PSYC 101 Unit 3

What is psychopathology, and how does the medical model approach it?

Psychopathology is the study of psychological disorders—patterns of thoughts, feelings, or behaviors causing problems for oneself or others. The medical model treats disorders as diagnosable conditions with causes, prognosis, and treatment plans, encouraging systematic diagnosis and treatment selection.

What are advantages and criticisms of the medical model of mental disorders?

• Advantages of the medical model: it encourages systematic diagnosis, directs investigations into causes, and helps select treatments.

• Criticisms: it can increase stigma or “medicalize” normal life experiences (e.g., grief, personality differences), and it isn’t obvious that every mental problem is an “illness” in the same straightforward sense as influenza or diabetes. Historical and cultural beliefs (including supernatural explanations) have also shaped what people label as “pathology.”

What are the "Three D’s" used to evaluate psychopathology?

Deviance — behavior, thoughts, or emotions that differ markedly from cultural norms.

• Example: public nudity is deviant in most cultures.

• Problem: deviance depends on which culture or subculture you use as the comparison group.

Dysfunction (maladaptive behavior) — the person’s ability to function in daily life is impaired (work, relationships, self-care).

• Example: severe anxiety that prevents someone from holding a job.

Distress — the person experiences subjective suffering or upset because of the symptoms.

• Example: persistent sadness that the person reports as tormenting.

Clinicians also consider danger (risk of harm to self or others), duration (how long symptoms have lasted), and impairment across multiple life areas. The DSM provides operationalized checklists and thresholds for many disorders.

Why is relying on a single criterion (deviance, dysfunction, or distress) insufficient for diagnosing mental illness?

Each of the Three D’s (or any single indicator) is insufficient on its own because:

• Deviance alone can capture harmless cultural or creative differences (e.g., an eccentric artist) and can pathologize minority behaviors.

• Distress alone can be a normal response to real-world problems (e.g., grieving a loss) rather than a disorder.

• Dysfunction alone might be caused by social factors (poverty, discrimination, illness) rather than intrinsic psychopathology.

Therefore clinicians combine multiple criteria to reduce false positives (labeling normal variation as illness) and false negatives (missing real disorder). Thresholds, duration requirements, and assessment of impairment help make the call more defensible.

How does subjectivity in diagnosis increase disagreement among clinicians?

ubjectivity is a big driver of diagnostic disagreement. Sources of subjectivity:

• Cultural and normative judgments. What’s “deviant” varies by culture, age, gender role, and community standards.

• Patient report. Many diagnoses depend on what the patient says (e.g., “I feel worthless”), which is subjective and influenced by insight, memory, desire to impress or conceal.

• Clinician judgment. Clinicians interpret symptoms, decide which ones are primary vs secondary, and weigh how much impairment matters. Different clinicians can weigh the same information differently.

• Heterogeneous presentations. Many disorders (depression, PTSD, ADHD) are syndromes: different patients meet the criteria with different symptom constellations.

• Comorbidity and overlap. Symptoms overlap across disorders (e.g., sleep problems appear in depression, anxiety, PTSD), making categorical choices ambiguous.

• Assessment methods. Some clinicians use structured interviews and rating scales (more reliable); others rely on open clinical interviews (more variable).

All this leads to lower inter-rater agreement for some diagnoses (e.g., dissociative disorders, personality disorders) and higher agreement for conditions with obvious, distinctive signs (e.g., frank psychosis, clear manic episodes). Subjectivity therefore increases diagnostic variability across clinicians.

What is the DSM-5, and how does it aid diagnosis?

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) is the American Psychiatric Association’s authoritative manual that defines mental disorder categories and operational diagnostic criteria (lists of symptoms, required duration, exclusion rules, specifiers). It is descriptive rather than explanatory — it tells clinicians what to look for and how to count symptoms, not necessarily the underlying cause.

How the DSM-5 helps clinicians:

• Standardization. Gives agreed symptom lists and thresholds so clinicians are more likely to call the same condition the same name. This improves communication, research comparability, insurance/record-keeping, and treatment selection.

• Operational criteria. By listing required symptoms, number needed, and time frames, it increases reliability, especially when paired with structured interviews.

• Specifiers and severity ratings. These allow clinicians to record nuance (e.g., “major depressive disorder, severe, with psychotic features”).

• Guidance for differential diagnosis. It lists exclusion criteria and similar conditions to consider.

Why DSM-5 does not completely prevent diagnostic errors:

• It can’t remove all subjectivity. Clinicians still interpret symptom severity, context, and whether impairment is present.

• Incomplete validity. Some DSM categories are pragmatically grouped syndromes rather than discrete diseases with known etiology; biological markers are lacking for most diagnoses.

• Boundary issues and comorbidity. Patients often meet criteria for multiple disorders; choosing a primary diagnosis still requires judgment.

• Cultural/context limitations. DSM criteria were developed largely from Western research; cultural expressions of distress may not fit neatly.

