Psychopathology from Aurdina

What is psychopathology

The scientific study of mental disorders, their causes, development, and treatment.

What is the purpose of a clinician

To understand, explain, and relieve as much suffering as science and wisdom will allow.

What is suffering

A state when one's present condition is both unpleasant and undesirable, creating incongruence between desired state and reality.

What are six sources of psychological suffering

Ignorance; Illness; Immaturity; Habitual Ways of Thinking/Acting; Pathogenic Relationships; Unmet/Unaddressed Needs.

What do all forms of suffering have in common

Incongruence between desired state and present condition.

What is the "Zone of Proximal Development" in psychopathology

Growth occurs in the space between current ability and new challenges; suffering and doubt contribute to development.

How is stress paradoxical

It is necessary for development but can also make us ill, anxious, or suicidal.

What are the two main ways "stress" is defined

As a threatening situation OR as the response to a situation.

What is "load" in stress theory

The amount of pressure applied in a situation.

What is "strain"

The physical and psychological consequence of stress.

What is the transactional model of stress (Lazarus)

Stress occurs when demands exceed perceived personal/social resources; outcome depends on perception of meaning and controllability.

What is a challenge appraisal

When stress is demanding but viewed as meaningful and manageable.

What is a threat appraisal

When stress is viewed as uncontrollable, meaningless, or overwhelming.

What were the three branches of medicine in the early 1800s

Internal Medicine; Surgery; Neurology.

Who distinguished psychiatry from neurology

Freud, Pierre Janet, Joseph Breuer.

What were the four advantages of Freud's "new concept of mind"

1) Psyche became a legitimate object of clinical concern; 2) Freed psychology from superstition; 3) Moved beyond Cartesian dualism; 4) Allowed treatment without blaming patients.

What is Freud's monism

The body produces the mind as a by-product (like heat from fire); the mind is an epiphenomenon.

According to Edward Shorter, what three insights birthed psychiatry

1) Mental illness can be studied empirically; 2) Doctor-patient relationship can heal psychogenic trauma; 3) Recognition of interplay between psychological and physical health.

What did early asylums become according to Shorter

Custodial institutions that later gained therapeutic function, leading to psychiatry's birth.

What is "metalanguage"

Conscious use of symbols or signs to express inner states.

What is "protolanguage"

Unconscious bodily communication (blushing, sweating, panic attacks, stomach aches).

What is an indexical sign

A sign causally related to what it represents (e.g., fever indicates infection).

What is a bodily sign (Szasz)

A symptom that symbolically communicates distress, like paralysis or seizures conveying "I am sick."

What is a necessary cause

A cause without which symptoms cannot occur (e.g., trauma for PTSD).

What is a sufficient cause

A cause whose presence guarantees symptoms (e.g., decapitation causes death).

What is a contributory cause

A factor that increases likelihood but is neither necessary nor sufficient.

What is a proximal cause

A cause where symptoms appear soon after onset.

What is a distal cause

A cause where symptoms appear long after onset (e.g., alcoholic parent → adult alcoholism).

What is a diathesis

Any factor (biological, social, or cognitive) increasing vulnerability to a disorder.

What is learned helplessness

When uncontrollable or unpredictable stress leads to passivity, paralysis of will, and depressive-like symptoms.

What is Seligman's triadic design

Experimental design with controllable, yoked (uncontrollable), and untreated groups showing effects of uncontrollability on behavior.

What did Seligman's triadic design reveal

Symptoms stem from uncontrollability/unpredictability, not just exposure to noxious stimuli.

Why are uncontrollable stressors especially harmful for humans

They impair functioning in close relationships and sense of agency.

What is trauma

The result of sudden or repeated external blows that render a person helpless and overwhelm coping.

What are common features of trauma

Intense surprise, sickening anticipation, lasting changes in coping, helplessness.

What is the trauma spectrum

ASD → PTSD → CPTSD → BPD.

What are PTSD's core symptom clusters

Intrusion; Avoidance; Hyperarousal; Social/occupational disruption.

What characterizes Complex PTSD (CPTSD)

Prolonged trauma; affect dysregulation; negative self-perception; memory/attention problems; somatization; interpersonal problems; disrupted meaning systems.

How does trauma affect the nervous system

Alters beliefs, perceptions, sensory processing, and brain structures.

What is the difference between causes and reasons in psychopathology

Causes = biological/neurological abnormalities; Reasons = personal explanations (e.g., "I'm stupid," "My partner betrayed me").

What is Van der Kolk's core thesis in The Body Keeps the Score

Trauma reshapes the brain and body, leaving lasting imprints on perception, memory, and regulation.

What are the brain's two main purposes

Survival and development.

How does trauma affect development

By altering satisfaction of needs, distorting beliefs, and disrupting capacities that would normally develop.

How are beliefs embodied

Through neural networks; trauma reshapes perception and belief at the biological level.

