Abnormal Psych

Psychopathology

study of symptoms and causes of mental disorders

psychodiagnosis

attempts to describe, asses, and understand the situation

Treatment Plan

propose course of therapy

Etiology

possible causes

Psychotherapy

-program of systematic intervention

-objective: tp omprove a person’s behavioral, emotional, or cognitive state

Mental disorder is scharacterized by

-distance in thinking, emotion, or behavior

-distress or difficulty with daily functioning

-Not being culturall expected

Opinions of Thomas Szasz

A society labels behavior that is different as abormal

-unusual belief systems are not necessarily wrong

-abnormal behavior is a reflection with something wrong with society

National Alliance on Mental Illness (NAMI)

-”YOu are not alone” cmapaign

-Goal: educating the public and reducing stingma

-commengin mrore accurate portayals of mental disorders in movies and TV

Benjamin Rush

-Father of US psychiatry

-Patients treated with respect and dignity, and gainfully employed during treatment

Dorothea Dix

Campaigned for better treatment of mentally ill

Clifford Beers

Wrote brook on his expereince with mental illness

Early viewpoints of causes of mental illness

• biological

• kraepeline

• louis pasteur’s germ theory of disease

• discovery of general paresis

• von Kfrafft-Ebing

The psychological viewpoint

• belief that mental disorderes are caused by psychological and emotional factors

• Fredrich Anton Mesmer

  • practiced therapies that evoled into modern hypnotism 

  • Mesmer was discredited 

  • idea that suggestion could treat hysteria 

• Liebeault and Bernheim demonstrated psychological basis of mental illness

Breuer

discovered symptoms disappeared after female patient spoke about past rauma while in a trance

Freud

• technique of psychoanalysis

• built on the practices of breuer 

Cathartic method

therapeutic use of verbal expression

Behaviorism

• Viewpoint rooted in laboratory science

• Focus on directly observable behaviors 

  • also conditions that evoke, reinforce, and extinguosh them 

• Alternative explanation 

• Offered successful procedures for treating some psychological conditions 

Influence of multicultural psychology

• culture, racce, ethnicity, gender, age, and socioeconomic class relevant to understnding and treating abnormal behavior 

• Mental health professionals need to:

  • increase cultural sensitivity 

  • acquire knowledge of diversity

  • develop culturally relevant therapy approaches 

Dimensions related to cultural diversity

• Cultural values and influences 

• sociopolitical influences

• cultural and ethnic bias in diagnosis 

Positive psychology

• Objectives

  • study, develop, and achieve scientific understanding of positive human qualitites that build thriving individuals, families, and communitites

• Focuses on human strength and capacity for resilience 

  • pyschological resilience

  • prevention 

Recovery Movement

• Perspectice that people with mental illness can recover

  • live satisfying, hopeful, and contributing lives

• Some of the recovery model assumptions

  • Recovery is possible and befins when person realizes that positive change is possivle

  • recovery involves occasional setbacks

  • Healing involves seperating one’s identity from illness

Drug revolution in psychiatry

• Introduction of psychotrophic medications in the 1950s 

  • considered one of the great medical advances in the 20th century

  • Naturally occuring lithium found to radically calm some mental patients

  • Many drugs are available for different disorders

  • Resulted in depopulation of mental hospitals 

Development of managed health care

• some changes brought about by industrialization of health care 

  • business interests of insurers influence treatment duration

  • cost-cutting focus affects: hiring

• Increased appreciation for research

  • denial coverage for unproven treatments

• Tech-assisted therapy

  • online programs 

One dimensional models of mental disorders 

Model
– Attempts to describe a phenomenon that cannot be directly observed
– Models are intrinsically limited and cannot explain every aspect of a disorder
– Human behaviors are complex
• Models of psychopathology
– Biological, psychological, social, and socio-cultural

Multipath model 

Considers the multitude of factors
researchers have confirmed are
associated with each disorder
– Views disorders from a holistic
framework
• Some assumptions of the multipath
model
– Multiple pathways and influences
contribute to the development of any
single disorder
– Not all dimensions contribute equally

