Test 1-PSYC 3230

Professor Joshua Miller

Important ramifications when defining a disorder: this colors the way we may interpret behavior.

- Insurance: reimbursement for treatment.

-Legal Responsibility for treatment

-Disability

Past and present diagnosis that have been controversial

-Drapetomania (enslaved Africans wanting to run away)

-Childhood masturbation

-Homosexuality

Psa- APA (American Psychiatry Association) is in power to create diagnosis or rule them out

No single definition of psychological abnormality or normality

most behaviors exist on a (CONTINUUM) not categorial

Wakefield argues for disorder as

harmful dysfunction - Hybrid of of "value judgment" (ex harmful) and "biological disadvantage" (a failure of a mechanism to perform naturally

Approaches to define disorders

Disorder as a pure value concept - judgment of desirability according to social norms and ideals

Issue : Very Subjectable

Approaches to define disorders

Disorder as whatever professionals treat

2 problems

1) Clients come in for treatment for behaviors that are normal

2) Individuals do NOT come in when they have a disorder

Approaches to define disorders

Disorder as a statistical deviance : known as (Intellectual Disability)

Problem

- Can be statistically deviant on many traits and it is a positive attribute (ex. IQ strength). Even undesirable behaviors are statistically deviant may not be a disorder such as being rude

Approaches to define disorder

Disorder as a biological disadvantage

- if behavior results in lowered reproductive fitness

- If some mental mechanism is not performing the specific function it was designed to perform (ex normal anxiety vs pathological anxiety)

- When a mechanism fails to perform as it was designed AND causes impairment.

Psa = normal anxiety is when someone brings in a physical lion and you react compared to pathological when someone shows a picture of a lion and they have a reaction.

Toward a Definition of Abnormal Behavior

Psychological Dysfunction

-Breakdown in cognitive, emotional, or behavioral function within the individual (it comes from within)

Toward a Definition of Abnormal Behavior

Personal Distress or Disability (functional impairment)

-difficulty performing appropriate and expected roles.
-some disorders may emphasize one over the other (ex antisocial personality disorder)

Toward a Definition of Abnormal Behavior

Atypical or unexpected cultural response

-reaction is outside cultural norms

Widiger : argues that two constructs are fundamental to definition of a mental disorder

1) Dyscontrol : an impaired ability to direct or regulate ovulation, emotion, behavior, or cognition, or some other area, which often entails inability to resist impulses and leads to abnormal behaviors without significant provocation (APA)

2 Maladaptively: a condition in which biological traits or behavior patterns are deterental, counterproductive, or otherwise interfere with optimal functioning in various domains, such as successful interaction with the environment and effectual coping with the challenged and stresses of daily life (APA)

-some argue that we will never have perfect definition of a mental disorder

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

widely accepted system and used to classify psychological disorders and problems.

contains diagnostic criteria for behaviors that
-fit a pattern
-cause dysfunction or stress

-present for a specified duration

-based on prototypes, a typical or standard example of a disorder

Clinical description of abnormality

-begins with presenting the problem (what is brining patient in)

clinical description: aims to distinguish clinically significant dysfunction from common human experience. While also describing demographics, relevant symptoms, age of onset ext.

When clinically describing abnormality keep in mind of

-prevelance : # of people in the population with this disorder

-incedence: # of new cases during give time

-Course of disorders : episodic, time-limited, or chronic

-onset of disorders: Acute (comes quick) or Insidious (comes slow)

Eitology

factors that contribute to the development of a disorder

Diathesis model: explains that a predisposition or diathesis for a certain condition is present due to hereditary, biological, temperamental, or other pre-existing factors. the theory that mental and physical disorders develop from a genetic or biological predisposition for that illness (diathesis) combined with stressful conditions that play a precipitating or facilitating role. Also called diathesis-stress hypothesis (or paradigm or theory).

treatment development

How can we help alleviate psychological suffering?
Includes pharmacological, psychosocial, and/or combined treatments

treatment outcome research

studies of the effectiveness of clinical interventions, including the comparison of competing treatments

How we know we have helped. That is limited and specifying actual causes of disorders.

When did the first good medication to come out?

50s

Three dominant traditions include

supernatural, biological, psychological

The Past: The Supernatural Tradition

Deviant behavior as good versus evil.

