Psychopathology: History, Models, Assessment, and Anxiety Disorders

Vocabulary practice flashcards covering fundamental concepts, historical treatments, biological models, assessment tools, and anxiety disorders from the psychopathology lecture.

Three Core Criteria of a Psychological Disorder

1. Psychological dysfunction that represents a deviation from cultural norms

2. Significant personal distress or impairment in social/occupational functioning

3. Persistence of symptoms across time

Scientist-Practitioner Model

A framework in mental health where clinicians integrate scientific inquiry into clinical practice by staying consumer-informed on current research, evaluating their own diagnostic and treatment methods, and conducting research.

Humoral Theory

An ancient biological model proposed by Hippocrates and Galen stating that abnormal behavior is a physical disease stemming from an imbalance among four bodily fluids: blood, phlegm, black bile, and yellow bile.

Early 20th-Century Biological Treatments

• Insulin Shock Therapy: Inducing comas via massive doses of insulin.

• Electroconvulsive Therapy (ECT): Delivering direct electrical currents to the brain (historically administered unanesthetized).

• Frontal Lobotomy: Severing frontal lobe connections to sedate aggressive patients.

• Early Tranquilizers: Chemical sedation to manage extreme agitation.

Moral Therapy

A 19th-century psychosocial movement (championed by Philippe Pinel, Jean-Baptiste Pussin, and Dorothea Dix) advocating for institutionalized patients to be treated in humane, normalized, and restful environments without physical restraints.

Classical Conditioning vs. Operant Conditioning

• Classical: Learning via association where a neutral conditioned stimulus (CS) is paired with an unconditioned stimulus (UCS) to produce an involuntary conditioned response (CR).

• Operant: Learning via consequences where voluntary behavior is shaped and maintained through positive/negative reinforcement or positive/negative punishment.

Multidimensional Integrative Approach

The perspective that psychological disorders cannot be traced to a single isolated cause, but rather emerge from continuous, reciprocal interactions among biological, psychological, and social-cultural factors.

Polygenic

A genetic pattern wherein a phenotypic trait or vulnerability is influenced by the interaction of many distinct genes, each exerting a modest effect, rather than determined by a single gene.

Diathesis-Stress Model

A gene-environment framework proposing that individuals inherit an underlying biological vulnerability (diathesis) that must interact with environmental life stressors to trigger the onset of a disorder.

Gene-Environment Correlation Model

A framework proposing that an individual's inherited genetic tendencies increase the probability that they will actively seek out, encounter, or trigger the environmental stressors that precipitate a psychological disorder.

Epigenetics

The study of environmental and external mechanisms that modify gene expression and activation without altering the underlying nucleotide DNA sequence.

Divisions of the Nervous System

• Central Nervous System (CNS): Brain and spinal cord.

• Peripheral Nervous System (PNS): Comprises the Somatic system (voluntary muscle movements) and Autonomic system (involuntary regulation), which further divides into the Sympathetic (fight-or-flight) and Parasympathetic (rest-and-digest) branches.

Neuron Anatomy and Signal Transmission

• Dendrites: Branch-like receptors receiving chemical signals from other neurons.

• Cell Body (Soma): Integrates signals and houses the cell nucleus.

• Axon: Transmits electrical nerve impulses away from the soma.

• Synapse: Microscopic cleft where neurotransmitters are released to bind with postsynaptic receptors or undergo reuptake.

Serotonin (5-HT)

A primary neurotransmitter regulating mood, behavior, information processing, and impulse control; dysregulation is implicated in depression, anxiety disorders, and OCD, with severe deficits linked to impulsivity.

Dopamine

A neurotransmitter regulating reward processing, pleasure pathways, and voluntary movement; implicated in substance use disorders and ADHD, with hyperactive levels associated with schizophrenia and severe deficits causing Parkinson's disease.

Brainstem vs. Forebrain

• Brainstem (Hindbrain & Midbrain): Controls essential vegetative and autonomic life functions, including breathing, heart rate, motor coordination (cerebellum), and alertness.