• Diagnostic inflation / medicalization. Adding new categories or lowering thresholds can broaden what is labeled a disorder (e.g., caffeine-related disorders, or disruptive mood dysregulation disorder) — sometimes reflecting expanded awareness and sometimes medicalizing normal variation.

• Human error and bias. Clinician biases, incomplete history, malingering, or poor assessment can still cause misdiagnosis.

In short: DSM-5 raises diagnostic reliability but does not guarantee accuracy (validity) or eliminate clinician error.

Define prevalence, lifetime prevalence, onset, and etiology.

• Prevalence: The proportion of a population that has a disorder at a specified time (e.g., point prevalence = right now; period prevalence = during a defined past interval).

• Lifetime prevalence: The proportion of people in a population who have ever had the disorder at any point in their lives up to assessment.

• Onset: The age or time when symptoms first appeared (e.g., childhood onset, adult onset). Onset can inform prognosis and possible causes.

• Etiology: The causes or causal factors that produce and maintain a disorder (biological, psychological, social). Etiology can include genes, neurobiology, trauma, learning history, and social stressors. 

• Diagnosis is to etiology as what is to why.

What is the difference between diagnostic criteria and associative features?

Diagnostic criteria are required for diagnosis; associative features are commonly associated traits, patterns, or risk factors but not required for diagnosis.

What are the four types of anxiety disorders?

Generalized Anxiety Disorder (GAD)

Specific phobia

Panic Disorder

Agoraphobia

Generalized Anxiety Disorder (GAD)

• Diagnostic features

• Differentiation

• Associative features

• Etiology

Symptoms / Diagnostic Features

• Chronic, excessive anxiety not tied to a specific threat.

Differentiation

• Unlike phobias, the worry is not about one specific object or situation.

• Unlike panic disorder, anxiety is constant, not episodic.

Associative Features

• 2/3 of sufferers are female.

• Prevalence: ~19% of population (large portion of population).

• One of the most common psychopathologies.

Etiology

• Biological: Modest heritability; neurotransmitters (e.g., GABA dysregulation - anxiety; 5-HT - OCD).

• Psychological: Maladaptive cognitive patterns (misinterpreting harmless situations, focusing on threats, selectively recalling threatening events).

  • biological preparedness (Seligman): we learn some fears more readily than others

  • evolved module for fear learning (Ohman & Mineka) : further develops how/in what way we learn some fears more readily than others

• Stress: Can precipitate or worsen.

• Those with panic disorder and PTSD tend to overgeneralize (classical conditioning) stimuli which trigger anxiety.

Specific phobia

• Diagnostic features

• Differentiation

• Associative features

• Etiology

Symptoms / Diagnostic Features

• Irrational fear of a specific object or situation.

• Types:

  • Animal type

  • Natural environment

  • Situational (e.g., claustrophobia)

  • Blood-injection-injury (distinct because blood pressure drops)

  • Other categories

Differentiation

• Fear is specific, unlike GAD.

• Blood-injection-injury type includes physiological fainting response, which other phobias lack.

Associative Features

• 2/3 female

• Prevalence: 19%

• Onset: Late adolescence or early adulthood.

Etiology

• Biological preparedness (Seligman): Some fears learned more easily.

• Evolved fear module (Öhman & Mineka): Fear of evolutionarily relevant stimuli.

• Conditioning and learning: Acquired by classical conditioning, maintained by operant conditioning.

• Stress: Can trigger or worsen phobias.

Panic Disorder

• Diagnostic features

• Differentiation

• Associative features

• Etiology

Symptoms / Diagnostic Features

• Sudden, intense panic attacks with:

  • Palpitations

  • Sweating

  • Shortness of breath

  • Chest pain

  • Derealization

  • Fear of dying or losing control

  • Hot flashes/chills

Differentiation

• Panic attacks are acute, unlike GAD’s chronic worry.

• Can lead to agoraphobia, but agoraphobia can also occur without panic disorder.

Associative Features

• Same prevalence and gender pattern as anxiety disorders (high, female-heavy).

Etiology

• Conditioning: Overgeneralization to cues that resemble the original trigger.

• Biological: Genetic vulnerability.

• Stress: Precipitates attacks.

Agoraphobia

• Diagnostic features

• Differentiation

• Etiology

Symptoms / Diagnostic Features

• Fear of being in public places where escape might be difficult.

• Often linked with panic disorder but may occur independently.

Differentiation

• Avoidance of public spaces is central.

Etiology

• Same as panic disorder, sometimes develops as a complication of panic attacks.

Obsessive Compulsive Disorder

• Diagnostic features

• Differentiation

• Associative Features

• Etiology

Symptoms / Diagnostic Criteria

• Obsessions: Intrusive thoughts (harm, sexual acts, contamination, failures).

• Compulsions: Ritualistic behaviors performed to reduce anxiety.

• Awareness varies: some know thoughts/rituals are irrational; others do not.

Differentiation

• Different from GAD because it involves intrusive thoughts + ritual behaviors.

• Not fear-based like phobias.

Associative Features

• Prevalence: 2–3%

• Onset: 19–20 years old

• Suicide risk increased

• Male = female

Etiology

• Biological: Serotonin (5-HT) involvement; executive functioning impairment in some.

