PSYC334 - October 7th FIRST EXAM

Fall 2025

Defining a Psychological Disorder

• Psychological disorder has three primary components:

  • Psychological dysfunction

    • Someone’s reaction to something. Is the reaction normal, or how normal is it? Spectrum of behaviors. Not adaptive.

  • Distress of impairment

    • Is it bothering them, and they can’t do what we expect them to do

  • Atypical response

    • Typical response may be atypical to someone else. Look at behaviors in context. 

Case Example:

Young girl

• Scenario 1: 

  • Describes herself (and is described by others) as shy

  • Unlikely to raise her hand in class unless prompted

  • Worries regularly about being called on

  • Comes from a very loud family

    • Distressed

    • Atypical (her family is loud)

      • Normal range of behavior, no psychological problems

• Scenario 2:

• Describes herself and is described by others as shy

• Refuses to go to school

• Throws up when she thinks about speaking in public

• Comes from a very quiet family

  • Atypical and not adaptive (bc she throws up)

  • Distressed because she refuses to go to school

Definition in the DSM-5:

• “Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning, or increased risk of suffering, death, pain, or impairment”

  • Mania (euphoria, increased energy)

The DSM:

• Describes “typical” presentations of different psychological disorders (generalized anxiety disorder, binge eating disorder)

The typical profile is called a prototype → diagnostic criteria in DSM are prototypes

Psychopathology: scientific study of psychological dysfunction

• Professionals:

  • Clinical or counseling psychologist (PhD or PsyD)

  • Psychiatrist (MD)

  • Psychiatric nurse (RN)

  • Licensed clinical social worker (MSW)

• Mental health professional:

  • Consumer of science

    • Enhancing the practice

  • Evaluator of science

    • Determining the effectiveness of the practice

  • Creator of science

    • Conducting research that leads to new procedures useful in practice

Studying psychological disorders:

• Focus:

  • Clinical description

  • Causation (etiology)

  • Treatment and outcome

    • Three major categories make up the study and discussion of psychological disorders

• Key terms:

  • Presenting problem

  • Clinical description

  • Etiology 

  • Course

  • Onset

  • Prognosis

  • Prevalence

  • Incidence

Presenting problem:

the reason someone came into a treatment setting

Clinical Description:

• the thoughts, feelings, and behaviors that describe a client’s presentation

• ex: “Aaron presents with a low mood. Over the last few months, he has reported feeling sad and thinking negatively about himself. His appetite and sleep have gotten worse, and he is spending less time with friends.”

Etiology:

why a disorder begins

Course:

the pattern of the disorder (chronic, episodic)

Onset:

• how a disorder starts (acute, insidious)

  • Insidious: noticing signs for a really long time, getting close to the criteria for a psychological disorder

Prognosis:

• anticipated progression of the disorder

Prevalence:

• how many people in the population have a disorder

Incidence:

• how many new cases occur during a period

• ex: “Aaron’s depressive symptoms are episodic with an acute onset after he lost his job. With treatment, his prognosis is good.”

Supernatural

• Deviant behavior seen as a battle of “good” vs “evil”

• Believed to be caused by demonic possession, witchcraft, sorcery (or, by Paracelsus, the moon and the stars)

• Treatments included exorcism, torture, and religious rituals

• Biological

• Hippocrates (460-377BC) - the “Father of modern Western medicine”

  • Mental disorders are understood as physical diseases

  • Linked abnormality with brain chemical balances

  • Foreshadowed modern views

• Galen (129-198 AD) extended Hippocrates’ work

• Humoral Theory of Disorders:

  • Functioning is related to having too much or too little of four key bodily fluids

    • Blood

    • Phlegm

    • Black bite

    • Yellow bite

  • Gut health can cause psychological problems

• General paresis (late-stage syphilis, a sexually transmitted infection) and the biological link with “madness”

  • Includes psychological and behavioral symptoms caused by a bacterium

  • Bolstered the view that mental illness = physical illness

• John P. Grey

  • Believed causes of “insanity” were always physical

  • Led to reform of hospitals to give psychiatric patients better care (though they became too large)