Causes of that behavior included, demonic, witchcraft, sorcery.


Treatments include exorcism, torture, beatings, crude surgeries

Outcomes, some worked placebo effect, fear

The Past: The Biological Tradition Comes of Age

Cause- Pasteur discovered the cause - bacterial microorganism

Syphilis- sexually-transmitted disease caused by bacterial infection advanced stage can result in psychosis and psychotic behavior's

Treatment- penicillin

Bolstered the idea that mental health = physical health

The past biological consequences

Believe mental illness equals physical illness.

Resulted in biological treatments in the 1930s

Biological treatments were standard practice included insulin shock, therapy, ECT brain surgery

Worldly causes of deviant behavior - the past

Movement of the moon and stars example lunatic from Luna moon

Hippocrates (biological tradition)

"Father of modern medicine medicine"

Believes that disorders could be treated like any other disease. Believe disease was not only the potential cause throughout head trauma.

Galen (Biological Tradition)

Extends Hippocrates work

Humoral theory of mental illness. Four major bodily fluids, or "humors" he had the idea that disease resulted too much or too little of a certain hummor

Galenic-Hippocratic Tradition (biological tradition)

-linked abnormality with brain chemical imbalances
-foreshadowed modern views

In 1950s meds are becoming available

Neuroleptics (antidepressants) are discovered in order to reduce hallucinations, delusions, agitation, and aggressiveness

1970s

Benzodiazepines introduces example Valium

The past: psychological tradition

Plato and Aristotle both thought that the social and cultural environment and early learning experiences impacted psychopathology

The rise of moral therapy

Normalizing treatment of mentally ill- reinforce and model appropriate behaviors. Emphasized importance of a nurturing environment. Around Plato and Aristotle time.

Reasons for falling out of moral therapy

Worked best with smaller populations,

Dorothea, Dix, lead mental hygiene, movement,

rise of mental hygiene, movement moved from moral therapy to "custodial care"

Psychological tradition, reemerges, and 1900s in three different forms

psychoanalysis, humanism, behaviorism

The Past: The Psychoanalytic Tradition

Freud in Breuer

Brewer had patients describe problems and conflicts under hypnosis. Two important discoveries were found with this.

Unconscious mind and catharsis

Unconscious mind (Freud)

contains memories, motives, fantasies, and fears. Revealed under Hipnosis, and appears to be outside of their explicit awareness.

Catharsis

the process of releasing, and thereby providing relief from, strong or repressed emotions.

Freudian Theory

unconscious needs or drives are at the heart of human motivation

The ID

The pleasure principle. This demands immediate gratification, unique processing of info, primary process, thinking that is emotional, irrational and primal. Source of sexual and aggressive motives, and energy, which is called libido.

Eros: drive for six

Thanos: death instinct, drive towards aggression in death

The ego

the largely conscious, "executive" part of personality that, according to Freud, mediates among the demands of the id, superego, and reality. The ego operates on the reality principle, satisfying the id's desires in ways that will realistically bring pleasure rather than pain. Characterized by logic and reasoning.

super ego (freud)

The partly conscious and partly unconscious. Represents the moral ideals we learn from family, friends, and society. Developed as a result of being rewarded and punished for various behaviors. The purpose is to counteract the drive toward sex and aggression offered by the id

Freud argued that the super-ego we're almost entirely subconscious

defense mechanisms

Unconscious protective processes that keep primitive emotions associated with conflict and check so that the ego can continue with its coordinating function. Anxiety serves as a warning that Ego might be overwhelmed results in defense mechanism.

Defense mechanism affiliation

The individual deals with emotional conflict or internal or external stressors by turning to others for help or support

Defense mechanism, humor

The individual deals with emotional conflict or internal or external stressors by emphasizing the amusing or ironic aspects of the conflict or stressor.

Defense mechanism, sublimation

dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms

someone with anger issues may channel their aggressive urges into sports instead of lashing out at others physically or verbally

Defense Mechanism: Displacement

shifting sexual or aggressive impulses toward a more acceptable or less threatening object or person

a person who is angry at their boss may "take out" their anger on a family member by shouting at them.

