PSYC 340:

Fundamentals of
Psychopathology
Joseph (Jake) Shenker

Week 2
Minor syllabus change
Added reading to Week 10 (November 10):

Heyman et al. (2021). Differential diagnosis of autism

spectrum disorder, intellectual disability and
attention-deficit hyperactivity disorder (ADHD).
Advances in Autism, 8(2), 89–103.
Today
• Frameworks/models of psychopathology
• The DSM: history, development, controversies, and
alternatives
Models
• Disclaimer: all psychological models are
theoretical
• Remember constructs? If something can’t be
objectively measured, then it can’t be objectively
defined.
Consider:
• An 11-year-old girl – believed to have witnessed
physical abuse in the family – believes she can
predict the future, and she engages in fortune
telling. Her behaviour changes: she has “fits” that
include screaming, throwing things, and making
strange sounds. Later, her body goes through
strange contortions.

Any theories?
Consider:
• An 11-year-old girl – believed to have witnessed
physical abuse in the family – believes she can
predict the future, and she engages in fortune
telling. Her behaviour changes: she has “fits” that
include screaming, throwing things, and making
strange sounds. Later, her body goes through
strange contortions.

This is Abigail Williams. She kicked off the Salem

Witch Trials (17th century).
Abigail Williams
“Some scholars have speculated that the strange
behaviour may have resulted from some
combination of asthma, encephalitis, Lyme disease,
epilepsy, child abuse, delusional psychosis, or
convulsive ergotism—the last a disease caused by
eating bread or cereal made of rye that has been
infected with the fungus ergot, which can elicit
vomiting, choking, fits, hallucinations, and the sense
of something crawling on one’s skin. (The
hallucinogen LSD is a derivative of ergot.)”

https://www.britannica.com/event/Salem-witch-trials/The-trials
Abigail Williams
But:
• Through a modern lens, most of her behaviour can
be seen as externalizing behaviours
• It is believed that she was told tales of voodoo by
her family’s slaves, Tituba and John Indian
• Her behaviour could be seen as acting out aspects
of voodoo culture
• When confronted about her “strange” behaviour,
she accused Tituba and John Indian of witchcraft
Abigail Williams
• Are voodoo and witchcraft real?
• I don’t know, but both are reasonable theories to
explain her behaviour (until/unless they are
disproven)
What’s happening here?
What’s the problem?
What’s the solution?

What is the model?

Models of psychopathology
• Biomedical model
• Behavioural model
• Cognitive model
• Psychodynamic theory
• Humanistic-existential theory
Models of psychopathology
• Biomedical model
• Biology is the problem, pharmacology is the solution
• Behavioural model
• Your behaviour is the problem, behave differently
• Cognitive model
• Your thoughts are the problem, think differently
• Psychodynamic theory
• Your unconscious is the problem, explore it
• Humanistic-existential theory
• Death is the problem, get comfortable with that
Biomedical model
• Sometimes called biological model or medical
model
• Concerned with physiology of the human body as a
basis for thinking about mental illness
• The mind is a manifestation of the body
• “A person who is having problems in living
(functioning in society, relationships, and work) is
not only a psychological and social being but also a
human body.” – Miller
Biomedical model
• In its most simplistic form, this model theorizes that
mental illness is the result of some physical
dysfunction
• “People with normal brains and nervous systems cope
with and adapt to whatever stresses are presented, and
people who do not cope and adapt effectively (people
who are thrown by stress) must therefore have
abnormal brains and nervous systems.” – Miller
Why biomedical theory?
• Mind is a construct – you can’t measure it
… humans don’t like things we can’t measure
Why biomedical theory?
• Hippocrates and Humoralism
• A system of medicine detailing a supposed makeup and
workings of the human body
• Four “humors,” each corresponds to one of the
traditional four temperaments: sanguine, choleric,
melancholic, and phlegmatic
• Galen later “connected” parts of the soul and three
major organs: the brain, the heart, and the liver.
Why biomedical theory?
• Ayurvedic medicine (India)
• “Based on the idea that disease is due to an imbalance
or stress in a person's consciousness, Ayurveda
encourages certain lifestyle interventions and natural
therapies to regain a balance between the body, mind,
spirit, and the environment.”
• Doshas in balance: balance of the doshas results in
health, while imbalance results in disease
• Does this sound silly? Maybe. But...
Why biomedical theory?
• Another “silly” theory:
• Your mind is created by your brain, a mass of folded
flesh housed inside your skull.
• Your brain runs on electricity! Electricity travels down
power lines (we call them neurons) until it reaches a gap
• Here, the electric signal triggers the release of special
chemicals (we call them neurotransmitters), which fill
the gap and influence new electric signals
• Neurotransmitters in balance: balance of these
chemicals results in health, while imbalance results in
disease
Evidence
• The biggest evidence for the biomedical theory of
mental illness came from the discovery of drugs to
treat depression and psychosis, so-called anti-
depressants and anti-psychotics
Evidence
• 1952: iproniazid was discovered to have
psychoactive properties while researched as a
possible treatment for tuberculosis
• Patients given iproniazid became cheerful, more
optimistic, and more physically active
• Oh and hey, it turns out iproniazid slows the
breakdown of serotonin by inhibiting monoamine
oxidase!*
• Therefore, depression must be caused (at least in
part) by a reduction in serotonin
*This class of drug later became known as monoamine oxidase
inhibitors, or MAOIs
Evidence
• Sort of like a Jeopardy clue, where the answer
came first
• When kept longer in the synaptic cleft, this chemical
makes depressed people feel less depressed
• What is serotonin?
Biomedical theory: pros and cons
• Let’s get serious: the biomedical theory of
psychopathology is true
…Except that it’s not
Biomedical theory: pros and cons
• We accept that the mind is a manifestation of the
brain, but we don’t understand the details – it’s a
black box