  • Treatments:

    • Electric shock therapy

    • Crude surgery

    • Medication

      • Neuroleptics (major tranquilizers) → antipsychotics

      • Minor tranquilizers → anxiety and related disorders

    • Mental illness is understood to have biological roots, which has increased the role of science in psychopathology 

• Moral Therapy

• Treated institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction

• Declined in use due to the size and composition of the institutionalized population

  • Immigration

  • The mental hygiene movement (Dorothea Dix) and an increase in the number of hospitalized patients

  • Biological tradition

• If we can’t treat the body, and you still have a disorder, there is no trying for biological treatment

• Psychoanalytic Theory (Freud)

• The unconscious mind, intrapsychic conflicts

• Id = maximizing pleasure. Illogical; emotional; irriational. Driven by pleasure principle

• Superego = moral principles, conscience. driven by moral principles

• Ego = mediates conflict between the id and superego. Logical;rational. Driven by reality principle

• Defense mechanisms = unconscious protective processes that keep conflicts in check between the id and superego

• Psychosexual stages of development = conflict arises at each stage and must be resolved

• Id

maximizing pleasure. Illogical; emotional; irriational. Driven by pleasure principle

• Superego

• moral principles, conscience. driven by moral principles

• Ego

• mediates conflict between the id and superego. Logical;rational. Driven by reality principle

Defense Mechanisms

• unconscious protective processes that keep conflicts in check between the id and superego

psychosexual stages of development =

conflict arises at each stage and must be resolved

Mechanism: Denial

refuse to acknowledge an aspect of objective reality

Mechanism: Displacement

transfers feelings about or a response to something that causes discomfort to another object or person

Mechanism: Projection

falsely attributes unacceptable feelings to another individual

Mechanism: Rationalization

conceals the true motivations for actions through elaborate reassuring or self-serving but incorrect explanation

Mechanism: Repression

blocks disturbing wishes, thoughts, or experience from conscious awareness

Historical Traditions: Psychological

Psychoanalytic Theory:

• Ego psychology (Anna Freud)

• Self-psychology (Heinz Kohut)

• Collective unconscious (Carl Jung)

• Inferiority/Superiority (Alfred Adler)

Psychoanalytic Psychotherapy:

• Designed to reveal the nature of unconscious mental processes and conflicts through catharsis and insight

• Techniques include free association (how you’re connecting ideas), dream analysis, and analysis of transference (how you interpret what your therapy is doing, in which you attribute things to the therapist and vice versa)

Psychodynamic Psychotherapy

• Focus on expression of emotions

• Exploration of attempts to avoid topics or engage in activities that hinder the progress of therapy

• Identification of patterns in actions, thoughts, feelings, experiences, and relationships

• Emphasis on past experiences and focus on interpersonal experiences

• Emphasis on the therapeutic relationship

Humanistic Therapy:

• Hierarchy of needs (Abraham Maslow)

  • Self-actualization: desire to become the most that one can be (top)

  • Esteem: respect, self-esteem, status, recognition, strength, freedom

  • Love and belonging: friendship, intimacy, family, sense of connection 

  • Safety needs: personal security, employment, resources, health, property

  • Physiological needs: air, water, food, shelter, sleep, clothing, reproduction (bottom)

• Emphasis on unconditional positive reg empathy, and innate tendency toward growth (Carl Rogers)

• Hopeful for those dealing with life stressors

Cognitive-Behavioral

• Classical Conditioning (Pavlov)

  • A learning process where an involuntary response to a natural stimulus becomes associated with a previously neutral stimulus. Examines how behaviors emerge through associations between stimuli.