What quote illustrates trauma perception

"We do not see the world as it is, we see it as we are."

What was found out about developmental trauma and violence

Developmental trauma increases risk of violent behavior, with complex interactions across individual, relational, and social contexts.

How is shame conceptualized as trauma

Shame memories act like traumatic memories, producing intrusions, avoidance, and emotional dysregulation.

What is Clancy's argument in The Trauma Myth

Many survivors of child sexual abuse did not initially perceive events as traumatic; challenges the assumption that trauma is always recognized at the time.

What is the main message of I'm Still Here

Shows lived experience of schizophrenia and challenges in understanding self vs. illness.

What is the main message of Crooked Beauty

Explores the space between brilliance and madness, highlighting stigma and resilience in mental illness.

What is the School of Life's definition of psychotherapy

A deliberate process of understanding oneself, recognizing patterns, and finding relief from suffering.

What are the main models of psychopathology causality

Biological, psychological, sociocultural, and biopsychosocial models.

What is the biopsychosocial model

A framework that integrates biological, psychological, and social factors in understanding mental disorders.

What role do culture and society play in psychopathology

They shape symptom expression, stigma, and access to treatment.

What is the scientist-practitioner approach in abnormal psychology

Using scientific research to inform clinical practice and clinical experience to inform research.

How did Vietnam veterans shape our understanding of PTSD as a clinical diagnosis

Vietnam veterans displayed recurring nightmares, flashbacks, hypervigilance, and emotional numbing that didn't fit traditional diagnoses. Their experiences helped solidify PTSD as a distinct disorder in the DSM-III (1980).

In what ways can trauma survivors be "stuck" in the past

Survivors often relive events through flashbacks, intrusive memories, or physical reactions to triggers, as if the trauma is happening again in the present.

How did Van der Kolk's work with war veterans reveal the limitations of medication for trauma (body keeps the score)

Medications sometimes reduced symptoms like anxiety or sleep problems but rarely resolved flashbacks or restored normal emotional regulation. Trauma needed more than symptom suppression.

What role does memory play in trauma, and how do traumatic memories differ from ordinary memories

Traumatic memories are fragmented, sensory-heavy, and lack narrative coherence. They are often recalled involuntarily and with intense emotion, unlike ordinary memories that are contextual and verbal.

Why is it important to study both the brain and the body in understanding trauma

Trauma impacts brain circuits, hormones, and physical health (e.g., immune, cardiovascular). Healing requires addressing both psychological and physiological effects.

How did Freud's ideas about trauma evolve over time, and why did he eventually abandon trauma theory

Freud initially believed neuroses were rooted in real traumatic experiences (often sexual abuse), but he shifted toward unconscious fantasies, partly due to social resistance and disbelief of widespread abuse.

What was the significance of the "discovery" of child sexual abuse in psychiatry in the 20th century

It re-established the reality of trauma as central to mental illness and highlighted how often children's reports were dismissed, delaying appropriate treatment.

How does trauma affect a person's capacity for trust and safety in relationships

Survivors may become hypervigilant, withdrawn, or mistrustful. Safety cues often fail to register, making intimacy and secure attachment difficult.

What happens in the brain when the body perceives threat

The amygdala activates, stress hormones surge, and the body prepares for fight, flight, or freeze. Prefrontal regulation is often bypassed.

What is the role of the amygdala in trauma responses

It detects danger quickly and triggers survival responses. In trauma survivors, it is often hyperactive, leading to exaggerated fear reactions.

How does the prefrontal cortex normally regulate emotions, and what happens to this regulation in trauma survivors

Normally, it calms the amygdala and enables rational responses. Trauma weakens this regulation, leading to overreactions and difficulty distinguishing real vs. perceived threats.

How does the hippocampus contribute to the experience of trauma and memory

The hippocampus helps contextualize memory in time and place. In trauma, it may fail, leading to fragmented, timeless, and intrusive recollections.

Why do trauma survivors often have fragmented or incomplete memories

Stress hormones disrupt hippocampal function, preventing the integration of sensory/emotional fragments into a coherent narrative.

What is the "fight, flight, or freeze" response, and why is "freeze" especially important in trauma

It's the body's survival mechanism. "Freeze" occurs when neither fight nor flight seems possible, often leaving survivors immobilized and helpless—feelings that may persist.

How do stress hormones like cortisol affect brain functioning after trauma

Chronic cortisol elevation damages hippocampal neurons, impairs memory, and disrupts normal stress regulation.

Why can trauma survivors react to triggers as if the original event is happening again

Their amygdala fires as if danger is present, while impaired hippocampus and prefrontal cortex fail to signal that the threat is past.

How does trauma affect the autonomic nervous system (sympathetic vs. parasympathetic)

Survivors often stay in sympathetic dominance (fight/flight) or collapse into parasympathetic shutdown (freeze), creating dysregulation and physical symptoms.

