Psychopathology Exam 1

Psychopathology

The field concerned with the nature, development and treatment of psychological disorders

Defining psychological disorders (DSM)

1. Inside the person — it lives in them, not in the situation around them.

2. Serious trouble in thinking, feeling, or behaving — big enough to matter clinically.

3. Usually painful — it typically causes the person real distress.

4. A breakdown — the mental machinery (psychological, developmental, biological) isn't working right.

5. Not just culture — it isn't simply a normal reaction to a specific cultural event.

6. Not just rebellion — it isn't mainly the person clashing with society or breaking its rules.

Mnemonic: It's inside you, it's serious, it hurts, processes down bad — and it's not just your culture or your attitude.

Three characteristics in defining a mental/psychological disorder

Personal distress, violation of social norms, disability and dysfunction

Personal distress

-> A person’s behavior causes significant distress (example: difficulty paying attention, emotional pain, and suffering)

->”Not all” both ways

Violation of social norms

->Social norms are widely held standards

->Beliefs and attitudes used to make judgements about behaviors

->Behaviors that violate social norms may be classified as disordered (ex. Repeatitive rituals, talking to nonexistent voices, etc)

Disability and dysfunction

Disability:

->Impairment in an important area (work, school, relationships, etc)

Examples:

->Chronic substance abuse resulting in job loss

->Rejection by peers due to social anxiety

“Not all” both ways

Dysfunction:
-> Developmental, psychological, and/or biological systems are not working as they should (impairment)

Stigma

Destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some way

Moral reform movement in the 19th century to make asylums more humane (and the people involved)

Philippe Pinel (1745-1826)

->Pioneered humane treatment in asylums

->People should be approached with compassion & dignity

->Humanitarian treatment reserved for upper class

Worked for more moral treatment

->Small privately funded, humanitarian mental hospitals

->Patients engaged in purposeful activities

->Lived as similar of an outside life as possible

-   Dorothea Dix (built public hospitals), Moses Sheppard (Sheppard Pratt, developed moral treatments)

Mnemonic: PP, DD and SP

The role of stigma in perpetuating discriminatory treatment of people with psychological disorders

Can make people refrain from getting help or support, suffer in silence, leads to prejudice and shame

Paradigm

Model, example or standard within which a scientist works

Paradigm:

Conceptual framework or approach within which a scientist works.

Genetic Paradigm:

Psychology stems from genetics & environment

Become more dominant of look

-   Almost all behavior is heritable to some degree

- Genes and environment work together, not alone

-  The relationship between genes and environment is bidirectional (two-way)

Example: Nature via nurture

Heritability quotient:

Heritability: the extent to which variability in behavior is due to genetic factors

→Heritability estimate ranges from 0.00-1.00

→Group, rather than individual, indicator

Genotype

genetic makeup inherited by an individual (unobservable)

Phenotype:

expressed genetic material, observable behavioral characteristics, this can depend on interaction of the genotype and environment

Epigenetics:

study of how the environment can alter gene expression or function

Shared environment:

→Events and experiences that family members have in common

→E.g: income level, child-rearing practices, parents marital status and quality

Nonshared environment

→Events and experiences that are distinct to each family member

→E.g relationships with friends, events unique to the person

Neuroscience paradigm

Psychological disorders are linked to aberrant processes in the brain.

Neuron

Cells of the nervous system have four major parts: cell body, dendrites, axons, and terminal buttons

Synapse

gaps between neurons, nerve impulse travels down axon to synapse

Neurotransmitter

chemicals that allow neurons to send a signal across the synapse to another neuron

Reuptake

reabsorption of leftover neurotransmitter by the presynaptic neuron

(garbage truck picking up excess)

Serotonin and dopamine

Implicated in depression, mania and schizophrenia

Norepinephrine

Communicates with the sympathetic nervous system, implicated in anxiety and other stress related conditions

GABA

inhibits nerve impulses, implicated in anxiety

In what ways may neurotransmitters contribute to psychopathology?

-  Excessive or inadequate levels of them

-   Errors in the synthesis of neurotransmitters at the metabolic level

-  Insufficient reuptake

- Faulty neurotransmitters receptors

Transmission process

Neurons communicate with each other by releasing neurotransmitters at synapses and transmitting signals (electrical!). Medication blocks the reuptake process, allowing neurons to receive the correct chemicals.

