Unit 8: Clinical Psychology

8.1: Introduction to Psychological Disorders

“Diagnostic Guidelines”

● Diagnostic and Statistical Manual of Mental Disorders Edition 5 (DSM-5) by American

Psychological Association (APA)

○ Descriptions for every disorder

○ Treatments

○ Reliable and valid

○ Hard to diagnose someone because symptoms may become too similar

● Psychological Disorders

○ Disorder → interference in one’s daily life and schedule

○ Cognition, emotion, behavior (maladaptive)

○ DSM-5 classifies disorders by categories:

■ Depressive disorders → extreme sadness and loss of interest

■ Bipolar disorders → depression and mania

■ Anxiety disorders → fear and worry

■ Obsessive-Compulsive and Related Disorders → obsessions and

compulsions

■ Trauma and Stressor Related Disorders

■ Dissociative Disorders → amnesia

■ Somatic Disorders

■ Eating Disorders

“Historical Conceptions of Psychological Disorders”

● History: supernatural, somatogenic, and psychogenic

○ Supernatural etiology

■ Mental illness was caused by supernatural phenomena

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● Possession, emotion of the gods or astrology

● Trephination → holes drilled into the skulls of people to release

evil spirit

○ Somatogenic etiology

■ Hippocrates and Galen

■ Root of psychological illness was due to a physiological cause

■ Humorism → each person had to balance 4 different fluids

● Blood, black bile, phlegm, yellow bile

● Blood-letting (drainage of blood)

● Aromatherapy

○ Psychogenic etiology

■ Mental illness is psychological

■ Modern and followed by some elements of somatogenic etiology

“Psychological Conditions in Legal Settings”

● Protect the patient

● Confidentiality laws → protect a patient from potential discrimantion or other negative

implications by protecting information presented during session

○ US → confidentiality can be broken to authorities and health workers if a patient

is seen as a danger to themselves or others

○ Court of law →”insanity plea or insanity defense”

■ legally insane (claim that the defendant performed the action but cannot

be held responsible as a result of psychiatric episode)

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8.2: Psychological Perspectives and Etiology of Disorders

● Etiology → cause of psychological disorders

“Review of each Approach”

● Behavioral Approach

○ Definition: the connection between our minds and behavior

○ Key figures: Ivan Pavlolv, B.F. Skinner

○ Disorders: could explain learned phobias

■ Little Albert study

○ Strengths: theories of conditioning to rewiring behavior

○ Weaknesses: little or no focus on biological aspects

● Biological Approach

○ Definition: behavior is based on physical processes (brain, hormones and

chemicals)

○ Key Figures: Paul Broca, Carl Wernicke, Roger Sperry

○ Disorders: disbalance in the brain (neurotransmitter or hormones)

○ Strengths: experiments are objective, concrete data

○ Weaknesses: little or no focus on environment

● Biopsychosocial Approach

○ Definition: acknowledges the person as a whole and look at all of the patient’s

circumstances

○ Key figures: modern psychology

○ Disorders: genetic predispositions, disbalance in the brain, maladaptive thoughts

and culture

○ Strengths: using three different approaches

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○ Weaknesses: relationship between each approach may be difficult to

comprehend

● Cognitive Approach

○ Definition: thought processes impact the behaviors

○ Key figures: Jean Piaget, Albert Bandura

○ Disorders: maladaptive thoughts

○ Strengths: successfully rewire thoughts in clinical settings

○ Weaknesses: extremely logical and rarely accounts for emotional responses

● Evolutionary Approach

○ Definition: use of evolutionary biology, how natural selection of traits promotes

the survival of genes

○ Key figures: Charles Darwin

○ Disorders: natural selection

○ Strengths: compare humans throughout different evolutionary stages

○ Weaknesses: more effectively used on animals than humans

● Humanistic Approach

○ Definition: humans have free will and the ability to grow, all individuals are striving