Defense mechanism, intellectualization

An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis

For example, a person might focus on funeral arrangements rather than dealing with their own grief or spending all their time researching an illness they've been diagnosed with rather than talking about how they feel about the diagnosis.

Defense mechanism, reaction formation

switching unacceptable impulses into their opposites

A classic example is a young boy who bullies a young girl because, on a subconscious level, he's attracted to her

Defense mechanism, repression

removing an unpleasant idea or memory from your mind

For example, a person dislikes an individual, but instead of accepting that they dislike them, they blame another person for disliking that individual.

Defense Mechanism: Projection

Blaming others for unacceptable thoughts and feelings

For example, the classroom bully who teases other children for crying but is quick to cry

Psychosexual stages of development

stages of child development in which a child's pleasure-seeking urges are focused on specific areas of the body called erogenous zones.

Freud posed five basic stages.

Oral Stage (0-18 months)

pleasure centers on the mouth- sucking, biting, chewing

Anal Stage (2-3 years old) Freud

Central focus in anus and the expulsion versus retention of feces. Stage resolved when toilet training is completed. Anal fixation example:
hyper fixation, ambiguous, perfectionist.

Phallic Stage (3-6 years)

pleasure zone is the genitals; coping with incestuous sexual feelings

Oedipus Complex (Freud)/ phallic stage

Conflict during phallic stage, a boy's sexual desires toward his mother and feelings of jealousy and hatred for the rival father. Fears father (casturation anxiety). Results in identification with father.

Electra complex

Conflict during phallic stage in which girls supposedly love their fathers romantically and want to eliminate their mothers as rivals. Girls desire penis (penis envy). Resolved with healthy heterosexual relationships.

latency stage 5-6

the fourth psychosexual stage, in which the primary focus is on the further development of intellectual, creative, interpersonal, and athletic skills. Sexual interest lies dormant during this period. Energy or known as libido, put into non-sexual interest, such as friendships, school, and sports.

Genital Stage (puberty on)

sexual feelings re-emerge and are oriented toward others. Central focus returns to genitals and interest in sexual relationships increased. Freud believe that this process was embedded in children remaining fixated at entire phases.

Psychoanalysis Therapy

Freudian therapy designed to bring unconscious conflicts which usually date back to early childhood experiences into consciousness.

Long term: (2-5 years) and high frequency of 3 to 5 times a week.

Goals is to analyze and resolve conflicts, restructure, personality focus is not on symptom reduction.


Typically patients lie on the couch and analyst behind the couch

Uses free association - no
censoring

Dream analysis - Contant reflects primary process(id)

Examines, transference, and countertransference issues

psychodynamic theory

Freudian theory that unconscious forces determine behavior

Focuses on patients expression of a (AFFECT) - non verbal emotions.

Explorers, patience, avoidance of topics or decisions to engage in behaviors that hinder therapy

Identify patterns in patients behaviors throughout feelings and personality

Emphasis on role of past experiences

Focuses on Insiah personal experiences

Emphasis on therapeutic relationships called therapeutic alliance

Explores, patients, fantasies, dreams, and wishes.

Humanistic theory and psychological tradition

Notion that there was a positive, uplifting quality of humanity. Humans as beings that strive for improvement and excellenceq

Self accusation- attain ones highest potential, only possible if overcome obstacles. Examples include basic, needs, psychological problems, interpersonal personal (the pyramid)

Major players : Carl, Rogers, Abraham, Maslow, and Ritz Pertz

Major theme : people are basically good, humans drive towards self accusation

Carl Rogers

humanistic;
Contributions: founded person-centered therapy, theory that emphasizes the unique quality of humans especially their freedom and potential for personal growth, unconditional positive regard, fully functioning person.

Belief that client has the resources to solve his or her own problems if given, adequate support. Minimal therapist interpretation. Belief that client therapist relationship with the most important aspect of treatment.

Hierarchy of Needs (Maslow)

Maslow's pyramid of human needs, beginning at the base with physiological needs that must first be satisfied before higher-level safety needs and then psychological needs become active

Physical, Security, social, Ego, self-actualization

behavioral model

emphasizes behavior and the ways in which it is learned

Classical conditioning : Pavlov Watson. Pairing neutral, stimuli, and unconditional stimuli, which has for aspects.

classical conditioning- unconditioned stimulus

Something that reflects a natural automatic response

Example (Food; Chemo) the smell of food automatically makes your mouth water in hunger. Chemo automatically makes you feel bad..