• Fear Conditioning (Watson)

  • Desensitizing your fears 

• Behavior Therapy

  • Systematic desensitization (phobias)

    • Exposure therapy is what helps us decrease our symptoms

• Operant conditioning (Skinner)

  • Type of learning where behaviors are learned through consequences, either by increasing or decreasing their frequency

Schedules of Reinforcement Type: Fixed ratio

Explanation: reinforcement after a specific number of times

Schedules of Reinforcement Type: Fixed Interval

Explanation: reinforcement after a specific length of time

Schedules of Reinforcement Type: Variable Ratio

Explanation: reinforcement after a variable number of times

Schedules of Reinforcement Type: Variable interval

reinforcement after a variable length of time

Psychology Today:

• Use more rigorous scientific methods

• Know not one influence occurs in isolation

  • Biological, psychological, sociocultural

  • Thoughts, feelings, and behaviors

One-Dimensional Models:

• Biological model

• Explain behavior in terms of a single type of cause

• Ignoring other pieces of information

• Linear

Multidimensional Models:

• Explain behavior from multiple influences

• Systemic

• Example influences on behavior include:

  • Biological

  • Behavioral

  • Emotional

  • Social + cultural

  • Environmental

  • Developmental

Genetic Contributions

• Genes are molecules of DNA at various locations on chromosomes, within the cell nucleus 

• Genes are passed down

• Key concepts:

  • dominant vs recessive genes

  • phenotype vs genotype

  • heritability

  • diathesis-stress

• Genes typically account for <50% of variations in psychopathology

• Adverse life events can overpower the influence of genes

• Genetic contributions should not be considered without also considering the environment

Dominant vs recessive genes

• Dominant: strongly influences a trait. Need only one of them to show up in order for us to have that trait

• Recessive: must be paired with another recessive for it to show up

Phenotype vs. genotype

• Phenotype: observable physical and biochemical characteristics such as appearance, development, and behavior

• Genotype: complete set of genes, its genetic makeup

Heritability

• How much variation in a given trait can be attributed to genetic variation

• Ex: schizophrenia has high heritability. More likely to be related to genes.

Diathesis-stress vs epigenetics

• Diathesis-stress:

  • Vulnerability to a disorder

• Epigenetics:

  • Change in gene expression

Development and behavior are almost always polygenetic

• Polygenetic: understanding of psychological traits and conditions, such as intelligence, personality, and mental health disorders, as being influenced by multiple genes rather than a single gene

Diathesis-Stress Model

• Disorders are the result of underlying risk factors combining with life stressors that cause a disorder to emerge

Reciprocal Gene-Environment Model

• Genes may increase the probability that an individual will experience stressful life events

Epigenetics

• Environmental influences affect the expression of certain genes both for the individual and for their descendants 

• Cause chemical changes in our DNA

Neuroscience

Refers to the role of the nervous system in disease and behavior

• Key Systems and Structures:

  • Central and peripheral nervous system

  • Neurons

  • The brain and its structures

  • Endocrine system

Nervous System —> Central nervous system (CNS)

brain, spinal cord

Nervous system —> Peripheral nervous system (PNS)

• autonomic nervous system (ANS)

  • sympathetic division

  • parasympathetic division

• somatic nervous system

Central Nervous System

Key to the CNS are neurons, which transmit information throughout the nervous system

Neurotransmitters:

• Excitatory: increase the likelihood that the connecting neuron will fire

• Inhibitory: decreases the likelihood that the connecting neuron will fire

Brainstem (medulla, pons, cerebellum):

• Handling automatic functions (breathing, sleeping, coordinated movement)

Thalamus and hypothalamus:

•  Regulating behavior and emotion

Limbic System:

• regulating emotional experiences/expressions, our ability to learn to control our impulses, and our basic drives of sex, aggression, hunger, and thirst

  • Hippocampus

    • Memory

  • Amygdala:

    • Fear, aggression

  • Cingulate gyrus

  • Septum

  • Basil ganglia and caudate nucleus

    • Associated with Parkinson’s and Huntington's Disease

    • Controlling motor activity

• Cerebral cortex:

• Performing higher level functioning (thinking, language, memory, sensory)

• Hemispheres:

  • Left: in control of the right side

    • Verbal, cognitive processes

  • Right: in control of the left side

    • Perception, creating images

• Lobes:

  • Temporal

    • Recognizing sights and sounds, long-term memory storage

    • Parietal

      • Recognizing various sensations of touch, monitoring body positioning

    • Occipital

      • Visual inputs

    • Frontal 

      • Higher cognitive functioning

The PNS (Peripheral Nervous System) coordinates with the brainstem to make sure the body is working properly

• Somatic nervous system: 

  • controls voluntary muscle movements

• Autonomic nervous system:

  •  controls our automatic or involuntary bodily functions

  • Regulate the cardiovascular system, endocrine system, digestion, and body temperature

  • Things we don’t think about that we do in everyday life are what the autonomic system controls

Somatic nervous system:

controls voluntary muscle movements

Autonomic nervous system:

•  controls our automatic or involuntary bodily functions

• Regulate the cardiovascular system, endocrine system, digestion, and body temperature

• Things we don’t think about that we do in everyday life are what the autonomic system controls

• Sympathetic nervous system

• Parasympathetic nervous system

Sympathetic nervous system:

• Flight, fight, freeze

• Mobilizes our body during times of stress or dangerous situations (by increasing heart rate, diverting blood to muscles, and releasing adrenaline, allowing more oxygen to the brain and limbs)

• “Sympathizing” with the stress

Parasympathetic nervous system:

• Balances the sympathetic nervous system

• Energy conserving

• Back to baseline, calms the body down, and has bodily functions operating as normal

• “Rest and digest”, calms the body, slows heart rate, aids digestion, and promotes rest, recovery, and healing by using the neurotransmitter acetylcholine

• Endocrine glands produce hormones (chemical messengers) and release them into the bloodstream

Adrenal glands: hormone —> epinephrine, cortisol —> function: energy in response to stress

Thyroid: hormone —> thyroxine —> function: energy metabolism and growth

Gonadal Glands: hormone —> estrogen, testosterone —> function: sexual functioning

Neurotransmitters

• chemical messengers that transmit messages between neurons

• Main neurotransmitters include:

  • Glutamate

  • Gamma aminobutyric acid (GABA)

  • Serotonin

  • Norepinephrine

  • Dopamine

Impact functioning by introducing:

• agonists: increase the activity of a neurotransmitter by mimicking its effects

• Antagonists: decrease or block a neurotransmitter

• Inverse agonists: produce effects opposite to the neurotransmitter

Psychiatric Medication

Examples of how psychiatric medication works to affect neurotransmitters include:

• Increasing the flow of a specific neurotransmitter

• Decreasing the flow of a specific neurotransmitter

• Directly inhibiting or blocking the production of a neurotransmitter

• Increasing the production of competing biochemical substances that may deactivate the neurotransmitter

• Preventing the chemical from reaching the next neuron by closing down or occupying receptors in that neuron

• Blocking the reuptake process

Glutamate + GABA

Glutamate = excitatory

GABA = inhibitory

• The balance of glutamate and GABA determines whether a cell will fire or not

• GABA has been studied extensively in relation to anxiety

• Benzodiazepines (minor tranquilizers) make it easier for GABA molecules to attach themselves to the receptors of specialized neurons 

  • Changing the way neurons talk to each other to decrease the symptoms of psychopathology

  • The calmer the person is

• GABA reduces OVERALL arousal (not just anxiety)

Serotonin

influences many of our behaviors, including regulation of mood, behavior, and thought processes

• Low levels of serotonin are associated with impulsivity

  • Aggression, suicide, overeating, and obsessive sexual behaviors

• Selective serotonin reuptake inhibitors (SSRIs) affect the serotonin system

• SSRIs are used to treat anxiety, mood, and eating disorders

Norepinephrine

stimulates alpha-adrenergic and beta-adrenergic receptors

• May be associated with panic, but likely not directly involved in specific psychological disorders