Aspects of the multipath model

Many disorders tend to be heterogeneous in nature
• Different combinations within the four dimensions may influence development of a
particular condition
– Within each dimension, distinct theories exist
• Same triggers or vulnerabilities may cause different disorders

Biological Dimension

The human brain
– Forebrain controls all higher mental
functions
– Cerebrum
– Cerebral cortex
– Prefrontal cortex helps manage
attention, behavior, and
emotions
– Limbic system
– Role in emotions, decision-
making, and memories

Multipath Implications

Biological explanations are best considered in the context of other factors
• Science suggests that most individual differences result from some combination of
genetic and environment variations
– People do not inherit a particular abnormality but rather, a predisposition to develop illness
– Environmental forces (stressors) may activate the predisposition, resulting in a disorder

Biochemical processes with the Brain and Body

The brain is composed of:
Neurons (nerve cells)
Dendrites
Axon
Glia cells that act in supporting roles

Nueroplaciscity

Ability of the brain to evolve and adapt
– The brain reacts to environmental circumstances by making new neural circuits and pruning old
ones
• “Neurons that fire together, wire together”
– Nerve pathways that we used frequently become mylienated which makes them stronger and
more efficient. When we practice a behavior it becomes more hard-wired over time.
• Chronic stress results in negative changes in brain activity
– Exercise can produce positive changes

Genetic and Heredity

Heredity: genetic transmission of traits
• Chemical compounds outside the genome control gene expression
– Whether genes are “turned on” or “turned off”
• Genotype and phenotype
• Genetic mutations
• Epigenetics
– Environmental factors trigger biochemical processes that affect gene expression

Biology-Based Treatment Techniques

Psychopharmacology
– Study of effects of psychotropic medications
• Medications
• Electroconvulsive therapy
– Induce small seizures with electricity or magnetism
– Can change brain chemistry and reverse some symptoms
– Reserved for those not responding to other treatments
• Neurosurgical and brain stimulation treatments
– Psychosurgery (removing parts of brain)
– Very uncommon today
– Repetitive transcranial magnetic stimulation
– Deep brain stimulation

Criticism of biological models and therapies

• Drugs are not always effective
• Drugs do not cure mental illness
• Side effects and interactions are possible

Psychological Dimension

Four major perspectives
– Psychodynamic
– Behavioral
– Cognitive
– Humanistic-existential

Psychodynamic Models

• The components of personality
– Id: pleasure principle
– Ego: realistic and rational
– Superego: moral considerations (conscience)
• Psychosexual stages
– Freud proposed that human personality largely developed during first five years of life
• Defense mechanisms
– Protect us from anxiety

Contemporary Psychodynamic theories

Adler and Erickson
– Suggested that the ego has adaptive abilities
– With the ability to function separately from the id
• Bowlby and Mahler
– Proposed that the need to be loved, accepted, and emotionally supported is of primary importance
in childhood

Therapies Based on the Psychodynamic Model

Psychoanalysis
– Objective: uncover material blocked from consciousness
– Free association
– Dream analysis
– Effect of experiences with early attachment figures
• Interpersonal psychotherapy
– Links childhood experiences with current relational patterns
– Focus on current relational patterns
– Helps clients learn more effective interaction strategies

Behavioral Model

Concerned with the role of learning in development of mental disorders
• Based on experimental research
• Three paradigms
– Classical conditioning (Ivan Pavlov)
– Operant conditioning (B. F. Skinner)
– Observational learning (Albert Bandura)

Behavioral Therapies

Exposure therapy
– Gradual exposure
– Flooding
– Systematic desensitization
• Social skills training
• Criticisms of behavioral models and therapies
– Often neglect inner determinants of behavior

Cognitive-Behavioral Models

Thoughts profoundly affect
emotions and behaviors
• Beck and Ellis
– A-B-C theory of emotional
disturbance
– A is an event
– C is a person’s reaction
– B are the person’s beliefs
about A, which causes
reaction C