How do children's brains develop differently when exposed to chronic trauma

Stress hormones alter neural pruning and connectivity, impairing emotional regulation, learning, and social engagement.

Why is attachment so important in childhood for resilience against trauma

Secure attachment builds safety, trust, and self-regulation skills. Without it, children struggle with vulnerability and recovery.

What is the relationship between neglect and brain development

Neglect deprives children of stimulation and safety cues, leading to underdeveloped neural circuits for attachment, empathy, and emotional regulation.

How does trauma affect the ability to regulate emotions later in life

Survivors may overreact, dissociate, or numb feelings because their brain's regulatory circuits were disrupted in development.

What is developmental trauma disorder (DTD), and how does it differ from PTSD

DTD describes the broad effects of chronic childhood trauma, including emotional dysregulation, self-perception issues, and relational difficulties. PTSD typically refers to reactions after a discrete traumatic event.

Why did Van der Kolk argue that DTD should be added to the DSM, and what resistance did he face

He believed PTSD was too narrow for children's trauma, but DSM committees resisted adding it, partly due to politics, insurance, and stigma around child abuse.

How does trauma in childhood interfere with a person's sense of self

Trauma teaches children they are worthless, unsafe, or unlovable, disrupting identity formation and self-esteem.

Why are traumatized children often misdiagnosed with conditions like ADHD or ODD

Their hyperarousal, inattention, or aggression mimic other disorders, leading clinicians to miss the underlying trauma.

What role does shame play in children's responses to abuse and neglect

They often internalize blame, believing they are bad, which compounds trauma and makes healing harder.

How does trauma affect interpersonal relationships and the ability to trust caregivers

Survivors may avoid closeness, misinterpret cues, or repeat abusive patterns, making stable relationships difficult.

What is meant by "the body keeps the score"

Trauma is stored in the body as sensations, tension, and dysregulation, not just in conscious memory.

How can trauma manifest physically in the body, not just psychologically

Chronic pain, autoimmune problems, digestive issues, cardiovascular disease, and unexplained physical symptoms.

Why do traditional talk therapies often fall short for severe trauma survivors

Trauma memories are often nonverbal and sensory-based, so verbal therapy alone may not access or integrate them.

How does unresolved trauma influence cycles of violence and abuse across generations

Survivors who cannot process trauma may repeat patterns of abuse, neglect, or violence, transmitting trauma to the next generation.

What is Clancy's main argument in The Trauma Myth

Many child sexual abuse survivors did not experience the abuse as frightening or traumatic at the time, but later recognized it as wrong, exploitative, and harmful. This challenges the assumption that all abuse is experienced as terrifying in the moment.

Why does Clancy call it a "myth"

The "trauma myth" is the widespread belief that child sexual abuse is always immediately traumatic and violent. She argues this is inaccurate and silences survivors whose experiences don't fit that narrative.

How do survivors describe their feelings at the time of the abuse

Most survivors reported confusion, helplessness, or discomfort rather than terror. Many lacked the cognitive or emotional capacity to understand what was happening.

How does delayed recognition shape the trauma of survivors

Survivors often realize only later (adolescence or adulthood) that what happened was abuse, which creates feelings of betrayal, shame, anger, and confusion about their own earlier responses.

Why is the myth harmful to survivors

Survivors whose experiences were not terrifying in the moment often feel invalidated, guilty, or excluded from support, believing their suffering "doesn't count."

What role does power imbalance play in abuse

Children comply with adult authority and lack the agency to resist. Many survivors described feeling unable to say no or fully understand the implications of what was happening.

What emotions dominate survivors' recollections of abuse

Confusion, helplessness, shame, betrayal, and powerlessness rather than fear or terror.

How does society's expectation of trauma responses affect survivors

Survivors may feel ashamed for not being terrified or resisting, blaming themselves for "going along" and feeling complicit.

Why do many survivors feel guilt or self-blame

Because they may not have resisted or even physically felt arousal, they later interpret this as consent, even though they were too young to give it.

How does Clancy distinguish between trauma and harm

The harm is real and long-lasting, but it doesn't always manifest as immediate trauma. The abuse damages trust, autonomy, and development even if it wasn't experienced as terrifying at the time.

How does this reframe our understanding of child sexual abuse

It highlights betrayal, powerlessness, and confusion as central elements, rather than only fear and terror.

What methodological approach did Clancy use

She conducted interviews with adult survivors of child sexual abuse, focusing on their experiences and perceptions at the time of abuse and afterward.

How did survivors describe their relationships with perpetrators

Often perpetrators were trusted figures (family members, friends, authority figures). Survivors expressed betrayal when they later realized the violation of that trust.

How does Clancy challenge the DSM and traditional psychiatric definitions

She argues the DSM framework (e.g., PTSD criteria) assumes immediate trauma and terror, which excludes many survivors' actual experiences.