Classical conditioning: unconditioned response.

An automatic response to a stimulus

Example : ( saliva, nausea)

In response to smelling the food or chemo, you feel hungry and salivate and nauseous from chemo

classical conditioning conditioned stimuli

A stimulus that leads to an automatic response

Example : (Bell, nurse)

Dog knows there is food and gets hungry. Patient sees nurse assumes she's going to get chemo and feel nauseous.

classical conditioning - Conditioned response

An automatic response from training or experience

Example : (saliva, nausea) the dog salivates because it knows it's going to get food. The patient gets nauseous because she knows she's going to get chemo.

Operant Conditioning (Skinner)

a type of learning in which behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher

Voluntary behavior is controlled by consequences positive and negative

Reinforcement- positive and negative: increases behavior

Punishment, positive and negative : decrease behavior

positive reinforcement example

student earns A in psych, mother pays him 10$ (good stimulus)

goal behavior- increase good grades

Add positive reinforcement = increase behavior

negative reinforcement example

the encouragement of certain behaviors by removing or avoiding a negative outcome or stimuli.


removing restrictions from a child when she follows the rules is an example

positive punishment example

spanking a child (adding punishment)

Positive = decreased behavior

negative punishment example

For a child that really enjoys a specific class, such as gym or music classes at school, negative punishment can be removal from that class and sent to the principal's office because they were acting out/misbehaving. (Taking away something)

shaping behavior

the process of guiding learning in graduated steps using reinforcement or lack of reinforcement

Example : potty training

From behaviorism to behavior therapy

Reactionary movement: against psychoanalysis and nonscientific approaches

Early pioneers of behavior therapy

-Wolpe: systematic desensitization
-Beck: cognitive therapy
-Bandura: social learning (cognitive-behavior therapy)

behavior therapy

therapy that applies learning principles to the elimination of unwanted behaviors

Tends to be time-limited, direct, here, now focused

Behavior therapies have widespread empirical support

One dimensional models

explains behavior in terms of a single cause

Could mean a paradigm (model, pattern), school, or a conceptual approach

Problem: other information is often ignored (BAD)

Multidimensional models

Interdisciplinary, eclectic, and integrative

"System" of influences that cause and maintain suffering

Use's information from several sources

Abnormal behavior results from multiple influences

BETTER

Multidimensional models of abnormal behavior

biological factors (genetics, physiology, neurobiology)

behavioral factors,
emotional influences,
social factors,
developmental factors (e.g. often in early adulthood as onset, usually soft signs before e.g. flat affect, paranoid thinking)

Genetic Contributions to Psychopathology

- phenotype (observable characteristics) vs. genotype (genetic makeup) One twin has schizophrenia, one doesn't -> their kids have the same risk to be schizophrenic! When one identical twin has schizophrenia there is a 50% chance the other one has it as well, 20% if not identical

- behavior is typically polygenetic

- genes aren't everything
-Generally less than 50%

The Interaction of Genetic and Environmental Effects

Eric Kandel and gene-environment interactions :

Propose that learning could affect genes by turning them on activating them

E.g., an inactive gene may become active because of environmental influences

diathesis-stress model

A genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to trigger behaviors or psychological disorders

○ Combo of having a genetic disposition and a stressor (can trigger onset of disorder)

○ If you dont have a stressor you probably wont have disorder

○ Less genetic vulnerability the more stress it may take

○ More genetic vulnerability the less stress it may take to trigger it

■ Examples?
● Depression

● Alcoholism

Interaction: when a third variable affects the strength or direction of the relationship between variables

gene-environment correlation

● Genes can influence the types of environments we find ourselves in

● Genes can increase the probability that an individual will experience environmental
events (which might increase the likelihood of experiencing psychological problems)

● Examples include depression, divorce, and substance use

○ For example, substantial evidence of genetic heritability of divorce- what do you inherit - eg being short tempered, strong reactions to arguments, being really dependent on significant other.