• Psychological: Operant conditioning (compulsions reduce anxiety so they are reinforced).

• Stress: Can worsen symptoms.

Posttraumatic Stress Disorder (PTSD)

• Diagnostic features

• Differentiation

• Associative Features

• Etiology

Symptoms / Diagnostic Criteria

• Re-experiencing trauma

• Avoidance of reminders

• Negative alterations in cognition/mood

• Hyperarousal

Differentiation

• Requires exposure to a major traumatic event.

Associative Features

• Lifetime prevalence: 7–8%

• Trauma exposure is more common than previously believed.

• Childhood adversity ↑ risk.

Etiology

• Stress and trauma directly cause the condition.

• Overgeneralization of fear signals (conditioning).

• Psychological vulnerability.

What are the two types of dissociative disorders?

Dissociative Amnesia / Fugue

Dissociative Identity Disorder (DID)

Dissociative Amnesia / Fugue

• Symptoms

• Differentiation

Symptoms

• Loss of extensive personal information.

• Fugue: travel to new location with loss of identity.

  • a state or period of loss of awareness of one's identity, often coupled with flight from one's usual environment

Differentiation

• Memory loss is far greater than typical forgetfulness.

Dissociative Identity Disorder (DID)

• Diagnostic features

• Associative Features

• Etiology

Symptoms / Diagnostic Criteria

• Two or more distinct personalities (“alters”).

• Amnesia between alters, though memory tests show partial awareness.

• Sudden transitions.

Associative Features

• Dramatic increase in diagnoses recently → likely overdiagnosis.

Etiology

• Severe emotional trauma in childhood (controversial).

• Stress

• Iatrogenic effects (symptoms unintentionally encouraged by clinicians).

• Etiology is unclear.

• ↑ # of diagnoses over the years – overdiagnosis by a few clinicians

What are the two depressive and bipolar disorders?

Major Depressive Disorder (MDD)

Bipolar I Disorder

Major Depressive Disorder (MDD)

• Diagnostic features

• Differentiation

• Associative Features

• Etiology

Diagnostic Criteria (5 or more):

• Persistent sadness or anhedonia (required)

• Appetite/weight changes

• Sleep disturbance

• Fatigue

• Psychomotor agitation/retardation

• Worthlessness/guilt

• Poor concentration

• Thoughts of death

Differentiation

• Must cause significant impairment and last at least 2 weeks.

• Not episodic like bipolar disorder.

Associative Features

• Onset: around puberty; highest incidence in 20s.

• Earlier onset = worse prognosis.

• Recurrence common (40–50%).

• Lifetime prevalence: 13–16%

• Women 2x men.

• Duration ~6 months.

• Large public health burden.

Etiology

• Genetic: Moderate heritability.

• Biological: Low serotonin/NE; ↓ hippocampal volume; ↓ neurogenesis; amygdala hyperactivity.

• Cognitive: Learned helplessness, pessimistic explanatory style, rumination.

• Interpersonal: Poor social skills lead to negative interactions.

• Stress: Can trigger episodes; impact decreases after multiple episodes.

Bipolar I Disorder

• Diagnostic features

• Differentiation

• Associative Features

• Etiology

Diagnostic Criteria

• At least one manic episode (1 week) with:

  • Grandiosity

  • ↓ need for sleep

  • Pressured speech

  • Flight of ideas

  • Distractibility

  • ↑ goal-directed behavior

  • Excessive risky behavior

Differentiation

• Manic episode is required; that makes diagnosis clear.

Associative Features

• Prevalence: 1%

• Male = female

• Onset: Late teens / early 20s

• High suicide risk (shared with depression)

Etiology

• Genetic: Very high heritability (65–80%).

• Biological: Neurotransmitters, structural abnormalities.

• Stress: Onset trigger; less role later in illness.

Schizophrenia

• Diagnostic features

• Differentiation

• Associative Features

• Etiology

Symptoms / Diagnostic Criteria (2 or more):

• Delusions (persecution, grandeur, thought insertion)

• Hallucinations (auditory most common)

• Disorganized speech/thinking

• Disorganized/catatonic behavior

• Negative symptoms (flat affect, alogia, avolition)

Differentiation

• Core feature = break from reality

• Not multiple personalities (DID)

Associative Features

• Onset:

  • Males: mid-20s

  • Females: late 20s–early 30s

• Lifetime prevalence: 1%

• Earlier onset = worse prognosis

• Subtypes no longer used because symptoms change over time and categories were unreliable.

Etiology

• Genetic vulnerability:

  • 48% concordance in MZ twins

  • 1–2 parents = 46% risk

• Neurochemistry: Dopamine dysregulation (updated DA hypothesis); 5-HT, GABA, glutamate.

• Brain structure: Enlarged ventricles, reduced gray/white matter.

• Neurodevelopmental factors: Prenatal viral infections, malnutrition, obstetric complications.

• Environmental: Expressed emotion increases relapse.

• Stress: Triggers episodes.