• Forebrain: Houses advanced structures for complex emotional regulation, sensory relay, and higher-order critical cognition (limbic system, basal ganglia, and cerebral cortex).

Limbic System

A subcortical forebrain circuit that governs emotional experiences, basic drives, and memory; consists of the amygdala (fear and emotional significance), hippocampus (long-term memory formation), and hypothalamus (homeostasis, sleep rhythms, and endocrine regulation).

Lobes of the Cerebral Cortex

• Frontal Lobe: Higher-order reasoning, planning, decision-making, and voluntary movement.

• Parietal Lobe: Somatosensory processing and tactile perception.

• Occipital Lobe: Visual perception, depth, and color processing.

• Temporal Lobe: Auditory processing, language recognition, and long-term memory.

Hypothalamic-Pituitary-Adrenocortical (HPA) Axis

The body's primary neuroendocrine stress circuit; involves communication between the hypothalamus, pituitary gland, and adrenal cortex to release stress hormones. Inability to terminate this response leads to chronic stress.

Cultural Concepts of Distress

Culturally specific patterns of suffering, including:

• Taijin Kyofusho (Japan): Debilitating fear of offending or making others uncomfortable.

• Dhat (South Asia): Severe somatic anxiety centered on semen loss.

• Susto (Latin America): Belief that illness is caused by soul loss or witchcraft.

Equifinality

A developmental psychopathology concept indicating that multiple distinct developmental trajectories and early causal pathways can result in the identical psychological disorder or outcome.

Clinical Interview Components and Objectives

A structured or semi-structured assessment used to understand the patient's lived experience, gather developmental and medical history, identify onset and maintaining factors, observe nonverbal presentation, and establish treatment recommendations.

Ethical Considerations in Clinical Assessment

• Patient confidentiality and its limits (e.g., child/elder abuse, imminent harm to self or others)

• Informed consent and the patient's right to refuse care (against medical advice / AMA)

• Avoiding dual relationships to preserve clinical objectivity

• Transparent disclosure of potential risks and limitations of interventions

Mental Status Exam and Sensorium

An observational clinical assessment of appearance, behavior, speech, thought processes, mood, affect, and sensorium—specifically assessing orientation across four spheres: person, place, time, and purpose (oriented $\times 4$).

Projective vs. Objective Psychological Testing

• Projective Tests: Present ambiguous stimuli to uncover unconscious processes (e.g., Rorschach Inkblot, TAT); scoring is inherently subjective.

• Objective Tests: Empirically validated, standardized instruments with fixed scoring criteria and built-in validity scales (e.g., MMPI, PAI, PHQ-9).

Reliability, Validity, and Standardization

• Reliability: The consistency and repeatability of a measurement tool.

• Validity: The degree to which an instrument truly measures the construct it claims to assess.

• Standardization: The uniform application of test administration, scoring norms, and population benchmarks.

Categorical, Dimensional, and Prototypical Diagnostic Approaches

• Categorical: Strict binary classification (either present or absent).

• Dimensional: Quantifying symptoms along continuous severity scales.

• Prototypical: The DSM approach, which identifies core essential diagnostic characteristics while permitting nonessential symptom variability.

Comorbidity

The co-occurrence of two or more distinct diagnosable psychological disorders within the same individual at the same time.

Adaptive vs. Maladaptive Fear and Anxiety

• Adaptive: A normal, proportionate survival mechanism that mobilizes appropriate protective behavior in response to danger or future challenges.

• Maladaptive: Apprehension or alarm that is excessive, persistent, and causes clinically significant distress or impairment.

Anxiety vs. Fear

• Anxiety: A future-oriented mood state marked by somatic tension and apprehension regarding prospective danger ('What if the plane goes down?').

• Fear: An immediate, present-oriented emotional alarm reaction to real or perceived current danger ('The plane is going down!').

The Yerkes-Dodson Law

An empirical principle stating that task performance improves with physiological arousal up to an optimal level, beyond which excessive arousal and anxiety cause a steep decline in performance.