to reach self actualization

○ Key figures: Abraham Maslow, Carl Rogers

○ Disorders: environment to grow and unable to reach self-actualization

○ Strengths: methods are adaptable to various types of people

○ Weaknesses: little objectivity

● Psychodynamics

○ Definition: unconscious mind, the behavior is determined by past experiences

stored in the unconscious mind

○ Key figures: Sigmund Freud, Carl Jung, Erik Erikson

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○ Disorders: unconscious thoughts or instability of the ego and not being able to

balance between the id and superego

○ Strengths: use concepts from both nature and nurture arguments

○ Weaknesses: theories cannot be proven

● Sociocultural Approach

○ Definition: how thinking and behavior vary across cultures and situation

○ Key Figures: Solomon Asch, Stanley Milgram

○ Disorders: norms that exist within a culture

○ Strengths: observations in real-world situations

○ Weaknesses: variables are hard to control

“Effects of Labeling”

● The purpose of diagnostic label: categorize/classify mental illnesses within easily

identifiable set of parameter

○ Unexpected negative consequences: increased stigma and discrimation toward

certain groups

○ Rosenhan Study (1973 experiment)

■ Analyzed labeling by sending mentally health subjects to psychiatric

hospitals by feigning hallucinations → faked the disorder but they were

normal

■ Stigma was driven by the diagnosis → inaccurate portrayal of

circumstances

● 7 people → schizophrenia, 1 person → bipolar

○ Didn’t know how to differentiate normal behavior from

symptoms of mental illnesses

■ Unethical experiment → subjects were treated differently, no privacy

■ Conclusion: labels do matter → change one’s perception and reality

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8.3: Neurodevelopmental and Schizophrenic Spectrum Disorders

“Neurodevelopmental Disorders”

● Caused by Unusual brain development, brain damage or any other abnormality in the

brain

○ Autism Spectrum Disorder (ASD)

○ Attention Deficit Hyperactivity Disorder (ADHD)

● Autism Spectrum Disorder (ASD)

○ Atypical behaviors, speech, interest, thought patterns, interpersonal interactions

○ Difficult time interpreting social cues and may prefer routine over spontaneity

● Attention Deficit Hyperactivity Disorder (ADHD)

○ Appearance of one or more symptoms:

■ Extreme inattention

■ Hyperactivity

■ Impulsivity

○ Inheritable and can be treated with medications

○ Often exists with another disorder (learning disorder or emotional disorder)

○ Skeptics:

■ Impulsiveness on the presence of the Y chromosome

■ Boring environment → energized child → improperly diagnosed with

ADHD

● Intellectual Disability

○ Having IQ below 70

○ Symptoms:

■ Limitations in learning

■ Hard time solving problems

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■ Hard time communicating

■ Lack of daily life skills

○ Require conceptual, social and practical skills

○ Down syndrome

● Neurocognitive disorder

○ Decrease in mental functioning by somatogenic cause

■ Breathing conditions, brain trauma, cardiovascular disorders

○ Most common: Alzheimer’s disease

■ Memory loss

■ Common symptoms:

● Short-term memory loss

● Headaches

● Difficult walking and driving

● Inability to focus

“Psychotic and Schizophrenia Spectrum Disorders”

● Schizophrenia: psychotic disorder that impacts on perception of reality

○ Psychotic episode → delusion and auditory and/or visual hallucinations

● Subtypes of Schizophrenia

○ Acute Schizophrenia

■ Developed rapidly after a period stress

■ Positive symptoms and responsive to therapy

● Possibly recover

■ Positive symptoms: added symptoms

● Delusions, hallucination → add to person’s personality

● Delusions: false beliefs that can be erotomanic, grandiose,

jealous, persecutory, somatic or mixed

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● Hallucinations: false sensory experiences → often auditory

○ Chronic Schizophrenia

■ Developed overtime and slow

■ Difficult to recover

■ Negative symptoms: remove from a person’s personality

● Inability to feel emotion

● Difficult to understand emotion

● Difficult to read others’ emotions

● Flat speech

● Impaired attention

● Lack of pleasure

● Catatonia → motionless for hours and agitated shortly after

● Flat affect→ emotionless state

○ Brain abnormalities

■ Schizophrenia = disease of the brain

● High dopamine level → too many receptors and intensified

schizophrenia

● Low brain activity in the frontal lobe and shrinkage of tissue

● Increased activity in the amygdala and thalamus

● Spaces in the brain are enlarged

● Genetic → increased risk during fetal development

● Acute schizophrenia → stress can turn on specific genes

● Mainly biological factors

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8.4: Bipolar, Depressive, Anxiety, and Obsessive-Compulsive and Related