• Cannabis use: Risk ↑ with genetic vulnerability.

Autism Spectrum Disorder

• Diagnostic features

• Associative Features

• Etiology

Diagnostic Criteria

• Social communication deficits

• Repetitive/restrictive behaviors/interests

Associative Features

• 30–40% no speech; others have unusual speech (echolalia).

• Strong negative reactions to minor changes.

• 50% have low IQ.

• Onset: Symptoms at 15–18 months.

• Diagnosis usually by age 2–3.

• Prevalence: 1.5%

• 80% male.

• Outcomes:

  • 20% good

  • 31% fair

  • 48% poor

• Increasing numbers entering workforce and college.

Etiology

• Genetic

• Brain abnormalities: Early brain overgrowth.

• Fraudulent mercury study discredited.

Definition of personality disorders and their associative features.

What are the three types of personality disorders?

Definition: Enduring maladaptive inner experiences & behaviors (chronic and pervasive).

Associative Features

• Onset: adolescence to early adulthood

• Lifetime prevalence: 10%

• Shortened life expectancy (18–19 years lost)

Dramatic/Impulsive Disorders

Borderline Personality Disorder (BPD)

Narcissistic Personality Disorder

Antisocial Personality Disorder (APD)

• Symptoms

• Associative Features

• Etiology

Symptoms

• Exploitation of others

• Violation of social norms

• Lack of affection

• Charisma possible

Associative Features

• More common in men

Etiology

• Genetics

• Dysfunctional family environment

• Erratic or neglectful parenting

• Parents modeling exploitative behavior

Borderline Personality Disorder (BPD)

• Symptoms

• Associative Features

• Etiology

Symptoms

• Instability in relationships, emotions, self-image

• Fears of abandonment

• Black-and-white thinking

• Risk of self-injury/suicide

Associative Features

• More common in women

Etiology

• Early trauma

• Genetic and environmental factors

Narcissistic Personality Disorder

• Symptoms

• Etiology

Symptoms

• Grandiosity

• Need for admiration

• Entitlement

• Extremely fragile self-esteem

Etiology

• Genetic + environmental

What are the three types of eating disorders?

Anorexia Nervosa (AN)

Bulimia Nervosa

Binge-Eating Disorder (BED)

Anorexia Nervosa (AN)

• Diagnostic features

• Differentiation

• Associative Features

• Etiology

Diagnostic Criteria

• Restriction → significantly low weight

• Fear of gaining weight

• Distorted body image

• Types: restricting vs. binge/purge

Differentiation

• Extremely low weight (unlike bulimia)

Associative Features

• Denial of illness

• Comorbidity common

• Serious physical problems (amenorrhea, osteoporosis, cardiac risk)

• Sudden cardiac death possible

• Prevalence: 1%

• 90–95% female

• Onset: 15–19

• 10-fold ↑ in premature death

Etiology

• Genetic predisposition

• Personality: perfectionism, anxiety, neuroticism

• Cultural thin-ideal

• Family influences and modeling

• Early abuse

• Cognitive distortions (all-or-none thinking)

Bulimia Nervosa

• Diagnostic features

• Associative Features

• Etiology

Diagnostic Criteria

• Recurrent binge eating

• Compensatory behaviors (vomiting, laxatives, exercise)

Associative Features

• Vomiting only reduces calories <50%

• Normal weight common

• Medical risks: heart problems, dental decay, metabolic issues

• More insight into pathology than AN

• Prevalence: 1.5%

• 90–95% female

• Onset: 15–21

Etiology

• Similar to AN

• Less strong genetic component than AN

Binge-Eating Disorder

• Diagnostic features

• Associative Features

• Etiology

Diagnostic Criteria

• Binge eating + loss of control

• 3+ of: rapid eating, eating until uncomfortably full, eating when not hungry, eating alone, guilt/disgust afterward

Associative Features

• Often overweight

• Stress triggers

• 60% female

• Prevalence: 3.5%

Etiology

• Genetic

• Psychological stress

• Cognitive distortions

• Emotion regulation problems

How many of those who seek therapy actually have a diagnosable mental disorder? 

Not everyone who seeks therapy has a diagnosable disorder.

People seek therapy for:

• Range of issues, from serious to everyday issues

• Most common issues:  depression and anxiety

• Many who need therapy do not receive it; often long delay in seeking treatment, even if treatment is sought

Many clients do not meet full diagnostic criteria but still benefit from treatment.

What are the obstacles for people seeking treatment? 

Barriers to seeking therapy: stigma, lack of insurance/cost

Whites > Blacks, Hispanic

Females > Males

Greater education > less education

Not married, divorced/separated > married

Public health insurance > private insurance > no insurance

How much does the degree the counselor hold important when considering a therapist? 

The specific degree is less important than the quality of the therapeutic relationship.

What matters most: the relationship, rapport, trust, empathy.

What sorts of people are trained to practice counseling? 