Input Output
Biomedical theory: pros and cons
• Saying that the mind – both normal and abnormal
functioning – are products of biology is accurate,
but insufficient

Input Output
Biomedical theory: pros and cons
• Because the only thing that matters is INSIDE THE
BLACK BOX

Input Output
Biomedical: stress-diathesis
• This is an “inside-the-black-box” theory
• Posits that people have a biological (genetic)
predisposition to certain disorders, and that
stressful conditions can precipitate illness
• Nature-nurture
Behavioural model
• Focuses only on observable behaviour
• There is NO black box
• In a nutshell: you behave in maladaptive ways
because you learned to behave that way…
• … so take the behavioural symptoms of mental
illness and learn new ways to behave
• Heavily influenced by animal models
• e.g. Pavlov’s dogs, Skinner box
Cognitive-behavioural model
• Expands upon the
behavioural model to include
thoughts and emotions
• Currently the predominant
clinical model taught in
psychology graduate
programs
Behavioural becomes cognitive-
behavioural
I am invited to a
I decide not to go I am sad
party
Behavioural becomes cognitive-
behavioural
I am invited to a
I decide not to go I am sad
party

I am invited to a
party

I become anxious

I am worried no one I decide not to go

will talk to me

I am sad
Humanistic-existential
• Initially tended to reject all diagnostic terms as
labels that categorized people and detracted from
individuality.
• Psychological pain is part of the human condition
and that people primarily need support,
encouragement, and hope
Humanistic-existential
• Carl Rogers (1902-1987)
• Theorized that one learns self-awareness and self-
growth through the relationship with one’s parents
• He believed that there was a “positive growth potential”
that would lead to a positive sense of self and healthy
relationships, unless obstacles were placed in the child’s
path.
• Obstacles were messages that invalidated the child’s
sense of what was happening around them.
Humanistic-existential
• Abraham Maslow (1908-1970)
• Hierarchy of needs
Psychodynamic theory
Psychodynamic theory
• The grandchild of Freud’s original ideas
• Psychoanalysis as Freud envisioned was not
intended as a model of or treatment for
psychopathology
• It was closer to philosophy, all about understanding the
self
• Psychoanalysis was adopted by American
psychiatrists and became psychodynamic theory –
a new name meant to medicalize the discipline
Psychodynamic theory
Three key ideas:

1. The unconscious exists, and it is conceptually

organized by emotions
2. We use defense mechanisms – partly
unconscious – to protect us from emotional
conflicts
3. We act out past relationships in the present, even
if those relationships were difficult/painful
Psychodynamic theory
• Yes, there was stuff about
psychosexual conflict.
• No, we’re not going to
talk about it.
Maggie
Maggie is very good at her job, and she hates her
boss. When she receives an email from him, she
becomes angry. Sometimes her anger is so strong
that she leaves work early. At home, she suddenly
finds that she is lonely. She smokes marijuana to
cope with her loneliness, because it is too painful to
feel.
 Maggie is very good at her job,
and she hates her boss. When
she receives an email from him,

Maggie – biomedical she becomes angry. Sometimes

her anger is so strong that she
leaves work early. At home, she
suddenly finds that she is lonely.
She smokes marijuana to cope
with her loneliness, because it is
too painful to feel.
• Maggie meets criteria for a
substance-use disorder.
• She may meet criteria for a major depressive
episode.

Input Output
 Maggie is very good at her job,
and she hates her boss. When
she receives an email from him,

Maggie – behavioural she becomes angry. Sometimes

her anger is so strong that she
leaves work early. At home, she
suddenly finds that she is lonely.
She smokes marijuana to cope
with her loneliness, because it is
too painful to feel.
• Maggie responds to anger with
avoidance.
• Maggie responds to loneliness with substance use.

Input Output
 Maggie is very good at her job,

Maggie – and she hates her boss. When

she receives an email from him,
she becomes angry. Sometimes
her anger is so strong that she

cognitive-behavioural leaves work early. At home, she

suddenly finds that she is lonely.
She smokes marijuana to cope
with her loneliness, because it is
too painful to feel.
• When Maggie thinks about her boss
she feels that he thinks she is incompetent. This
makes her angry, because she is very good at her
job.
• When she goes home in her anger, she becomes
lonely because she thinks about not having a
partner and worries that she will never find love.
She smokes marijuana to avoid these
feelings/thoughts.
 Maggie is very good at her job,

Maggie – and she hates her boss. When

she receives an email from him,
she becomes angry. Sometimes
her anger is so strong that she

humanistic-existential leaves work early. At home, she

suddenly finds that she is lonely.
She smokes marijuana to cope
with her loneliness, because it is
too painful to feel.
• Maggie feels self-esteem at work,
but when her boss questions her capability, her
self-esteem drops. This is an existential fear – to
lack value – and she becomes angry.
• Her lack of a partner at home reminds her that she
has not found love and may never have children,
which leads her to consider her own mortality. She
smokes marijuana because she cannot handle
thinking about death.
 Maggie is very good at her job,

Maggie – and she hates her boss. When

she receives an email from him,
she becomes angry. Sometimes
her anger is so strong that she

psychodynamic leaves work early. At home, she

suddenly finds that she is lonely.
She smokes marijuana to cope
with her loneliness, because it is
too painful to feel.
• As a child, Maggie was not validated
unless she was being useful. When she was not being
useful, her mother would hit her. As a result, her self-worth
is dependent on her ability to be capable and useful.
• When her boss questions her capability, she becomes aware
of her low self-worth and feels the same emotions she felt
as a child: fear of physical punishment.
• She runs home just as she would run to her room as a child,
where she feels lonely.
• What does loneliness mean to Maggie? It means “to be
locked away with my emotions and no one to help me”
• It has nothing to do with her lack of a partner, but this is how she
has interpreted the problem until now.
Henriques, A New Unified Theory of Psychology
Measuring mental illness
If you’ve been paying attention, then you understand
that there is no objective way to measure mental
illness

But that hasn’t stopped us from trying!