• Beta blockers block beta receptors so that their response to a surge of norepinephrine is reduced

  • Response to a surge of norepinephrine is reduced. Keeps blood pressure low, heart rate lower

Dopamine

has been connected to several mental health disorders, including schizophrenia, substance use disorders, depression, and ADHD

• Dopamine turns on various brain circuits, possibly associated with certain types of behaviors; once the switch is turned on, other neurotransmitters may then inhibit or facilitate emotions/behavior

• Associated with exploratory, outgoing, pleasure-seeking behaviors

  • Balances out serotonin

• L-dopa (drug for Parkinson’s disease) impacts dopamine circuits (switching on the locomotor circuit)

Neurotransmitters and their relevance to psychopathology

Implications for Psychopathology

Understanding the brain is critical to understanding psychopathology, but it does not explain the sole cause of any disorder

• Damage to an area of the brain

• Increased/decreased activity in an area of the brain

• Too much/too little of a neurotransmitter

Other Influences on Brain Structure + Function

Neurological activity may be influenced by:

• Psychotherapy

• Placebos

• Stress and early development

• Gut health

Paradigm

• A framework or model that shapes how individuals view and understand a field

• It guides research and treatment

• They make sense of complex phenomena

• Paradigms have different assumptions, methods, and communities of scholars

Biological Paradigm

Behavioral and Cognitive Science

• Cognitive science refers to how we acquire and process information, and how we store and retrieve information

  • Social learning

  • Prepared learning (evolution)

    • Ex: food poisoning. Not likely to want to eat that food again. Your body inherently learns not to eat something that made you sick.

  • Implicit memory

    • Type of unconscious, non-declarative long-term memory that influences behavior and performance without conscious recall of past experiences

Example: Learned Helplessness

An example from the work of Martin Seligman

Emotions

• Another contributor to the development of psychopathology, sometimes included in the cognitive behavioral perspective, is emotions

• Emotion = a feeling state that is strong lived, and in response to an external event

  • Behavioral, cognitive, physiological

Behavioral and Cognitive Paradigm

Psychodynamic Paradigm

One-Dimensional vs. Multidimensional Models

• One-Dimensional

  • Explain behavior in terms of a single type of cause

    • Linear

• Multidimensional

  • Explain behavior from multiple influences

    • Systemic

      • We want more of this approach when looking at psychopathology

Biopsychosocial Model

Biological

• Genetics and genetic vulnerability

• Physical health

• Brain chemistry

• Disease or injury

• Exposure to toxins

Psychological

• beliefs/thoughts

• Emotions

• Behaviors

• Coping skills

• Prior history of mental health

Sociological:

• Family relationships

• Peer relationships

• Cultural background

• Cultural beliefs about mental health

Biopsychosocial Assessment

• We can use the biopsychosocial model to better understand the etiology and symptoms of mental health disorders through clinical interviewing

• Clinical interview:

  • A process meant to gather pertinent information for making a diagnosis and planning for treatment

• Biological:

  • Family history

  • Physical health, injury

  • Medications

  • Substance use

• Psychological

  • Current thoughts, feelings, behaviors

  • Early childhood adversity

  • Current life stressors

  • History of mental health symptoms or disorders

• Social

  • Peer relationships

  • Family relationships

  • social/support/community

  • College environment 

  • Cultural understanding of anxiety

• Imagine that an 18-year-old female college student presents to your clinic with symptoms of anxiety. If you are adhering to the biopsychosocial model, what questions might you ask to better assess the etiology and presentation of the disorder?

• general health and history

• family and genetic history

• symptom exploration

• cognitive patterns

• college and academic life

• relationships and social support

• cultural and personal context questions

Takeaways from Module 2

• There are multiple approaches to understanding the causes of psychopathology that impact how we think about, diagnose, and treat mental health disorders

  • One-dimensional versus multidimensional

  • Biological, cognitive/behavioral, psychoanalytic paradigms

  • Biopsychosocial model

Defining Psychopathology:

• Recall the DSM definition:

  • “Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning, or increased risk of suffering, death, pain, or impairment”

Why classify behaviors as mental disorders?