Clinical Psychologists (PhD or PsyD)

Psychiatrists (MD; can prescribe medications)

Counseling Psychologists (PhD, PsyD, EdD)

Psychiatric social workers

Psychiatric nurses

Marriage and family therapists

Clergy (pastoral counseling)

What are three types of Insight Therapies?

Psychoanalysis

Psychodynamic Therapies

Client-Centered Therapy

Insight Therapy: Psychoanalysis (Freud)

• How might psychopathology develop?

• Defintion

• Treatment goal

• Tools

• Effectiveness

• How might psychopathology develop? Unconscious, unresolved conflicts; may not have successfully gone through psychosexual stages

• TX goal: Uncover and resolve conflicts, motives, defenses; achieve insight and catharsis

• Tools: Free association, dream analysis, analyzing resistance, analyzing transference

  • Free association - where the patient says whatever comes to mind without filtering.

  • Analyzing Resistance - when a patient avoids certain topics, feelings, or thoughts (changing the subject, forgetting appointments, joking, getting defensive).

  • Transference - when a patient projects feelings about significant people (parents, partners, etc.) onto the therapist.

Insight Therapies: Psychodynamic Therapies

• How might psychopathology develop?

• Defintion

• Treatment goal

• Tools

• Effectiveness

• Less intense/shorter than psychoanalysis; consider internal drives and forces

• Core features: Focus on emotional experience; exploration of resistance; identify recurring patterns; discuss past experience; analyze interpersonal relationships; focus on therapeutic relationship (e.g., transference); explore fantasy life

Insight Therapies: Client-Centered Therapy (Rogers)

• How might psychopathology develop?

• Defintion

• Treatment goal

• Tools

• Effectiveness

• How might psychopathology develop? Incongruence of self-concept vs. reality; caused by conditional love; people have innate drive to grow with support

• TX goal: Decrease incongruency = mismatch between how someone sees themselves (self-concept) and how they actually are in reality

• Tools: Create positive emotional climate—genuineness, unconditional positive regard, accurate empathy; mirroring

Definitions:

• Genuineness = therapist is honest and real, not fake

• Unconditional positive regard = accepting the client without judgment

• Accurate empathy = truly understanding the client's feelings from their perspective

• Mirroring = therapist repeats or paraphrases what client says for clarity

Effectiveness of Insight Therapies

• Hard to assess because of spontaneous remission, variation in techniques, and variation in severity; generally effective; roughly as effective as drug therapy without side effects; greatest effects in first 10–20 weeks; durable; about 1/3 spontaneous remission, 1/3 big improvement, 1/3 less effective; can combine with biomedical therapies

• How they work: Debated; may accomplish same outcome differently; strong support for common factors

• Formats: Individual, group, couples, family

• Common factors: Relationship with therapist; emotional support/empathy; hope/positive expectations; explanation + plausible solution; opportunity to express feelings, confront problems, gain insight

• Group therapy: Therapist screens members, sets goals, maintains process, prevents harm; 4–12 people (ideal 6–8); costs less; benefits include normalization and practical tips

  • Definition: Normalization = realizing others have similar struggles, reducing feelings of isolation

• Couples/family therapy: Some from individual therapy, some systems-based; goals: understand the system and facilitate communication

Behavior Therapies

• How might psychopathology develop?

• Defintion

• Treatment goal

• Tools

• Effectiveness

• How might psychopathology develop? Learned maladaptive behaviors

• Definition: Maladaptive behavior = behavior that makes life harder or worsens problems instead of helping

• TX goal: Unlearn or suppress maladaptive responses; replace with adaptive behaviors

• Tools: Systematic desensitization: anxiety hierarchy, relaxation, imagined exposure

• Definitions:

  • Anxiety hierarchy = list of feared situations ranked from least to most scary

  • Exposure therapy: real exposure; can combine with systematic desensitization; VR

  • Social skills training: modeling, behavioral rehearsal, shaping:

  • Modeling = learning by watching someone else

  • Behavioral rehearsal = practicing new behaviors

  • Shaping = gradually reinforcing closer and closer versions of the desired behavior

  • Aversion therapy: pair behavior with unpleasant consequence (e.g., disulfiram + alcohol → sickness)

• Effectiveness: Effective for many issues; some treatments fit certain problems better than others

Cognitive Therapies

• How might psychopathology develop?

• Defintion

• Treatment goal

• Tools

• Effectiveness

• How might psychopathology develop? Maladaptive thinking and unreasonable global assumptions

• Definitions:

  • Maladaptive thinking = distorted ways of thinking that worsen mood or behavior

  • Global assumptions = broad, overly general beliefs (e.g., “I fail at everything”)

• TX goal: Change maladaptive thinking

• Tools:

  • Beck’s cognitive therapy: identify maladaptive thoughts, challenge unreasonable negatives

  • Homework assignments

  • Behavioral activation: identify activities giving pleasure/accomplishment

    • Then the therapist creates a structured plan to increase these activities so mood improves.

  • Cognitive bias modification: A computer-based training program that helps people change automatic, unconscious thinking habits.

    It targets cognitive biases like:

    paying more attention to threats

    interpreting neutral things as negative

    expecting bad outcomes

Summary of the differences between therapies

What is CBT? Is it different from DBT?