What is the DSM?
• The Diagnostic and Statistical Manual of Mental
Disorders, currently in its fifth edition (first
published in 1952), produced by the American
Psychiatric Association (APA)
• An attempt to quantify mental illness: to assign
measurable, repeatable, simple criteria to people’s
subjective experiences of suffering
• A tool to aid in both the assessment/diagnosis, and
treatment of mental illness
Useful
• Provides a common language for caregivers and
patients
• Although your anxiety disorder doesn’t look like my
anxiety disorder, they are probably more similar than
different… and perhaps the treatment should be the
same, too
Bloated
• “It has grown from a modest document involving
about 75 diagnostic entities in DSM–II to an
imposing tome of about 490 diagnostic codes in
DSM–5.” (Miller)
Bloated
• Although your anxiety disorder doesn’t look like my
anxiety disorder, they are probably more similar
than different
Separation Anxiety disorder
Selective mutism
Specific phobia
Social anxiety disorder
Panic disorder
Agoraphobia
Generalized anxiety disorder
Substance/medication-induced anxiety disorder
Anxiety disorder due to another medical condition
Other specified anxiety disorder
Unspecified anxiety disorder
DSM alternatives
• International Classification of Diseases (ICD)
• Psychodynamic Diagnostic Manual (PDM)
• Hierarchical Taxonomy of Psychopathology (HiTOP)
International Classification of
Diseases (ICD)
• Free online resource managed by WHO
• Not just for mental illness, but all disease-related
diagnoses
• Similar to the DSM: category-based diagnosis,
health insurance codes
• No checklists
Psychodynamic Diagnostic
Manual (PDM)
• PDM asserts that the “major flaw of the DSM and
ICD is that they fail to properly assess personality
[and] fail to provide clinicians the detailed
information necessary to guide effective
interventions.” (Raskin)
• Classifies patients on three axes:
• P-Axis – Personality Syndromes
• M-Axis – Profiles of Mental Functioning
• S-Axis – Symptom Patterns: The Subjective Experience
Psychodynamic Diagnostic
Manual (PDM)
• P-Axis – Personality Syndromes
• “Levels of personality organization (i.e., a spectrum of
personality functioning from healthy, through neurotic and
borderline, to psychotic levels) and personality style or
pattern (i.e., clinically familiar types that cross-cut levels of
personality organization)” (PDM-2)
• Looks at the spectrum of personality types and places the
person's personality on a continuum from unhealthy and
maladaptive to healthy and adaptive
• Intended to be viewed as a “map” of personality instead of a
listing of personality disorders
• M-Axis – Profiles of Mental Functioning
• S-Axis – Symptom Patterns: The Subjective Experience
Psychodynamic Diagnostic
Manual (PDM)
• P-Axis – Personality Syndromes
• M-Axis – Profiles of Mental Functioning
• “Takes a more microscopic look at inner mental life,
systematizing and operationalizing such capacities as
information processing; impulse regulation; reflecting on
one’s own and others’ mental states; forming and maintaining
relationships; experiencing, expressing, and understanding
different emotions; regulating self-esteem; using coping
strategies and defenses; adaptation and resiliency; forming
internal standards; and giving coherence and meaning to
personal experience.” (PDM-2)
• S-Axis – Symptom Patterns: The Subjective Experience
Psychodynamic Diagnostic
Manual (PDM)
• P-Axis – Personality Syndromes
• M-Axis – Profiles of Mental Functioning
• S-Axis – Symptom Patterns: The Subjective
Experience
• “Takes as its starting point the DSM and ICD categories
and depicts the affective states, cognitive processes,
somatic experiences, and relational patterns most often
associated with each.” (PDM-2)
Hierarchical Taxonomy of
Psychopathology (HiTOP)
• Takes a dimensional approach
• Divides psychopathology into six dimensions and
assesses along each dimension
• Fewer diagnoses, more overlap
“Constructs higher in the figure are broader and more general, whereas constructs lower in the
figure are narrower and more specific. Dashed lines denote provisional elements requiring further
study. At the lowest level of the hierarchy (i.e., traits and symptom components), conceptually
related signs and symptoms (e.g., phobia) are indicated in bold for heuristic purposes, with specific
manifestations indicated in parentheses.”

Ruggero, C. J. et al. (2019). Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical
practice. Journal of consulting and clinical psychology, 87(12), 1069–1084.
Other alternatives
• Research Domain Criteria (RDoC)
• Power Threat Meaning Framework (PTMF)
Optional reading

https://www.psychologytoday.com/ca/blog/making-
meaning/201905/are-there-viable-alternatives-the-dsm-5
Throw out the book?
• If there is so much controversy, differences of
opinions, lack of clarity, etc., should psychologists
even be consulting these documents?
• YES… but with caution
This week’s readings:
• Miller, R. B. (2015). Not so abnormal psychology:
Chapter 3
• Johnstone, L. (2022). A Straight Talking Introduction
to Psychiatric Diagnosis: Chapter 3
Quiz available tomorrow at 8am;
closes September 22 at 4pm