The role of the neuroendocrine system in the mediating of psychological stress

The HPA axis regulates stress. The hypothalamus works with the pituitary gland to regulate stress through cortisol levels. In normal people, this functions normally; however, individuals under constant stress will release too much cortisol, creating health problems.

Behaviorism- Classical Conditioning:

Associative learning

Unconditioned stimulus, unconditioned response, conditioned stimulus, conditioned response.

Examples:

-              Pavlov (1849-1936) Dog experiment: bell and salivating

-              Watson & Rayner (1920): Little Albert and the white rat experiment: loud noise, sign of rat

Operant conditioning:

Learning through consequences.

Law of effect: behavior that is followed by satisfying consequences will be repeated; behavior that is followed by unpleasant consequences will be discouraged.

Mnemonic: Oh the consequences!

Reinforcement types

BF skinner

→Given something: positive

→Removed something: negative

→Reinforcement: Increases behavior

→Punishment: decreases behavior

The role of cognition in psychopathology

Importance of Cognition: How we think or appraise a situation influences our feeling and behaviors.

→How people construe themselves and the world is a major determinant of psychological disorders

5. The idea of the stress-diathesis model and how each component contributes to the development of a disorder

This model suggests that it is the combination of a diathesis plus stress factors that leads to the onset of illness.

Diathesis:

Underlying predisposition (biological or psychological) increases risk of developing disorder (not a guarantee, though)

Diathesis→ Di→ disposition

Stress:

Environmental or life disturbances (may occur at any point after conception, triggering event)

Reliability

Consistency of measurement: the same diagnosis is made over time or across multiple raters

Measured from 0 to 1.0 (higher the number, the better the reliability)

Interrater:

The degree of agreement or consistency between two or more different people (raters or observers) when they evaluate, score, or observe the same thing

Test-retest

Testing the same group of people over time and getting the same results (this would mean high reliability)

Alternate forms

measures whether two different versions of the same test (Form A and Form B) give consistent, matching scores when given to the same group of people

Internal consistency

If multiple questions are meant to be measuring the same thing, they should be getting similar results

Content validity

Whether a measure adequately samples the domain of interest. Is the measure measuring the domain of the content? Does it interview the correct things?

Construct validity

Is the measure or the thing being studied what you think it is? Example: if you are doing a depression screening, do the questions align with what we know about depression?

History of DSM

-   Published by American Psychiatric Association; by psychiatrists!

-   First edition published in 1952

-  DSM III in 1980: very important moment

→ Big moment where it took every disorder and gave them all symptoms and specific diagnostic criteria (example. Need 5/9 of the following criteria.., must last x long)

-   Revised multiple times since then: Currently at DSM-5-TR done in 2022

For each psychological disorder: the DSM-5 provides

→ Concise and specific diagnostic criteria for a diagnosis

-   Description of associated features

→ Laboratory findings, results from physical exams

-    Summary of research literature

→ Age of onset, course, prevalence, risk and prognosis factors, cultural and gender factors, differential diagnosis

Critiques of DSM

-  Number of diagnoses continues to increase

-  Comorbidity

→Presence of a second diagnosis

→45% of people diagnosed with one DSM disorder meet criteria for a second disorder

Advantages of categorical and dimensional classification

-  Categorical classifications can provide helpful treatment guidance- at what point do you need to treat the disorder

-  Dimensional classifications are a way to describe and capture subthreshold symptoms

→DSM 5 has added severity ratings for nearly all disorders

Clinical interview

First way of gathering information from a client about their background and presenting problems

Intake therapy interview

Structured clinical interview

-    All interviews ask the same questions in a predetermined order

-  Good interrater reliability

- Rarely used in a clinical setting but often used in research studies

Advantages of an unstructured clinical interview:

-    Establishes rapport with the client

→Empathize with client experiences

→Encourage client to elaborate on concerns

Disadvantages of an unstructured clinical interview

-    Can be unreliable- two clinicians can ask very different sets of questions and arrive at different conclusions

→ relies on the skill and training of the clinicians

Objective Personality tests:

→ Standardized tests with norms to compare people’s scores to

→”correct” answers and checkboxes

Projective Personality tests

→ Based on psychodynamic theory of personality

→ Open-ended questions; answers are more vague, revealing more unconscious thoughts and information. Open to interpretation

Rorschach test type (abstract, no right answers)

Minnesota Multiphasic Personality Inventory

Objective test:

→ Contains 10 clinical skills (e.g hypochondriasis, hysteria, paranoia,etc) plus 3 validity scales to detect lying and faking “good” or bad”

→ You look across the person’s profile to get a sense of their personality and psychological functioning

Big Five Inventory 2

→Designed to assess a well-known “theory” of personality known as the five-factor model of personality

→ Five Factors: OCEAN:

Openness to experience,

Conscientiousness

Extraversion/introversion

Agreeableness

Neuroticism. (N is most heavily linked to psychopathology)

Rorschach Inkblot tests

Herman Roschach (projective)

→ Originally designed to assess for thought disorder (psychosis type disorders), only later used as a more general measure of personality

→Instructions: ask the person, “what might this be?”; later ask them what made it look that way

→Exner developed a standardized system for scoring answers, which shows high reliability, but questions remain about its validity

Thematic Apperception Test

Projective

→ The person is shown a series of “ambiguous” pictures and is encouraged to tell a story about them, with a beginning, middle, and end, and say what the characters are thinking and feeling

→No standardized system exists for “scoring” this test

Mnemonic: Tell A Tale

Intelligence tests Purpose:

-              Access current cognitive ability

-              predict school performance

-              Diagnose learning disabilities or intellectual ability

-              neuropsychological examinations

Mnemonic: A Pretty Darn Nice test.

Pros and Cons of IQ tests

Pros: IQ tests are highly reliable and demonstrate good validity.

Cons:  Explain only a small part of school performance, Impacted by stereotype threat

Stereotype threat:

Any situation that puts pressure on a marginalized individual to avoid confirming stereotypes (e.g., test-taking scores). Leads to disidentification and underperformance

Neuropsychological tests

Non-invasive, indirect ways of measuring brain functioning (cognitive)

Neurobiological tests

images of the living brain to assess structural and functional features (CAT, MRI, FMRI, etc)

Sociocultural concerns in psychological testing

What is considered “Atypical” is different depending on the culture

Not everything can be directly translated, or may not be able to be translated

Health bias- ignoring POC or women, “hysteria” or underplaying of symptoms

Cultural assumptions may lead clinicans to over or underdiagnose disorders in particular groups (AA more likely diagnosed w schizophrenia than other groups)

Specific cultural disorders

Unipolar

One end of the spectrum, typically negative

Bipolar

both ends of the spectrum, highs and lows

Major Depressive Disorder (MDD) Symptoms:

Sad mood OR loss of interest and pleasure (anhedonia)

-  PLUS four other symptoms

→Sleeping too much or too little

→Loss of energy

→Appetite and weight change

→Psychomotor changes

→Worthlessness/excessive guilt

→Difficulty concentrating, thinking, or making decisions

→Recurrent thoughts of death or suicide

Starter: Sad mood or loss of interest and pleasure

When I was majorly depressed I didn’t get out of bed 4/7 days.

What do you do when your depressed: Slap with Deathrow

MDD Duration of Symptoms/Episode Information:

- Symptoms are present:

→ Nearly everyday

→Most of the day

→For at least 2 weeks

-  An episodic and recurrent disorder:

→ Episodic: symptoms tend to dissipate over time, can last as long as 6 months if left untreated

→Recurrent: once depression occurs, future episodes are likely

• (Everyday, All day, Everyday, All Day (repeat twice, two weeks)

• Symptoms get bad, you go to ER (episodic and reccurent)

Persistent Depressive Disorder (PDD) or formally Dysthymia

Form of chronic depression

-    Depressed mood for at least 2 years
→1 year for children/adolescents

-    PLUS 2 other symptoms:
→ Poor appetite or overeating
→ Sleeping too much or too little
→ Low energy
→ Poor self-esteem
→ Trouble concentrating or making decisions
→ Feelings of hopelessness

-   Symptoms do not clear for more than 2 months at a time

Differences between Bipolar 1 and Bipolar 2

1: had a full manic episode, dangerous actions, maybe hallucinations. Only need 1 episode to qualify

2: never had a full manic episode, may have been hypomanic (small symptoms), have to have had a major depressive episode.