Cognitive Behavioral Therapy (CBT)

• Combines behavioral + cognitive

• Connection to etiology: both learning + thinking patterns contribute to illness

• Strong evidence base

DBT = Dialectical Behavior Therapy

• A type of cognitive-behavioral therapy created for people who have intense emotions, self-harm behaviors, or difficulty with impulsivity and relationships.

• Type of CBT specialized for emotion dysregulation

• Especially helpful for extreme negative affect or self-destructive behaviors

• Focus: emotion regulation + distress tolerance

What’s the difference between “systematic  desensitization” vs. “flooding”?

Systematic desensitization vs. flooding

• Systematic desensitization: gradual exposure + relaxation

• Flooding (exposure therapy): rapid, intense exposure without slow buildup

• Desensitization = gentle → exposure = direct and intense

How might treatment from the cognitive perspective differ from treatment from the  behavioral perspective?

Cognitive vs. Behavioral treatment

• Cognitive: changes thoughts

• Behavioral: changes actions

• CBT: both

What are the different types of biological treatments for depression? 

General biological mechanism: They modify neurotransmitter levels (serotonin, norepinephrine, dopamine).

Examples:

• SSRIs: block serotonin reuptake → more serotonin in synapse

• MAO inhibitors: prevent breakdown of monoamines

• Tricyclics: block reuptake of serotonin + norepinephrine

• Lithium: stabilizes mood by affecting glutamate + neuronal signaling

• ECT: induces controlled seizure → major neurochemical reset

• Antianxiety drugs have been found to be very effective for treatment of depression as well 

Are biological treatments effective? 

• Effective for many: Most effective for the severely depressed 

• Can treat some cases where talk therapy does not seem to be effective

• Issues: short-lived, treating symptoms not the cause (leading to relapse when medication is stopped), overprescribed/overmedicated, severity of side effects may be underestimated

• Research difficulties: conflict of interest (e.g. drug companies doing the research on drug effectiveness), studies are not long-term enough, research is biased towards publishing positive results (vs. no effect).

How long do biological treatments take to work? 

Antidepressants: early effects around 2 weeks, full effects over several weeks

ECT: often produces improvement after a few sessions (days–weeks)

Anxiolytics: work within hours, but short-lived

Are there negative consequences to biological treatments?

Side effects (drowsiness, nausea, tremors, rigidity, cottonmouth)

• Increased suicidal thinking in adolescents and young adults (though they are at risk when untreated as well) – research results are mixed

Withdrawal

Abuse potential (esp. anxiolytics)

Tardive dyskinesia (traditional antipsychotics)

Increased suicide risk in adolescents (mixed evidence)

Overmedication, relapse after discontinuation

Ethical issues: drug-company bias

How do biological treatments compare to psychotherapies? How do they compare with CBT?

Medications: quicker symptom reduction, helpful for severe cases; side effects; relapse risk when stopped

CBT: durable results, no side effects, slightly slower onset

Combining both can reduce medication dosage and side effects

What are things like anxiolytics and antipsychotics? 

Antianxiety drugs (aka anxiolytics, sedatives, tranquilizers)

• Technical drug name vs. brand/trade name: Valium = diazepam; Xanax = alprazolam

• Effects are short-lived (hours)

• Side effects: drowsiness, lightheadedness, cottonmouth, depression, nausea, constipation

• Risks: abuse, drug dependence, overdose, synergistic effects

• Withdrawal effects can occur

Antipsychotic drugs (aka psychotropic drugs, neuroleptics)

• Traditionally DA antagonists

• About 70% of patients respond (in varying degrees)

• Take 2 days to 1 week to start working; improvement can continue for months

• Side effects: drowsiness, cottonmouth, tremors, rigidity, etc.

• Tardive dyskinesia in 15–25% of patients on traditional antipsychotics

• 2nd generation antipsychotic drugs (aka atypical antipsychotics)

  • Can have milder side effects but may increase risk of diabetes and cardiovascular disease

  • Lower risk of tardive dyskinesia

  • Partial agonists can help both positive and negative symptoms

    • Affinity = how strongly they bind to receptors

    • Efficacy = how much they activate the receptors

  • Relapse

  • Has been used to treat other conditions, including bipolar disorder.

Have you noticed that some drugs treat more than one type of psychopathology? Give a couple of examples to support this. 

Antidepressants can treat depression and anxiety

Antipsychotics can treat schizophrenia and bipolar disorder

Mood stabilizers treat bipolar disorder and help prevent depressive relapse

Bupropion treats depression and is used for smoking cessation

What’s the difference between traditional neuroleptics vs. atypical antipsychotics?

Traditional neuroleptics

• Strong dopamine antagonists

• Higher risk of tardive dyskinesia

• Less effective on negative symptoms

Atypical antipsychotics

• Partial dopamine agonists

• Lower risk of TD

• Can increase diabetes/cardiovascular risk

• Treat both positive and negative symptoms

What’s a partial agonist? 