Third-Wave Cognitive Behavioral Therapies

• Nonreactive attention to emotions can reduce their power to create distress
• Mindfulness
– Conscious attention to the present
• Dialectical behavior therapy (DBT)
– Supportive and collaborative therapy
– Reinforce positive actions
• Acceptance and commitment therapy (ACT)

Humanistic Models

Humans need unconditional
positive regard
• Person-centered therapy focuses
on facilitating conditions that allow
clients to grow and fulfill their
potential
• Maslow’s concept of self-
actualization
– The inherent tendency to strive
for full potential

Humanistic Therapies

Communicating respect, understanding, and acceptance are more important
than techniques
• Unconditional positive regard fosters self-acceptance
• Self-growth aids in present and future problem solving
• The relationship between client and therapist is critically important to outcome

Social Dimension 

• Social-relational models
– Healthy relationships are important for human development and functioning
– Provide many intangible benefits
– When relationships are dysfunctional or absent, individuals are more vulnerable to
mental distress

Family, Couple, and Group Pespective

• Family systems model
– Behavior of one family member affects entire family system
– Characteristics
– Personality development strongly influenced by family characteristics
– Mental illness reflects unhealthy family dynamics and poor communication
– Therapist must focus on family system, not just an individual

Social-Relational Treatment Approaches

Conjoint family therapeutic approach
– Stresses importance of teaching message-sending and message-receiving skills to
family members
• Strategic family approaches
– Consider family power struggles and move towards more healthy distribution
• Structural family approaches
– Reorganizes family in relation to level of involvement with each other

Couple and Group therapy

Couples therapy
– Aimed at helping couples understand and clarify their communication, needs,
roles, and expectations
• Group therapy
– Initially strangers
– Share certain life stressors
– Provides supportive environment
– Allows therapist to observe patient’s actual social interactions

Sociocultural Dimension

Emphasizes importance of several factors in explaining mental
disorders
– Race
– Ethnicity
– Gender
– Sexual orientation
– Religious preference
– Socioeconomic status
– Other factors

Gender Factors

• Higher prevalence of depression, anxiety, and eating disorders among
women
– Women experience greater stress in certain areas:
– Lower wages;, less decision-making power
– Expectations of combining chores, childcare, and paid work
• Exposure to sexual harassment, interpersonal violence
– Affects well-being and learning

Socioeconomic Class

• Lower socioeconomic class associated with:
– Limited sense of personal control
– Poorer physical health
– Higher incidence of depression
• Life in poverty subjects people to multiple stressors
– Fulfilling life’s basic needs

Immigration and Acculturation Stress

Acculturation stress
– Associated with challenges of moving to a new country
– Loss of social support
– Hostile reception
– Educational and employment challenges
– Most common among first generation immigrants and their children

Race and Ethnicity

Two early inaccurate, biased models:
– Inferiority model
– Deficit model
• Multicultural model
– Emerged in the 1980s and 1990s
– A contemporary view that emphasizes the importance of considering a person’s cultural
background and related experiences when determining normality and abnormality

Sociocultural Considerations in Treatment

• Multicultural counseling is the “fourth force” in psychotherapy
• Multicultural counseling is assuming greater importance as our
population becomes more diverse
• Cultural factors, such as family experience and degree of assimilation,
are important in assessment and intervention

Scientific method in clinical research

• Scientific method
– Systematic data collection, controlled observation, and testing hypotheses
• Hypothesis
– Tentative explanation for certain facts or observations
• Theory
– Group of principles and hypotheses that together explain some aspect of a particular area of
inquiry

Important of Replication

Replication
– Repeating results under similar test conditions
• Replicating research has resulted in changes to previous findings described as “conclusive” in mass
media
– Examples:
– Childhood vaccines may cause autism (not supported)
– Antidepressants raise suicide risk in children and adolescents (needs further research)

Characteristics of Clinical Research

• Development of hypotheses about relationships
• Potential for self-correction
• Consideration for reliability and validity
• Use of operational definitions
• Acknowledgement of base rates
• Evaluation based on statistical significance