• The goal of a classification system is to subdivide or organize a set of physical or mental conditions

• DSM + ICD are based on symptom presentations, “prototypes”

• These systems do not propose cause “etiology”

• Access to knowledge base and research

• Informs treatment decisions

• Validates concerns (ex: PTSD)

• Treatment access and development (ex: internet gaming disorder)

• Insurance

• Disability payments

• Accommodations

• Benefits

  • Creates a shared language (including for providers)

  • Aids treatment decision-making

  • Facilitates research on etiology and treatment

  • Necessary for insurance reimbursement

• Drawbacks

  • Risks reducing people to “simple” labels

  • Can affect others’ beliefs or expectations about abilities

  • Unrelated problems can be misattributed to the disorder

Approaches to Classification

• Categorical: assumes or suggests qualitative differences

  • objects/concepts differ in kind

  • Each represents a distinct type of something

• Dimensional

  • Focuses on quantitative differences

    • obejcts/concepts differ in degree

    • All exist in one continuum

Where does the DSM fall?

• Mostly categorical

• Meets criteria

• Also dimensional

Changes in the DSM-5

• Introduces dimensional axes rating:

  • Severity

  • Intensity

  • Frequency

  • Duration

• AND new understanding of some diagnoses as existing on a spectrum

  • Ex: autism spectrum disorder, schizophrenia spectrum disorder

A third approach

• A prototypical approach:

  • Identifies essential characteristics

  • Allows nonessential variations

How is a diagnosis made?

• Diagnoses are made by skilled clinicians based on:

  • Number of symptoms

    • arbitrary

  • How long the symptoms have lasted

    • arbitrary

  • Whether the symptoms cause distress or functional impairment

    • Subjective

Clinical Assessment

• The systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder

  • Clinical interview

  • Behavioral assessment

  • Psychological testing

  • Neuropsychological testing

• Reliability

  • The degree to which a measurement is consistent

  • Interrater reliability:

    • Consistency across multiple rates

  • Test-retest reliability: 

    • Consistency across multiple times taking a test

• Validity:

  • The degree to which a measurement measures what it is supposed to measure

    • Concurrent validity: how well a new measure aligns with the “gold standard”

    • Predictive validity: how well a score predicts future outcomes

• Standardization

  • The process by which a certain set of standards or norms is determined so that the test-taker is compared to similar test-takers

Clinical Interview

• Process is meant to gather pertinent information for making a diagnosis and planning for treatment

  • Presenting problem

  • Detailed history (development, social history, etc)

  • Attitudes and emotions

  • Current and past behavior

• Clinical Interview: Unstructured

Clinical Interview: Semi-Structured

• Carefully phrased and tested questions that elicit useful information in a consistent manner

• Advantages

  • Clinician can feel confident that a semi-structured interview will accomplish its purpose

• Disadvantages

  • Loss of spontaneity

  • May inhibit the patient from volunteering useful information that is not directly relevant to the questions being asked

Clinical Interview: The Mental Status Exam

• During most client encounters, clinicians perform the mental status exam

• Behavioral Assessment

• Allows us to use direct observation to formally assess an individual’s thoughts, feelings, and behaviors in a specific situation or context

  • Antecedents: what happened before the behavior?

  • Behavior: What was the behavior?

  • Consequences: what happened after the behavior?

Behavioral Assessment: Rating Scale

• We can also observe behavior through checklists and behavior ratin scales

  • Self rating scale

  • Parent rating scale

  • Teacher rating scale

Pscyhological Testing:

• Tools to determine cognitive, emotional, or behavioral responses that might be associated with a specific disorder

• More general tools that assess long-standing personality features

Psychological Testing: Projective Tests

• Theory: people project their own personality and unconscious fears onto other people and things (ex: ambiguous stimuli)

• Rorschach inkblot test

• Thematic apperception test

• Sentence completion test