Partial agonists can help both positive and negative symptoms.

• Affinity (how strongly they bind to receptors) vs. Efficacy (how much they activate the receptors)

Schizophrenia

• Low levels of dopamine activity in the frontal lobe

• High levels of dopamine activity in the nucleus accumbens area

• They use partial agonists which have low efficacy (don’t activate the receptor as much as dopamine itself) but have high affinity for dopamine receptors

• Will fill up the empty receptors in the frontal lobe (net increase level of the activity of dopamine)

• Nucleus accumbens area - will compete for dopamine for the receptors, but activate the receptors less than dopamine itself so there will be less overall activity in this area

Know some of the most common types of treatments per mental disorder. 

Anxiety: CBT, exposure therapy, SSRIs, anxiolytics

PTSD: exposure therapy, CBT

Depression: CBT, SSRIs, SNRIs, ECT (severe), behavioral activation

Schizophrenia: antipsychotics (traditional or atypical), social skills training

Bipolar disorder: lithium, valproate, psychotherapy adjunct

Why is ECT controversial? 

Involves inducing seizures

Cognitive side effects (short-term memory loss, or rarely long-term deficits)

Historically misused

Stigma

Yet it remains one of the most effective treatments for severe, treatment-resistant depression

Relapse is high but may be so because this is used for the most severely depressed who do not respond to medication

What does “small therapeutic index” mean and for which drug is this an issue for, in particular? 

Small therapeutic index = small difference between effective dose and toxic dose.

Very risky; requires monitoring.

Lithium is the primary example.

What’s one of the quickest ways to address depressive symptoms? 

Sleep deprivation therapy (fast but temporary)

ECT also works fast compared to medications

Anxiolytics help anxiety quickly but not depression

What are some of the challenges involved with trying to assess the effectiveness of psychopathological  treatment, whether talk therapy or biological forms of treatment? What is “spontaneous remission” and  explain why this is an issue when trying to assess effectiveness of both talk therapies and biological forms  of treatments?  

Challenges

• People get better on their own sometimes

• Research bias (drug-company funding)

• Different severities of disorders

• Hard to compare different therapy styles

• Placebo effects

• Publishing bias

Spontaneous remission

• Improvement without treatment

• Makes it hard to determine if therapy caused the improvement

• Affects both talk therapy and medication evaluation

Spontaneous remission refers to the natural resolution of symptoms without treatment. It can complicate assessments of treatment effectiveness, as improvement may occur without any intervention.

What are the pros and cons of using talk therapies? 

Pros

• No side effects

• Durable results

• Helps with insight & long-term coping skills

• Builds emotional understanding

• Strong alliance improves outcomes

Cons

• Slow onset

• Not effective for everyone (about 1/3 minimal benefit)

• Depends on therapist skill and client motivation

• May not be enough for severe disorders alone

What are the pros and cons of using biological treatments for psychopathologies?

Pros

• Faster symptom relief (esp. meds, ECT)

• Necessary for severe disorders

• Effective when other treatments fail

Cons

• Side effects

• Dependence (anxiolytics)

• Relapse after stopping

• Only treat symptoms, not root causes

• Research bias and underreported side effects

What is “fee for service” vs. “managed care?” What are the benefits and disadvantages of managed care? 

Fee for service

• Patient chooses provider

• Insurance reimburses

• More independence for clinician

Managed care

• HMOs define what’s “medically necessary”

• Lower cost

• But:

  • restricted provider choice

  • underdiagnosis

  • limited sessions

  • pressure to use cheaper, less trained providers

  • rarely approve long-term therapy

What was the deinstitutionalization movement? Was it a success? Why or why not?

Movement in the 1960s to shift mental health care away from large institutions toward community-based care

• Goals: prevention, local treatment, less hospitalization

Mixed success

Successes:

• Cheaper

• Increased freedom

• People closer to families

Failures:

• Inadequate community support

• “Revolving door” phenomenon

• More homelessness among mentally ill

• Many end up in prisons or shelters instead of hospitals

What diversity issues do we have when it comes to mental health treatment? 

Minorities underutilize therapy

Barriers: previous negative experiences, language, financial issues

Better outcomes when therapist and client match in ethnicity

Need for cultural competence + cultural humility

Broad definition of “culture” (includes sexual orientation, etc.)

When it comes to the homeless, what do we know about mental health issues?

1/3 have mental illness (schizophrenia, mood disorders)

1/3 have substance dependence

High comorbidity

Homeless shelters and prisons house more mentally ill people than psychiatric hospitals

High readmission rates:

• 1 in 7 rehospitalized within 30 days

• 40–50% within a year

A 25-year-old woman constantly worries about her work, finances, and relationships. She finds it hard to relax, feels fatigued, and cannot sleep well. Her worry is not tied to one specific event. Which disorder is most likely? What treatment approaches might help?

Generalized Anxiety Disorder (GAD); CBT to challenge maladaptive thoughts, relaxation techniques, SSRIs if symptoms are severe.

