biological
issues. In fact, cultural-familial retardation is involved in 75% of the cases . The rate
of dementia is often small here, and people are seen as normal, except for them
just fell into the wrong part of IQ normal distribution ( developmental view ). Another
vision is the difference view , which states that the problems these individuals experience belong to the
set that individuals with more severe forms experience.
Biological treatment is almost impossible. People try these people as good and evil as it is
can learn social and communication skills. A problem is where this should happen;
in the classroom of a normal class, or in special institutions?
>> PSYCHIATRY'S GLOBAL CHALLENGE (ARTICLE)

The number of psychological problems in developing countries has risen. This is due to:
1) Improved care makes the lifespan longer. People reach critical ages
2) The rapid development (urbanization, modernization, crime)
3) The population is growing , so the number of problems is also increasing
Moreover, the problem is that many misdiagnoses take place and become wrong drugs
prescribed.
>> THE PSYCHIATRY REACTION

People stick to old theories and models. They reject culture-specific
symptoms and looks for known symptoms that occur worldwide. There are a number
myths
>> MYTH 1
It is assumed that psychological problems occur less frequently in underdeveloped countries. It appears
not to be - rather the other way around. In the meantime, this has been more or less accepted by the psychiatry.
>> MYTH 2
It is assumed that the same biological basis ensures the same numbers of sick people everywhere. Every one
population has an equally large ratio of schizophrenics. This turned out to be incorrect from studies. In
In some countries, schizophrenia is much more common in women than in men (5x as often). This
undermines the idea that there is a completely biological basis.
A solution has been developed that is called the pathogenic / pathoplastic model . This model
states that the biological basis is the cause, and the culture determines what the "content" is. So is with
paranoia the cause is right, but for an american the CIA is chasing him, and for an aboriganol
are the evil spirits.
This model is not completely complete. Westerners, for example, usually express complaints as emotions and
feelings while non-Westerners usually express it as physical complaints . You can see all the symptoms
as masks for the underlying cause. But who says the causes are the same? There is no
clear-cut biological marker to determine which disorder one has.
>> MYTH 3
It is said that there are a number of exotic disorders that only come from outside the West. There are
however, hundreds of disorders that are culture specific . Moreover, they ignore that many Western ones
disorders such as anorexia nervosa are also culture-specific for us.
>> MYTH 4
It is said that there is little to do against the disorders. This statement is simply not correct because
there are indeed successful treatments.
Page 67
>> CONCLUSION
In the urge to make the psychiatry scientific, one has too much pinned on the
biological basis . Up to now, cultural aspects have not been sufficiently considered. One must
accept that the knowledge base is no longer sufficient. The new challenge is to make the connections
between socio-economic , cultural and biological aspects.

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Page 1

Summary: book "Abnormal Psychology", Barlow &

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CHAPTER 1: ABNORMAL BEHAVIOR IN HISTORICAL CONTEXT

>> THE SCIENCE OF PSYCHOPATHOLOGY

The data flow of the research branch tries to do three things:

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A number of things are described:

>> THE PAST: HISTORICAL CONCEPTIONS OF ABNORMAL BEHAVIOUR

>> THE SUPERNATURAL TRADITION (1400+)

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>> THE BIOLOGICAL TRADITION

THE PSYCHOLOGICAL TRADITION

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An unwanted impulse from service source is directed at someone else. A man to be by

Followers of Freud adapted his theories to form their own movements:

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Theory of development ( Erikson )

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>> THE PRESENT: THE SCIENTIFIC METHOD AND AN INTEGRATIVE APPROACH

CHAPTER 2: AN INTEGRATIVE APPROACH TO PSYCHOPATHOLOGY

>> GENETIC CONTRIBUTIONS TO PSYCHOPATHOLOGY

1 Inability to metabolize phenylalanine - more in H12

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>> NEUROSCIENCE AND ITS CONTRIBUTIONS TO PSYCHOPATHOLOGY

CENTRAL NERVOUS SYSTEM

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3] Cerrebellum: regulates motor coordination

The cerebral cortex consists of a number of areas with different functions:

PERIPHERAL NERVOUS SYSTEM

The ANS consists of the:

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3] introduction of inverse agonists that cause opposite effects

The most important neurotransmitter groups are:

>> BEHAVIOURAL AND COGNITIVE SCIENCE

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An emotion is usually defined as a tendency towards certain behavior ( action tendency ),

Emotions consist of three components:

>> CULTURAL, SOCIAL AND INTERPERSONAL FACTORS

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>> LIFE-SPAN DEVELOPMENT

CHAPTER 3: CLINICAL ASSESSMENT AND DIAGNOSIS

>> ASSESSING PSYCHOLOGICAL DISORDERS

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Interviews are unstructured if there is no systematic format. Interviews that completely

There are two ways to observe behavior:

A number of forms of psychological tests are treated:

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Dfy a ko [ped gjop

Disadvantages of these methods are:

>> DIAGNOSING PSYCHOLOGICAL DISORDERS

One can describe the disorder of an individual in two ways:

Every system of classification must be reliable and valid:

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DSM-IV does have a number of problems / criticisms:

Categories are usually formulated based on the opinion of multiple professionals.

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CHAPTER 4: RESEARCH METHODS

A problem is the patient uniformity myth . Scientists tend groups

>> STUDYING INDIVIDUAL CASES