○ Diathesis (disposition) and
stress (e.g. divorce) may not be independent

3 types- passive, evocative, proactive

passive

Types of genes a child inherits can correlate with environment one is raised in. (Individuals could inherit genes for lower IQ and be raised in a non-intellectually rich environment)

evocative

Individuals genes may lead to behavior that evokes a response from the environment.

■ Antisocial child (noncompliant; aggressive) may evoke certain responses from the environment (harsh, punitive, parenting)

Proactive

individuals genes make the selection of certain environments more likely (not random who decides to get into extreme sports)

Epigenetics

Environment (diet, stressors, behaviors; experiences) can affect how genes are expressed (turning them on or off)

Some genes will never express themselves unless in a certain environment. And, some environments may have little effect unless the genetic predisposition is there.
○ Genes arent whole story but affect and constrain the impact of our environment

The field of neuroscience

the role of the nervous system in disease and behavior

Branches of human nervous system

-The Central Nervous System-Brain and spinal cord

-The Peripheral Nervous System- Somatic and autonomic branches

Neuroscience and the Central Nervous System

-The neuron
-Soma--cell body
-Dendrites--branches that receive messages from other neurons
-Axon--trunk of neuron that sends messages to other neurons
-Axon terminals--buds at end of axon from which chemical messages are sent
-Synapses--small gaps that separate neurons
-Neurons operate electrically, but communicate chemically
-Neurotransmitters are the chemical messengers
-nerve cells are not connected- separated by synaptic cleft. Neuro transmitters (eg. Serotonin, dopamine, GABA, norepinephrine) are released into cleft and communicate with next neuron.

Neuroscience and Brain Structure

Two main parts- brainstem in forebrain

Brainstem: is the more ancient part of the brain also found in animals, and controls, basic processes, like breathing, sleeping, physical coordination

Forebrain : largest, and most recently evolved

Three Main divisions: hindbrain, midbrain, forebrain

Hindbrain

Medulla- heart rate, blood pressure, respiration

Pons- regulates sleep stages

Cerebellum- involved in physical coordination

Midbrain

Coordinates movements with sensory input

Contains parts of the reticular activating system (RAS) - related to arousal and consciousness; sleep cycles

Forebrain (cerebral cortex)

Lobes of the cerebral cortex
Frontal - thinking and reasoning abilities, memory

Parietal - touch recognition

Occipital - integrates visual input

Temporal- recognition of sites, smells, it sounds in long-term memory storage; process complex stimuli.


Limbic system : (hippocampus, amygdala, septum, cingulated gurus) - related to emotion, motivation, and memory, motivation in memory

*thalamus- receives and inter grated sensory information

*hypothalamus- eating, drinking, aggression, sexual activity

Ceberal cortex - 2 different hemispheres (connected by corpus callosum)

*right deals with visual, spatial, processing, visual, imagery, creativity

*left deals with language and reasoning. Usually dominant

Somatic branch of PNS

concerned with the external environment

Controls, voluntary muscles and movement

autonomic branch of PNS

Sympathetic and parasympathetic branches
Regulates cardiovascular system & body temperature
Also regulates the endocrine system and aids in digestion

Sympathetic system: mobilizes body during times of stress (fighter flight; heart races increased respiration, decrease in digestion

Parasympathetic: takes over when not stress, focus on restoring energy, and equilibrium, which increases digestion and slow, breathing and heart rate

Function of neurotransmitters

Agonists- increase activity by mimicking it's effects

Antagonists- decrease or block Neuro transmitter

Inverse agonists- produce effects opposite to those produces by neurotransmitter

Related to psychopathology

Almost all current psychiatric drugs impact one or more Neuro transmitters

functions of neurotransmitters

"Chemical messengers" - transmit messages between brain cells

o Agonists - increase activity by mimicking its effects

o Antagonists - decrease or block a neurotransmitter

o Inverse agonists - produce effects opposite to those produces by neurotransmitter.

- Can manipulate levels and examine impact on psychological functioning

Seratonin (neurotransmitter)

o Serotonin - regulates behavior, mood and cognition

▪ Low levels - disinhibition, emotional reactivity, impulsivoty
▪ Related to aggresion, suicide, depression, impulsive overeating. Treated by SSRIs (selective serotonin reuptake inhibitor e.g. prozac, celexa, paxil, zoloft)