MD + hypomanic = 2

• I have BP2, meaning no hallucinations. 2 things= MD + hypomanic

Mania (and hypomania)

→State of intense elation, irritability, or activation

→Hypomania (hypo=under)

→Symptoms of mania but less intense

→Does not involve significant impairment

Mane→ e→ elation ia→ intense irritability activation

Epidemiology of Depression

Depression is the most common psych disorder

16.2% USA meet MDD criteria

5% report experience of depressive episode for more than 2 years

Why do women have higher rates of depressions

Twice as common in women than in men

Biological factors → hormones

Stressors→ childhood sexual abuse, chronic stressors

Societal and self-critical attitudes and rumination→ societal image and comparison

“ugh this is bullshit that women suffer twice as much as men”

bullshit: biological, stress, society

Depression epidemology across cultures

Three times as common among people in poverty- think about why

Prevalence rates vary quite a bit across cultures

→Range: 6.5% in China to 21% in France

Why?

→Distance from the equator (seasonal effects)

→Consumption of fish is associated with less depression

→Symptomatic expression varies across cultures

Epidemiology and severity of Bipolar

Prevalence rates of bipolar disorder much lower than MDD

- No gender difference rates of bipolar disorder (but women with BP experience more depressive episodes)

-  Recurrent and severe form of mental illness

Beck’s Cognitive Theory of Depression:

-              Begins with Negative Cognitive Triad: Negative view of self, world, future

→Self- defective, blameworthy

→World- pessimism; things are basically bad

→Future- things will not work for me because of my flaws

-              Cognitive distortions: automatic thoughts that distort incoming information

→Example: “They probably think that I’m incompetent” (mind reading)

(Eeyore Example)

Beck→ Victorious→ Sings with Fear (Not a singer) Self, world, future

Hopelessness Theory (Abramson, Seligman and colleagues):

- Hopelessness is a critical feature of depression

-  A major factor that contributes to hopelessness is one’s attributional style

Global vs Specfic Attributions

Global: cause of event is applicable to all areas of your life

Example: I am dumb

Specfic: cause of event is specific to that cause

Example: I lack mathematical ability

Unstable vs stable attributions

Unstable: Fluctuating, temporary

Example: I am exhausted

Stable: fixed, permanent

Example: I lack mathematical ability

What type of attributions do depressed people often make?

Stable and global attributions (think about catastrophizing)

Specific Phobias

-              Disproportionate fear caused by a specific object or situation

-              Thing avoided or else endured with intense anxiety

-              The person is self-aware that their fear is excessive

-              significant distress or dysfunction in the person’s life

-              High comorbidity among specific phobias; people with one phobia often have another one

Panic Disorder

-              Recurrent panic attacks unrelated to specific situations

-              At least 1 month of concern about the possibility of more attacks occurring or the consequence of an attack, or maladaptive behavioral changes because of the attacks

-              Panic attacks that are situationally specific are not considered part of a panic disorder

-              As many as 25% of people have occasional panic attacks without having panic disorder

Panic Attacks

-              Sudden attack of intense apprehension, terror, and feelings of impending doom

-              Symptoms of a panic attack:

→Shortness of breath, Heart palpitations, Nausea, upset stomach, chest pain, Feelings of choking and smothering, Dizziness, lightheadedness, sweating, Chills, heat sensations,Numbness or tingling sensations

→Depersonalization: feeling outside one’s body

→Derealization: feeling of the world not being real

→Fears of going crazy, losing control, or dying

-              Symptoms come on rapidly and peak in intensity within 10 minutes

-              Many people interpret symptoms as having a heart attack

-              Misfiring of the fear system

→Physiological response similar to what most experience when faced with an immediate threat

-              Because the symptoms are inexplicable, 90% of people feel like they are dying, going crazy, losing control, might faint (which makes the fear worse)

Agoraphobia

-              Disproportionate and marked fear or anxiety about at least 2 situations where it would be difficult to escape or receive help in the event of incapacitation, embarrassing symptoms, or panic-like symptoms.

