3 psychodiagnosis (61Q & 20TF)

a framework that helps clinicians understand and explain mental disorders.

What is a theoretical model?

emphasize different factors involved in the development and maintenance of symptoms.

What do different theoretical models emphasize regarding mental disorders?

• Diagnosis asks: “What mental disorder does this person have.?

• A theoretical model/formulation asks: “How might we understand or explain this person’s mental disorder?”

What is the difference between diagnosis and a theoretical model of diagnosis?

1. Spirit possession was one of the earliest explanations for mental disorders.
2. In the classical Greek and Roman periods, biological and environmental explanations were proposed for some major mental disorders, including depression and schizophrenia.
3. Later, these theories declined in Western Europe but continued to develop in the Middle East.
4. During the Renaissance, biological and environmental explanations appeared again in Europe.

What is the historical development of theoretical models of diagnosis?

true

Each etiological theory has strengths and limitations, and no single theory can fully explain mental disorders. ✅❌

true

Mental disorders are complex and are likely influenced by a combination of biological, psychological, and sociocultural factors. ✅❌

What is the core idea of the biological model?

What are the traditional assumptions of the Medical/Biological Model?

Mental disorders are increasingly understood as complex, multi-level conditions rather than diseases caused by one biological abnormality.

How are mental disorders increasingly understood in the modern update of the Medical/Biological Model?

Depression → low serotonin.

Schizophrenia → excess dopamine

What was the simplified traditional biological explanation for depression and schizophrenia?

Mental disorders involve interactions among

• neurotransmitter systems,

• brain circuits,

• genetics,

• immune and physiological processes,

• neurodevelopment,

• stress and environmental factors

What do mental disorders involve according to the modern biological model?

The key biological model has not been rejected — it has become more complex.

What happened to the key biological model?

true

Recent research has transformed the biological model from a simple disease/chemical-imbalance model into a complex, dimensional, and developmental model of psychopathology. ✅❌

Many genetic variants contribute very small effects

Polygenic = متعددة الجينات

يعني أن العديد من الجينات أو genetic variants يمكن أن تساهم في قابلية الشخص للإصابة باضطراب نفسي.

لكن كل متغير جيني عادةً يكون له تأثير صغير جدًا بمفرده.

يعني بدل ما يكون:

Gene A → disorder

التصور هو أقرب إلى:

Variant 1 + Variant 2 + Variant 3 + ... + many other variants → genetic influence

لذلك يسمى التأثير polygenic.

What does it mean that mental disorders are polygenic?

1. Polygenic—many genetic variants contribute very small effects.

2. Probabilistic rather than deterministic.

3. Influenced by environmental conditions.

4. Partly shared across different psychiatric disorders

What are the general characteristics of genetic influences on psychopathology?

false, Many mental disorders show substantial familial and genetic influences.

Many mental disorders show little or no familial and genetic influences. ✅❌

true

A 2023 study of more than 1.3 million people identified 243 genetic risk loci for depression, demonstrating its highly polygenic nature ✅❌

حددت دراسة نُشرت عام 2023 وشملت أكثر من 1.3 مليون شخص 243 موضعًا جينيًا مرتبطًا بخطر الاكتئاب، مما يوضح الطبيعة متعددة الجينات للاكتئاب.

true

A 2025 Nature study of 14 psychiatric disorders and more than 1 million cases found extensive genetic overlap between disorders, with five broad genomic factors accounting for much of the genetic variance. ✅❌

false, There is no single “depression gene” or “schizophrenia gene”; genetic risk is distributed across many variants and often overlaps between disorders.

Each psychiatric disorder is caused by a single specific gene that is unique to that disorder ✅❌

What are the main strengths of the Medical/Biological Model?

What are the main limitations of the Medical/Biological Model?

A clinician might consider

1. family psychiatric history,

2. medical conditions,

3. medication/substances,

4. sleep,

5. biological vulnerabilities.

How does the Medical/Biological Model affect assessment? (what should be included to assess biological model)

It involves

• briefly considering pharmacological and other biological interventions

• #while emphasizing that biological vulnerability does not imply that treatment must only be biological

How does the Medical/Biological Model affect treatment?

true

The biological model supports biological treatments, but biology alone cannot fully explain or diagnose most mental disorders. ✅❌

both can be influenced by processes outside full conscious awareness.

What do psychodynamic approaches propose about psychological distress and behaviour?

1. unconscious processes,

2. internal conflict,

3. early relationships,

4. repetition of relational patterns.

What are the four important concepts in the core psychodynamic assumptions?

• Motives,

• emotions,

• memories,

• expectations

may influence behaviour without conscious awareness.