Case Study

ntensive study of one individual
– Relies on clinical data
– Observations
– Medical and psychological tests
– Historical and bibliographic information
• Can determine characteristics, course, and outcome of a rare disorder
• Used to study therapeutic or diagnostic techniques

Correlational Studies

• Statistical analysis to determine
correlation between variables
• Allow analysis of variables that
cannot or should not be controlled
• Types of correlation
– Positive correlation
– Negative correlation
– No correlation

Experiments

• Best tool for testing cause-and-effect relationships
• Components of a simple experiment
– Experimental hypothesis
– Independent variable
– Manipulated by the experimenter
– Dependent variable
– Expected to change as a result of manipulating the independent variable
• Experimental group
– Group exposed to an independent variable
• Control group
– Similar in every way to experimental group but not exposed to independent variable
• Placebo group
– Participants receive an inactive substance

Additional Controls in Experimental Research

Design of the experiment
• Single-blind design
• Participants unaware of purpose of research
• Double-blind design
• Participant and individual working directly with the participant unaware of
the experimental conditions
• Some variables cannot be manipulated
• Example: child abuse
• Correlational studies are appropriate

Analogue Studies

• Investigation that attempts to simulate real-life situation under controlled conditions
• Used when not possible to control all variables in real-life situations or when ethical,
legal, or moral issues preclude other types of studies
– e.g., to test effects of lack of control on depression, exposing rats to uncontrollable negative
events

Field Studies

Behaviors and events are observed and recorded in their natural environment
(e.g., after floods, earthquakes, and war)
• The main technique is observation
– Also uses interviews, questionnaires, and review of existing data
• Observers must be highly trained
– Avoid disrupting the natural environment

Biological Research Strategies

Methods for studying biological processes involved in mental illness
– Endophenotypes
– Twin comparisons
– Genetic studies
– Study of the epigenetic processes

The endophenotype concept 

Endophenotypes: measurable characteristics
– Characteristic must be heritable
– Occur more frequently in affected families than in the general population
– Examples: anatomical or chemical differences in the brain, eye-tracking irregularities
• Guide prevention and early treatment efforts

Twin Studies

Monozygotic (identical) twins
– Share the same DNA
– Have different fingerprints
– Develop more differences from one another as they age
• Dizygotic/Fraternal twins
– Share same childhood environments
– Often used to evaluate hereditary versus environmental influences on development

Epigenetic Research

Study of environmental factors that influence whether or not a gene is expressed
• Builds on idea that certain environmental factors have greatest impact during
sensitive periods in development
• Epigenetic changes can leave an imprint on eggs or sperm
– Affects traits inherited by future generations

Epidemiological Survey research

Examines rate and distribution of
mental disorders in the population
• Prevalence
– Percentage of individuals in
targeted population with a
particular disorder during a specific
period of time
• Incidence
– Number of new cases of a disorder
that appear in an identified
population within a specific period
of time

Reliability and Validity

Degree to which a test or procedure yields the
same results repeatedly under the same
circumstances
– Reliability
• Extent to which a procedure actually performs its
designed function
– Validity

Standardization

Standard administration
• Professionals administering a test must follow common rules or procedures
• Standardization sample
– Group of people who initially took the measure
– Performance is used as standard or norm
– Test-takers should be similar to the standardization sample for test to be valid

Assessment techniques

Psychological assessment
• Gathering information and drawing conclusions
• Traits, abilities, emotional function, and more
• Four main assessment methods
• Interviews
• Observations
• Psychological tests and inventories
• Neurological tests

Interviews

Interviews
• Observe client and collect data about the person’s life history, current situation, and
personality
• Analyze
– Verbal behavior
– Nonverbal behavior
– Content
– Process of communication
• Interviews vary in degree of structure and formality
• Structured interviews
– Common rules and procedures
– Standard series of questions
– Disadvantage: limit conversation
– Advantage: collect consistent and comprehensive information

Observations

Controlled (analogue) observations
– e.g., laboratory, clinic
• Naturalistic observations
– Natural setting (e.g., classroom, home)
– Usually in conjunction with an interview