→Eg crowds, stores, malls, churches, trains, bridges, tunnels, etc

-              These situations are avoided, require the presence of a companion or are endured with intense fear of anxiety

-              Causes significant impairment: unable to leave house or leaves house with great distress

-              About half of the people with agoraphobia experience panic attacks

Generalized Anxiety Disorder

-              The core symptom is worry:

→ cognitive tendency to chew on a problem

→ at least 50% of days for 6 months

→ person finds it difficult to control the worry

-              Worry focuses on common problems like: relationships, health, finances, work, school and daily hassles

-              Accompanied by at least 3 of the following physical symptoms

→Restlessness

→fatigue

→muscle tension

→sleep disturbance

Fear conditioning:

a type of learning where an individual or animal learns to fear a harmless thing because it has been paired with something scary or painful.

Mowrer’s two factor model

-              First step is classical conditioning

→ A person learns to fear a neutral stimulus (CS) that is paired with an intrinsically aversive stimulus (UCS)

-              Second step is operant conditioning

→A person gains relief by avoiding the CS

→ Example: a dog bit at you when you were young, so you get a fear of dogs

→Avoidance is negatively reinforced by feelings of relief by not having to encounter the fear stimulus (dogs)

Flaws with Mowrer’s two factor model:

-              Many people who develop anxiety disorders do not remember a triggering event

-              Many people who experience a threatening event do not develop an anxiety disorder

Epigentics of Anxiety (what are they more prone to? why?)

People with anxiety disorders are more prone to develop fearful responses. Genetics: heritability estimates around .5-.6

Neurobiology: the fear circuit

Neurobiology of fear: the fear circuit

→Amygdala- reactive to fearful stimuli; overactive in people with anxiety disorders

→Prefrontal cortex- helps extinguish fearful responses and regulate emotions

→Connective pathway between these two structures may be deficient in those with anxiety disorders

Shared personality traits for those with anxiety:

-              Tendency to become agitated, distressed, and cry in unfamiliar settings

-              Particularly strong predictor of social anxiety in adolescence

Neuroticism: One of the big 5 factors

-              Tendency to experience frequent or intense negative affect

-              Predicts onset of anxiety disorder and depression

-              People with high levels are twice as likely to develop anxiety disorders than those with low levels

Cognitive factors that fuel anxiety disorders:

-              Sustained negative beliefs about future

→engage in safety behaviors

-              Belief that one lacks control over the environment

→negative childhood experiences like trauma, punitive or restrictive parenting promote a view that life is not controllable

-              Attention to threat

→ People with anxiety disorders are more likely to attend to threatening stimuli

-              Intolerance of uncertainty & ambiguity

Safety behaviors

physical actions, mental routines, or subtle avoidances that help prevent a feared disaster or lower immediate distress.

How safety behaviors help maintain anxious feelings:

Prevent exposure/confronting of fears, stays afraid of them instead of realizing its not that bad

Reinforces negative beliefs: keeps your brain on a crutch

Blocks the learning that the fear is actually just uncomfortable, not dangerous.

Heightens self-focused attention and self-conscious monitoring.

BRAP (Block, Reinforce, Awareness, Pushes)

Exposure therapy and how it works?

-              Face the situation or object that triggers anxiety

→Often done in a hierarchical way from least to most fearful situation

-              Effective for 70-90% of clients

Why does exposure therapy work?

-              Behavioral view: newly learned associations inhibit fearful association

-              Cognitive view: corrects mistaken beliefs about the feared object/situation

Anxiety disorder

An anxiety disorder is the fear response misfiring- being triggered when there is no clear danger. The anxiety is excessive- interferes with performance and functioning.

Interpersonal psychotherapy

Depression treatment:

Goal: analyze a significant interpersonal problem and work to resolve it.

Interpersonal p: problem within individual

Cognitive therapy

→Monitor and identify automatic thoughts

→Challenge and replace negative thoughts with more neutral or positive thoughts

→ can be used for depression or mania (addressing automatic signs of mania)

Catastrophizing thoughts are automatic, this is what you have learned in CBT

Mindfullness-based cognitive therapy:

→Help people adopt a more de-centered perspective on their thoughts- thoughts are just a “mental activity”; “thoughts are not facts”; “I am not my thoughts”

→ Naming your anxiety a name in your MIND

Behavioral Activation

→ Increase the person’s participation in positively reinforcing activities