What are unconscious processes in psychodynamic approaches?

Distress may arise when competing wishes, emotions, values, or fears are difficult to reconcile.

What is internal conflict, according to psychodynamic approaches?

expectations about

• self and others

• intimacy and rejection,

• safety and trust

What may early interpersonal experiences shape according to psychodynamic approaches?

Previously developed interpersonal patterns may be recreated in later relationships.

What is meant by repetition of relational patterns?

partly through

• unconscious processes

• internal conflict

• patterns developed through relationships and experience.

How do psychodynamic models understand psychopathology?

psychological processes that reduce awareness of, or protect against, distressing thoughts, feelings, or conflicts.

What are defence mechanisms?

What are common examples of defence mechanisms?

false, are normal psychological processes that can help people manage distress; they become clinically significant when they are rigid, excessive, persistent, or interfere with adaptive functioning.

Defence mechanisms are inherently pathological and always indicate psychological dysfunction. ✅❌

true

Contemporary psychodynamic approaches focus less on labelling defence mechanisms as simply “good” or “bad” and more on their flexibility and impact on functioning ✅❌

what does contemporary psychodynamic therapy focuses on?

the activation of expectations, emotions, and interpretations associated with earlier relationships within current relationships.

What is transference?

identify recurring interpersonal expectations and relationship patterns that contribute to current difficulties.

What can transference help identify?

No. Contemporary psychodynamic therapy is not simply about uncovering hidden childhood memories.

Instead, therapy seeks to understand connections between

• past experiences,

• current emotions,

• interpersonal patterns,

• present difficulties

Is contemporary psychodynamic therapy simply about uncovering hidden childhood memories?

false, The claim that “psychodynamic therapy has no empirical support” is outdated. A major 2023 umbrella review concluded that psychodynamic psychotherapy has empirical support for several common mental disorders.

The claim that “psychodynamic therapy has no empirical support” remains accurate because research has found no evidence for its effectiveness. ✅❌

true

The 2023 umbrella review concluded that psychodynamic psychotherapy has empirical support for several common mental disorders; evidence was strongest for depressive and somatic symptom disorders, with moderate-quality evidence for anxiety and personality disorders. ✅❌

true

A 2024 meta-analysis found no statistically significant difference in depressive outcomes between manualised psychodynamic therapy and CBT immediately after treatment ✅❌

true

Evidence that psychodynamic therapy works does not prove that every part of its underlying theory is correct, and its effectiveness does not automatically validate every claim of classical psychoanalysis. ✅❌

toward an empirically informed developmental and relational model centred on

• attachment,

• mentalization,

• emotion regulation,

• interpersonal processes.

How has the psychodynamic model shifted from the traditional Freudian model in 2020–2026?

the ability to understand our own and others' behaviour in terms of underlying thoughts, feelings, intentions, and beliefs

What is mentalization?

can affect emotion regulation, relationships, and sense of self.

What areas can difficulties with mentalization affect?

What are the strengths of the psychodynamic model?

What are the limitations of the psychodynamic model?

true

Psychodynamic assessment focuses not only on symptoms but also on underlying psychological and interpersonal processes, including attachment style and interpersonal functioning, emotional regulation, and capacity for mentalization. ✅❌

• Increase self-understanding and psychological insight.

• Identify recurring interpersonal patterns.

• Improve emotional awareness and regulation.

• Strengthen the capacity for mentalization.

• Use the therapeutic relationship as a context for understanding and changing interpersonal patterns.

What does psychodynamic treatment commonly aim to achieve?

true

Psychodynamic therapy now has empirical support for several mental disorders. ✅❌

developed from the integration of behavioural and cognitive theories.

particularly associated with Aaron Beck and Albert Ellis.

How did Cognitive Behavioural Therapy (CBT) develop?

true

The behavioural foundations of CBT include classical conditioning, operant conditioning, reinforcement, exposure, and avoidance learning. ✅❌

by interactions between:

1. situations,

2. thoughts,

3. emotions,

4. physiological responses,

5. behaviour.

According to CBT, what influences psychological difficulties?

can create feedback loops that maintain psychological difficulties.

What can the interactions between situations, thoughts, emotions, physiological responses, and behaviour create?

includes disorder-specific and transdiagnostic approaches.

What approaches does contemporary CBT include?

• Catastrophising: expecting the worst possible outcome.

• All-or-nothing thinking: viewing situations in extreme categories.

• Overgeneralisation: drawing broad conclusions from limited experiences.

• Mind-reading: assuming what others are thinking without sufficient evidence.

• Selective attention: focusing disproportionately on negative information.