Mental Status Exam

Objective: evaluate client’s cognitive, psychological, and behavioral functioning
• Uses questions, observations, and tasks
• Clinician considers the appropriateness and quality of the client’s responses
– Forms tentative opinion of diagnosis and treatment needs
– Mini-Mental Status Exam

Psychological tests and inventories

• Standardized tools
• Measure characteristics such as personality, social skills, and more
• Projective personality tests
– Test taker presented with ambiguous stimuli and asked to respond in some way
– Rorschach Technique
– Thematic Apperception Test (TAT)
– Sentence-completion test
– Draw-a-person test

Self report inventories

Used to assess depression, anxiety, or emotional reactivity
• May involve completion of open-ended sentences
• Minnesota Multiphasic Personality Inventory (MMPI and MMPI-2)
– Interpretation is complicated

Intelligence tests

Primary functions
– Obtain intelligence quotient (IQ), or estimate of current level of cognitive functioning
– Provide clinical data
• Wechsler scales
– Assess verbal and perceptual reasoning, working memory, processing speed
• Stanford-Binet scales
– More complicated; uses basal and ceiling
• Fail to consider the effects of culture, poverty, discrimination, and oppression
• Do not consider multidimensional attributes of intelligence
• Have a poor level of predictive validity
– Do not accurately predict future behaviors or achievement
– Motivation and work ethic may matter more

Tests for Cognitive Impairments

Bender-Gestalt Visual-Motor Test
– Involves copying geometric
designs
• Halstead-Reitan
Neuropsychological Test Battery
– Differentiates patients with brain
damage
– Can provide valuable
information about the type
and location of the damage

Nuerological tests

• Allows noninvasive visualizations of
brain structures
• Electroencephalograph (EEG)
• Computerized axial tomography (CT)
• Magnetic resonance imaging (MRI)
– Functional MRI (fMRI)
• Magnetoencephalography (MEG)
• Positron emission tomography (PET)

Diagnosing and Classifying Abnormal Behavior

• Psychiatric classification system
– Similar to a catalogue, with detailed descriptions of each disorder
– Patterns of behavior are distinctly different
– Each category accommodates symptom variations
• Widely used classification system
– DSM-I (1952): Identified 106 mental disorders
– DSM-II (1968): Identified 182 disorders
– DSM-III (1980): 265
– DSM-III-R: 292
– DSM-IV (1994): 297
– DSM-V (2013): no significant increase in disorders, but many changes
– Revisions (DSM-II, DSM-III, DSM-III-R, DSM-IV, DSM-5) attempt to increase reliability and
validity

Evaluations of the DSM-5

More people meet criteria for diagnosis
– e.g., alcohol use disorder criteria less strict
• Influence of outside forces
– e.g., 70% of professionals who developed DSM-5 had direct ties to drug companies
• Medicalization of some issues
– e.g., gambling disorder; premenstrual dysphoric disorder
• Cross-cultural applicability concerns

Understanding anxiety disorders from a multipath perspective

Anxiety
– Produces tension, worry, and
physiological reactivity
• Anxiety disorders
– Unfounded fear
– Produces clinically significant
distress
– Symptoms interfere with an
individual’s day-to-day
functioning

Biological Dimension

Ruling out medical or physical causes of anxiety symptoms is
important
– Hyperthyroidism
– Cardiac arrhythmias
– Stimulants
– Asthma medications

Fear Circuitry in the Brain

Amygdala
– Plays a central role in triggering state of fear or anxiety
– HPA activity triggers “fight-or-flight” response
• Sensory signals travel to hippocampus and prefrontal cortex
– Process sensory input and evaluate danger
– Higher-level mental processing may result in signals to stop the HPA response

Genetic Influences

Amygdala
– Plays a central role in triggering state of fear or anxiety
– HPA activity triggers “fight-or-flight” response
• Sensory signals travel to hippocampus and prefrontal cortex
– Process sensory input and evaluate danger
– Higher-level mental processing may result in signals to stop the HPA response