Disorders

“Mood Disorders”

● Unusual and disruptive changes in mood → depression, mania or both

○ Chemical imbalances, genetic factors, environmental factors and/or the time of

year

● Depression

○ Seasonal Affective Disorder (SAD) → seasonal pattern

○ Major Depressive Disorder (MDD) → last months or years/severe

○ Dysthymic Disorder → multiple years/mild

● Major Depressive Disorder

○ Long period of time

○ Often occurs after present or past loss

○ Loss of reality → due to prolonged depressive thoughts

● Dysthymic Disorder

○ Persistent depression, mild depression for at least two years

○ Symptoms:

■ Loss of appetite

■ Sleeping problems

■ Low energy and self-esteem

■ Loss of focus

■ Hopelessness

● Bipolar disorder (BP)

○ Fluctuation of mood swings between depression and mania or hypomania

■ Mania → hyperactive state of euphoric

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○ Manic episode → impulsive, irritable, hyperactive, energetic, reckless behavior

○ Can be cured

● Suicide

○ Depression or bipolar disorder

● Self-Injury

○ Nonsuicidal self-injury

○ Coping mechanism related to past traumas

● Etiology

○ Biological

■ Depression and BP → genetic

■ Smaller left frontal lobe (usually with positive emotions)

■ Little norepinephrine and serotonin

○ Social-Cognitive

■ Explanatory style → way viewing life

“Anxiety Disorders”

● Trauma, compulsion, fear-based anxiety

● Panic Disorder

○ Panic disorder: mixture of physiological and fear-based anxiety

■ Unpredictable panic attacks with physical symptoms and terror

○ Panic attack

■ Physiological symptoms: sweating, fast heart rate or dizziness

■ Fear → onset from the anxiety of panic attack

● Obsessive-Compulsive Disorder

○ Obsessions: repetitive thoughts that cause anxiety and disruptions in daily life

○ Compulsions: repetitive behaviors

■ Results of obsessions
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● Generalized Anxiety Disorder (GAD)

○ Consistent anxiety of worst-case scenario situations regarding to any event

○ Anxiety is always present for general reasons and tends to be exaggerated

■ Arousal of autonomic nervous system

■ Hard time sleeping and accompanied by depressed mood, low

concentration level

■ Symptoms: dizziness and sweaty palms → only the first six months of the

disorders

● Phobias

○ Disruptive fear of any specific source

○ Cause avoidant behavior towards the source of behavior

○ Social Anxiety Disorder (social phobia)

■ Anxiety caused by social interactions → fear rejection, embarrassment or

judgement

■ Agoraphobia → extreme phobia → loss of control over situation → often

develops after experiencing panic attacks

● Etiology

○ Behavioral

■ Unpredictable bad events lead to anxiety

● Stimulus generalization

● Reinforcement

○ Social-Cognitive

■ Albert Bandura

■ Observational learning

○ Cognition

■ Perception of certain stimuli

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8.5: Trauma - and Stressor Related, Dissociative, and Somatic Symptom

and Related Disorders

“Post-Traumatic Stress Disorder (PTSD)”

● Truma-rooted anxiety disorder

● Have triggers that provoke anxiety or flashbacks from a traumatic event in the past

● Intrusive thoughts and emotions → disruption in daily functioning

● Survivors of accidents, assaults, war experience

● Posttraumatic growth → positive changes after a hard time or life crisis

“Somatic Symptom Disorder”

● Derived from somatogenic etiology

● Fixated on physical symptoms where the emotional health is affected

○ Reactions to physical pain

● Examples: vomiting, dizziness, blurred vision

● Conversion disorder

○ Functional neurological symptom disorder → physical symptoms for no reason

○ May lose function and no physiological sense

○ Unexplained paralysis and blindness

● Illness Anxiety Disorder

○ Hypochondriasis

○ Interpretation of regular physical symptoms → sign of disease

“Dissociative Disorders”