What are common patterns of unhelpful thinking described in CBT?

true

Contemporary CBT aims to develop more flexible, realistic, and evidence-sensitive interpretations rather than simply encouraging positive thinking. ✅❌

CBT targets unhelpful patterns of interpretation, rather than simply replacing negative thoughts with positive ones.

What does CBT target rather than simply replacing negative thoughts with positive ones?

focuses not only on what people think, but also on what they do.

• avoidance,

• escape,

• safety behaviours,

• reassurance seeking,

• compulsions,

• reduced rewarding activities.

What does CBT focus on besides what people think?

What are the important behavioural processes in CBT?

Behaviours can be maintained through reinforcement.

can unintentionally maintain psychological problems over time.

How can behaviours be maintained?

How can behaviours that provide short-term relief affect psychological problems over time?

true

Significant benefits of CBT have been found across several disorders, including depression, anxiety disorders, PTSD, OCD, and eating disorders. ✅❌

• Strong empirical support: CBT is one of the most extensively researched psychological therapies.

• Effective across disorders: Evidence supports its use for depression, anxiety, PTSD, OCD, and other conditions.

• Structured and goal-oriented: It provides clear treatment goals and techniques.

• Practical skills: It teaches patients strategies they can continue using after therapy.

• Focuses on maintenance: It identifies thoughts and behaviours that maintain psychological difficulties.

What are the main benefits of the cognitive-behavioural model?

• Not equally effective for everyone: Treatment response varies between individuals and disorders.

• Complexity can be reduced: Focusing mainly on thoughts and behaviours may underemphasise biological, developmental, and social factors.

• Evidence quality varies: Although the evidence base is large, not all studies are high quality.

What are the main limitations of the cognitive-behavioural model?

CBT assessment focuses on identifying the individual's maintenance cycle, including:

• Triggers and situations

• Automatic thoughts and interpretations

• Emotions and physiological responses

• Behaviours and avoidance

What does CBT assessment focus on identifying?

CBT treatment targets the specific processes maintaining the individual's difficulties.

What does CBT treatment target?

Depending on the disorder, CBT interventions may include:

• Psychoeducation

• Self-monitoring

• Cognitive restructuring

• Behavioural activation

• Exposure and response prevention

What interventions may be included in CBT treatment depending on the disorder?

• Traditional CBT is summarized as thoughts, emotions, and behaviour.

• Contemporary CBT continues to target cognition and behaviour.

What is the traditional CBT model mainly focused on?

and

What does contemporary CBT continue to target?

Contemporary CBT increasingly emphasises maintenance mechanisms rather than simply “negative thoughts.”

How has the focus of contemporary CBT shifted from the traditional emphasis on “negative thoughts”?

includes both disorder-specific and transdiagnostic approaches.

What approaches does contemporary CBT include?

CBT has evolved

from changing “negative thoughts”

to targeting the specific cognitive, behavioural, emotional, and environmental processes

that maintain psychological difficulties.

How has CBT evolved in its approach to psychological difficulties?

classifies mental disorders into distinct diagnostic categories. The person either meets diagnostic criteria or does not.

What is the categorical approach to mental disorders?

1. clinical communication,

2. treatment planning,

3. research,

4. service organisation

What is the categorical approach useful for?

views psychopathology as existing on continuous dimensions and focuses on severity and individual symptom patterns, not only diagnosis.

What is the dimensional approach to psychopathology?

people just above and below a diagnostic threshold may be more similar than the diagnostic category suggests.

What does the dimensional approach recognise about people near a diagnostic threshold?

Categorical = “Does the person have the disorder?”

Dimensional = “To what degree does the person experience psychopathology?”

What is the key difference between categorical and dimensional approaches?

High comorbidity: people often meet criteria for multiple disorders.

Heterogeneity: people with the same diagnosis can have very different symptoms.

Arbitrary thresholds: symptoms often occur continuously rather than in clear categories.

What are the three limitations of traditional diagnostic categories highlighted by dimensional models?

Different disorders may share

• genetic,

• biological,

• psychological

• environmental risk factors.

What types of risk factors may be shared across different mental disorders?

increasingly supports understanding psychopathology as dimensional, overlapping, and transdiagnostic rather than as completely separate disorders.

How does recent research increasingly conceptualise psychopathology?

true

Categorical diagnosis remains useful because it makes DSM and ICD important in routine clinical practice ✅❌

Dimensional information adds detail, such as symptom severity.

What does dimensional information add to categorical diagnosis?

Mental disorders may be diagnosed categorically, but psychopathology itself is often dimensional

How can mental disorders be diagnosed, and how is psychopathology itself often conceptualised?