Psychological Dimensions

• Psychological characteristics can interact with biological predispositions
• Negative appraisal
– Interpreting events as threatening
• Anxiety sensitivity
– Tendency to interpret physiological changes as signs of danger, leads to anxiety
• Sense of control, mastery
– Reduces anxiety

Social and Sociocultural Dimensions

Daily environmental stress can produce anxiety
People with biological or psychological vulnerabilities are most likely to be
affected
Factors
Poverty, traumatic events, adverse working conditions, limited social support,
and acculturation
Culture can influence how anxiety is expressed

Specific Phobias

Strong, persistent, unwarranted
fear of a specific object or
situation
– Extreme anxiety or panic is
expressed when phobic stimulus is
encountered
– Affect approximately 8.7 percent of
population
– Twice as common in women
compared to men

Etiology of Phobias

• Phobia subtypes have moderate genetic contribution
– 31 percent heritability
• Perspectives regarding the psychological dimension
– Classical conditioning
– Observational learning or modeling
– Negative information
– Cognitive-behavioral response

Sociocultural dimention of phobias

Females more likely to have phobias
– Some objects of phobia trigger both fear and disgust responses (e.g., snakes)
– Disgust response stronger in females

Treatment of Phobias

Medications:
– Benzodiazepines
– Examples: Ativan, Xanax, Valium
– Can produce dependence
– SSRIs
– Often prescribed for chronic forms of anxiety
– Beta-blockers
– D-cycloserine

Cognitive-Behavioral therapy

Exposure therapy
– Gradual introduction to the feared situation
• Systematic desensitization
– Exposure techniques with relaxation
• Cognitive restructuring
– Identifying and changing irrational thoughts
• Modeling therapy
– Viewing another person’s successful interactions with the subject of the phobia

Social Anxiety Disorder

ntense fear of being scrutinized or
doing something embarrassing or
humiliating in the presence of
others
• Often comorbid with major
depressive disorder and
substance-use disorders
• Women twice as likely as men to
have social anxiety disorder
• Can be chronic and disabling

Social Dimension

Parental behaviors influence development of social anxiety in children
– Overprotection
– Lack of support for independence
– Punitive maternal parenting style
• Negative family interactions and family stress
– Associated with social anxiety in middle childhood

Agoraphobia

Intense fear of at least two of the following:
– Being outside of the home alone
– Traveling via public transportation
– Being in open spaces
– Being in stores or theatres
– Standing in line or being in a crowd
• Situations are feared because escape or help may not be readily available

Panic Attacks

People with agoraphobia
sometimes fear having a panic
attack
• Fear of a panic attack can
prevent people from leaving
their homes
• Is an episode of intense fear
accompanied by physiological
symptoms
– e.g., sweating or heart palpitations

Panic Disorder

Recurrent, unexpected panic attacks
– Combined with apprehension about
having another attack or behavior
changes designed to avoid having
another attack
– Reactions present for one month or
more
• Twelve month prevalence rate in the
U.S. is 2.7 percent
– Twice as common in women as in
men

Etiology of a Panic Disorder

Biological dimension
– Heritability is 32 percent
– Individuals with panic disorders have fewer serotonin receptors
– SSRIs have been shown to be effective
– Designed to increase serotonin levels
• Psychological dimension
– Individuals show heightened fear responses to bodily sensations

Sociocultural dimensions of panic disorders

Contributing factors
• Stressful childhood
• Separation anxiety, family conflicts, school problems, or loss of a
loved one
• Cultural differences:
• Asian American and Latino/Hispanic adolescents report higher anxiety
sensitivity but are less likely to have panic attacks (compared to
European Americans)

biological treatment of panic disorder

Benzodiazepines
• Antidepressants
• Beta-blockers
• High relapse rates after cessation of drug therapy

Cognitive-Behavioral Treatment of panic disorder

Promotes self-efficacy
• General steps
– Educating the client about panic disorder
– Identifying and correcting catastrophic thinking
– Teaching client to self-induce physiological symptoms in order to extinguish the conditioning
– Encouraging client to face the symptoms