● Dissociative disorder → disruption causing inconsistencies in consciousness

○ Memory loss of complete change in identity

○ Common: psychogenic amnesia

■ No physiological cause
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■ After a traumatic or stressful event

○ Dissociative fugue

■ Similar to psychogenic amnesia except that individuals are in completely

unfamiliar environment with no recollection

■ Psychological stress

● Dissociative Identity Disorder (DID)

○ Most controversial dissociative disorder

○ Multiple Personality Disorder (MPD)

○ Rooted in trauma, alternate personalities to cope with stress and intense pain

○ Rare , completely different personalities

○ Nicholas Spanos → investigating DID by hypnosis

○ DID → a way to deal with anxiety

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8.6: Feeding and Eating, Substance and Addictive, and Personality

Disorders

“Substance Abuse Disorders and Addiction”

● Any substance that forms chemical dependency

○ Brain has difficulty to naturally create and receive neurotransmitters due to

disruptions caused by substance addiction

○ Body become dependent on substance → chemical imbalances in the brain

“Eating Disorders”

● Disordered eating patterns

○ Body image issues

○ Inability to regulate hunger

○ Comorbid conditions

○ Difficulty with sensory input

● Common eating disorders: Anorexia Nervosa, Bulimia Nervosa, Binge eating

● Anorexia Nervosa

○ Somatic condition by body image issues

■ Starvation and restriction of food

■ Unhealthy obsession and compulsions regarding weight, malnutrition

■ Continue to feel overweight

● Bulimia Nervosa

○ Body image issues → different disordered eating patterns

○ Cycles of binge eating and purging to lose weight

○ Weight loss patterns tend to fluctuate due to inconsistency of food consumption

● Binge Eating Disorder

○ Low and nonexistence of hunger regulation due to hypothalamus

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○ Feel guilty or disgusted shortly after the binge eating

● Possible causes

○ Usually caused by judgements

○ Genetic → slightly increases risk

○ Ideal body images on social media → modeling

■ Body dissatisfaction

■ Every culture has their own “ideal body image”

“Personality Disorders”

● Complex patterns of thoughts and behavior that are detrimental to personal growth,

relationships and other areas of life

○ Difficult to treat due to inflexible nature

● Clusters of personality disorders (3 categories for personality disorders)

○ Cluster A: Eccentric behavior → emotionless disengagement

○ Cluster B: Dramatic and Impulsive behavior → attention-getting

○ Cluster C: Anxiety → fearing rejection

● Cluster A

○ Paranoid Personality Disorder (PPD)

■ Irrational fear

■ Inability to trust others

■ Worst case scenario situation

○ Schizoid Personality Disorder

■ Detachment from emotions and relationships

■ Little or no interest in social interaction

○ Schizotypal Personality

■ Eccentric and/or erratic thought, behavioral and speech patterns, delusion

● Cluster B
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○ Antisocial Personality Disorder (ASPD)

■ Lack of empathy, patterns of manipulation for selfish benefits

■ Little or no remorse

■ Exhibiting a lack of conscience for wrongful action

○ Borderline Personality Disorder (BPD)

■ Extreme emotional swings and perceptions of the world

■ Black and white thinking

■ Impulsive behavior

○ Histrionic Personality Disorder (HPD)

■ Dramatic and impulsive behaviors

■ Obsessive need to be the center of attention

■ People-pleasing

○ Narcissistic Personality Disorder (NPD)

■ Grandiose delusions

■ Manipulation

■ Perfectionism

■ Defensive and upset if criticized

● Cluster C

○ Avoidant Personality Disorder (AVPD)

■ Low self esteem

■ Avoidance of social interactions

■ Afraid of rejection and criticism

○ Dependent Personality Disorder (DPD)

■ Abandonment issue

■ Anxiety when alone

■ Afraid of rejection and criticism

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○ Obsessive-compulsive Personality Disorder (OCPD)

■ Obsessions and compulsions regarding perfectionism

■ Unable to notice any problem present

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8.7: Introduction to Treatment of Psychological Disorders