Specific Phobia

An anxiety disorder marked by disproportionate, irrational fear and avoidance of a circumscribed object or situation, lasting at least 6 months, with an estimated U.S. prevalence of approximately 9%.

Social Anxiety Disorder

A persistent fear of negative evaluation, embarrassment, or scrutiny in social or performance settings, persisting for at least 6 months, affecting approximately 7% of the U.S. population.

Panic Disorder

An anxiety disorder (2-3% prevalence) characterized by recurrent, unexpected panic attacks accompanied by at least 1 month of persistent apprehension about future attacks or significant maladaptive behavioral changes to avoid them.

Depersonalization vs. Derealization

• Depersonalization: A dissociative sensation of detachment, unreality, or estrangement from one's own body, thoughts, or self.

• Derealization: A dissociative experience wherein the external physical environment feels dreamlike, artificial, or unfamiliar.

Agoraphobia

Marked fear and avoidance of two or more environments (public transit, open spaces, enclosed places, lines/crowds, or leaving home alone) due to worries that escape might be difficult or help unavailable should panic symptoms occur (~1.7% prevalence).

Generalized Anxiety Disorder (GAD)

Excessive, uncontrollable worry occurring on most days for at least 6 months across multiple everyday domains, accompanied by at least three somatic symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance).

Biological and Psychological Contributions to Anxiety Disorders

• Biological: Genetic vulnerabilities, limbic hyperreactivity (amygdala), and neurotransmitter deficits in GABA, serotonin, and norepinephrine.

• Psychological: Early unpredictable or uncontrollable stressors, behavioral conditioning (classical and operant), and cognitive distortions such as catastrophic thinking.

PTSD Diagnostic Clusters

Following exposure to an actual or threatened traumatic event, symptoms must persist for over 1 month across four clusters:

1. Intrusion / Re-experiencing (flashbacks, nightmares)

2. Avoidance (trauma-related cues, thoughts)

3. Negative alterations in cognition and mood (blame, amnesia, detachment)

4. Hyperarousal and reactivity (irritability, hypervigilance)

PTSD Trajectories and Acute Stress Disorder

• Acute PTSD: Symptoms present between 1 and 3 months post-trauma.

• Chronic PTSD: Symptoms persist beyond 3 months post-trauma.

• Delayed Onset: Diagnostic criteria met 6 months or more following trauma.

• Acute Stress Disorder: Trauma symptoms that manifest within the first month and resolve quickly.

Etiological Factors of PTSD

• Trauma Intensity: Perceived threat to life and severity of initial emotional reaction.

• Conditioning: Learned alarms pairing neutral trauma-associated cues with intense panic/fear.

• Vulnerability & Environment: Genetic predisposition, prior history of uncontrollable stress, and lack of post-trauma social support.

Obsessions vs. Compulsions

• Obsessions: Recurrent, intrusive, and distressing thoughts, impulses, or images that generate significant anxiety.

• Compulsions: Repetitive behavioral or mental acts enacted to neutralize obsessions and temporarily reduce anxiety, maintained via negative reinforcement.

Thought-Action Fusion

A cognitive distortion common in OCD wherein an individual equates having an unacceptable intrusive thought with morally committing the action, or believes that the thought directly increases the probability of the event occurring.

Cognitive Behavioral Therapy (CBT) for Anxiety

A psychotherapeutic model targeting the bidirectional relationship among thoughts, feelings, and behaviors by identifying cognitive errors (e.g., all-or-none thinking, emotional reasoning, jumping to conclusions) and modifying them alongside behavioral change.

Exposure with Response Prevention (ERP)

The primary behavioral treatment protocol for OCD, systematically exposing individuals to fear-inducing stimuli or obsessions while strictly preventing the performance of compulsive rituals, thereby facilitating habituation and tolerance to distress.

Exposure Modalities in Anxiety Treatment

• In Vivo: Direct, real-life contact with the feared object or situation.

• Imaginal: Vivid mental visualization of feared situations.

• Virtual Reality (VR): Computer-generated environmental simulations.

• Interoceptive: Deliberate induction of feared internal somatic sensations (e.g., hyperventilation, spinning).