● Key ideas:

○ Correcting thought patterns that are psychologically damaging

○ Conditioning proper emotional responses to various situations

○ Teaching proportionate and healthy responses

○ Coping with various conditions and symptoms

● Psychologists

○ Aaron Beck

■ Youth inventory

■ Anxiety inventory

■ Beck Scales depression inventory

■ Hopelessness scale

■ Cognitive therapy

○ Albert Ellis

■ Rational-Emotive Therapy

■ Problems come from irrational thinking

○ Sigmund Freud

■ Therapy

● Resistance in the mind and transfer feelings

○ Mary Cover Jones

■ Exposure therapy “systematic desensitization”

■ Behavioral approach and aimed to treat phobia by exposing the stimuli

○ Carl Rogers

■ Humanistic psychologist

■ Client-centered therapy
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● Use of unconditional positive regard and provide

acceptance,genuineness and empathy (environment) to overcome

the disorders

○ B.F. Skinner

■ Operant conditioning, reinforcement schedules, Skinner box

■ Behavior modification therapy → learning principles to eliminate

unwanted thoughts and fears

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8.8: Psychological Perspectives and Treatment of Disorders

● Three types of therapy:

○ Biomedical Therapy: drugs to relieve physical and physiological pain

○ Eclectic Approach: techniques from different types of therapies

○ Talk Therapy: taking to the client or group/family therapy

“Different Perspectives”

● Behavioral Psychology

○ Identifying learned behaviors and using conditioning and reinforcement for

correction

○ Counter conditioning → classical conditioning to create new conditioned

response

○ Systematic Desensitization

■ Mary Jones → exposure therapy

■ Pairing stimulus of fear with relaxation techniques and conditioning the

subjects to associate the stimulus with relaxation

■ Use of hierarchies

○ Virtual Reality Exposure Therapy

■ When an anxiety is too difficult to recreate with systematic desensitization

○ Aversive Conditioning

■ Conditioning something unpleasant with one’s addiction

○ Behavior Modification

■ Use of token economy

● Clients earn a token for doing a desired behavior

● Accumulation of tokens → reward

● Ethical issues
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● Cognitive Psychology

○ Emphasis on current thoughts, behaviors

○ Rational Emotive Behavior Therapy (REBT)

■ Challenges people to think otherwise and enable healthier behaviors

● Humanistic Psychology

○ Individualism in treatment planning

○ Non-deterministic approach by Carl Rogers

■ Humans are innately good and capable of change

○ Client-centered talk therapy ⇒ primary treatment method

■ Tries to grow the self-awareness of patients and grows self-acceptance

■ Focuses on reaching self-actualization

● Focuses on the present and the future

■ Promotion of active listening → accepting, genuine and empathic

environment

● Listen, repeat, restate and clarify the statements of patients

● Psychodynamic Psychology

○ Behavior is influenced by unconscious motive through id, superego and ego

○ Uncontrollable urges and motivations lead to disorders and irrational thinking

○ Childhood may be analyzed to determine the root of current problems

○ Four main points:

■ Bringing unconscious thought into awareness, providing an insight of

where the disorder may be coming from → disorder from the inside

■ Use of free association → mental block which shows resistance

■ Interpretation of blocks

■ Transferring thoughts in the past into the present → provide insight

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○ Psychodynamic theories → focus on therapy and provide immediate relief

through understanding feelings and learning about yourself

● Cognitive-Behavioral Psychology

○ Uses concepts and theories from the cognitive and behavioral approaches

○ Cognitive Behavioral therapy (CBT)

■ Most widely practiced therapies and most successful

■ Change the way someone thinks and acts

■ Patients learn that their negative thoughts are irrational and begin to

replace it with positive way of thinking

● Anxiety disorders, mood disorders, and anorexia

○ Sociocultural Psychology

■ Personal development within society expectation and norms

“Effectiveness of Approaches by Disorder”

● Behavioral

○ Any disorders that lead to abnormalities in behavioral patterns of patients with a

history of trauma

● Cognitive

○ Disorders where cognition behind thoughts and behaviors is affected or people

who cannot rationally problem solve

● Humanistic

○ Interpersonal problems, mood disorders, anxiety disorders or personality

disorders

● Psychodynamic

○ People with a history of unresolved trauma

● Sociocultural

○ A broad range of disorders throughout a variety of different cultures

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● Factors of treatment

○ Cultural stigma of mental illness

○ Socioeconomic status

○ Life outlook

○ Environment

○ Demographic information
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8.9: Treatment of Disorders from the Biological Perspective

● Biological psychology → chemical imbalance

● Psychopharmacology: the study of drugs on the mind and on behavior

○ Antidepressants

○ Mood stabilizers

○ Antipsychotics

○ Antianxiety drugs

“Types of Drugs”

● Antidepressants

○ Depression, anxiety, OCD and PTSD

○ Selective serotonin retake inhibitors (SSRI) or Selective norepinephrine reuptake

inhibitors (SNRI)

■ Increases serotonin and norepinephrine levels

■ Promotion of neurogenesis

○ Drug, therapy, exercise

○ Treats/How it works

■ Depression and anxiety

■ Increases serotonin or norepinephrine levels

○ Examples/Disadvantages

■ Prozac, Zoloft, Celexa

■ Can take weeks to notice changes in mood

● Anti-anxiety Drugs

○ Anxiety disorders

○ Anxiety = results of activity in the central nervous system

■ Anti-anxiety drugs reduce CNS activity

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○ Treats/How it works

■ Anxiety-panic attacks

■ Depresses central nervous system

○ Example/Disadvantages

■ Xanax, Klonopin

■ Build a tolerance, physical dependence

● Addiction

● Mood Stabilizers

○ Bipolar disorder

○ Balance both sides of the disorder: mania and depression

○ Treats/How it works

■ Bipolar disorder

○ Example/Disadvantages

■ Lithium

● Antipsychotic Drugs

○ Schizophrenia by decreasing dopamine levels

○ Long Term use → tardive dyskinesia

■ Tremors or twitches → involuntary movement of muscles

○ Treats/How it works

■ Schizophrenia

■ Decreases dopamine levels

○ Example/Disadvantages

■ Abilify, Seroquel

“Other Procedures”

● Electroconvulsive Therapy (ECT)

○ Used with those severely depressed

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■ Anesthetic and then brief electric currents

○ Clients do not remember the whole procedure

○ 80% of the depression fades away

○ Lowes the activity of the brain and promotes neurogenesis (the formation of new

neurons)

● Repetitive Transcranial Magnetic Stimulation (rTMS)

○ ASD (autism spectrum disorder) or depression

○ Magnetic energy is sent to the brain

■ Either stimulate or suppress activity in the brain

■ Painless and quick

■ Magnetic energy might be activating the brain’s left frontal lobe

(association with positive emotion and usually shrinks when people have

depression)

● Deep-brain stimulation

○ Not the most effective

○ Depression and possibly OCD

○ Helen Mayberg found an area in the brain that helped activate the frontal lobes

and the limbic system

■ Created procedure where she would connect the area of the brain to

other areas of the brain to treat depression

● Psychosurgery

○ Removal of part of the brain to ease or treat disorder

○ Dangerous and never used because of how it would affect the brain
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8.10: Evaluating Strengths, Weaknesses, and Empirical Support for

Treatments of Disorders

“Other Types of Therapy”

● Individual Therapy

○ One-on-one client centered setting with various areas that can be improved

○ down side → any interpersonal techniques may be hard to practice

● Group Therapy

○ Support-centric type of therapy

○ Helps patients feel less isolated in their problems

○ Developing interpersonal and social skills

○ Hard for individuals who prefer to keep their issues out of the public

● Family Therapy

○ Heal relationships and open up communication between family members to

resolve conflicts

● Rational-Emotive Therapy

○ Rationalize, contextualize and identify negative feelings and associated patterns

○ Deeply rooted issues take time to undo

“Benefits of Psychotherapy”

● Hope

● New attitude

● New relationships → therapeutic alliance

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“Comparing Therapy Techniques”