A 30-year-old man has sudden episodes of heart palpitations, sweating, and fear of dying. Afterward, he avoids leaving his apartment. Which disorders could explain his symptoms, and what is a likely course of treatment?

Panic Disorder with possible Agoraphobia. Treatment: exposure therapy, CBT, SSRIs; gradual exposure to feared places for agoraphobia.

A teen refuses to eat most foods, has an intense fear of gaining weight, and exercises excessively. She believes she looks overweight despite being underweight. What disorder does she likely have, and what factors might have contributed?

Anorexia Nervosa. Contributing factors: genetic predisposition, perfectionism, cultural thin-ideal, early trauma, family modeling.

A 40-year-old man believes his coworkers are plotting against him, hears voices commenting on his actions, and has flat affect. Which disorder is most likely? Which biological treatment could help?

Schizophrenia. Treatment: antipsychotics (traditional or atypical), social skills training.

A 35-year-old woman experiences flashbacks, nightmares, hypervigilance, and avoids situations reminding her of a car accident she survived. What disorder does she have, and which therapy is evidence-based for this condition?

PTSD. Treatment: trauma-focused CBT, exposure therapy, possibly SSRIs for anxiety/depression.

A client reports persistent sadness, lack of energy, trouble concentrating, changes in sleep and appetite, and thoughts of death for 3 months. What is the diagnosis, and what are two treatment options?

Major Depressive Disorder. Treatment: CBT, SSRIs/SNRIs, behavioral activation, ECT (if severe).

A patient exhibits two distinct personalities, each with its own memories, and experiences amnesia between them. How should a clinician approach treatment, and what controversy surrounds this disorder?

Dissociative Identity Disorder; therapy may involve integrating personalities, managing trauma; controversy: overdiagnosis, iatrogenic effects, unclear etiology.

A client has intrusive thoughts about contamination and repeatedly washes her hands for hours daily. What behavioral therapy technique is best suited for this problem, and why?

Exposure + Response Prevention (ERP). Rationale: Gradual exposure to feared stimuli while preventing compulsive behavior reduces anxiety over time.

A man with Bipolar I Disorder experiences elevated mood, grandiosity, and risky behaviors lasting over a week. He previously had depressive episodes. What treatment plan is recommended?

Mood stabilizer (lithium, valproate) plus psychotherapy; monitor for rapid cycling and adherence; may use antipsychotics if severe mania.

A patient undergoing psychotherapy reports feeling understood, supported, and hopeful. He also completes homework assignments and practices new skills. Which type of therapy is likely being used, and what key factor contributes to its effectiveness?

CBT; key factor: therapeutic alliance and structured skill-building exercises.

During a therapy session, a client repeatedly describes traumatic events but avoids confronting reminders in daily life. What therapy could help, and what is the mechanism?

Exposure therapy (including imaginal or in vivo); mechanism: habituation to feared stimuli reduces avoidance and anxiety.

A patient experiences sudden severe depression and suicidal ideation resistant to medications. The psychiatrist recommends ECT. What are the benefits and risks of this treatment?

Benefits: rapid symptom relief, effective for treatment-resistant depression. Risks: short-term memory loss, possible cognitive side effects, stigma, relapse if untreated afterward.

A 17-year-old girl binge eats large quantities of food but does not purge. She feels guilty and eats secretly. What disorder does she likely have, and what treatment approach is appropriate?

Binge-Eating Disorder; treatment: CBT focused on emotion regulation and healthy eating patterns, possibly pharmacotherapy.

A client complains of maladaptive beliefs: “I fail at everything” and “Nobody will ever like me.” She also avoids social situations. What therapy would target these cognitions, and what is the principle behind it?

Cognitive therapy (CBT); principle: identify and challenge distorted thoughts, replace with more adaptive thinking.

A homeless man is repeatedly hospitalized for mental illness but quickly discharged due to lack of community support. Which movement aimed to reduce institutionalization contributed to this scenario, and what is the term for this pattern?

Deinstitutionalization; “revolving door” phenomenon.

A patient has severe schizophrenia with both positive (hallucinations) and negative (flat affect) symptoms. Which type of antipsychotic is preferable, and why?

Atypical antipsychotic; treats both positive and negative symptoms, lower risk of tardive dyskinesia.

During assessment, a clinician notes cultural differences in expressing distress, overlapping symptoms, and reliance on patient self-report. What challenge in psychopathology diagnosis does this exemplify?

Subjectivity in diagnosis; leads to variability and lower inter-rater reliability.

A client improves after therapy, but you notice improvement may have occurred naturally over time. What term describes this, and how does it complicate treatment research?

Spontaneous remission; complicates research because improvement may not be due to therapy.

A patient takes lithium for bipolar disorder. What does “small therapeutic index” mean for this drug, and what precautions are necessary?

The effective dose is close to the toxic dose; requires monitoring blood levels to avoid toxicity.

A patient is prescribed an anxiolytic for acute anxiety. What are the benefits, risks, and potential short-term limitations of this medication?

Benefits: rapid symptom relief. Risks: dependence, side effects (drowsiness, nausea), short-lived effect; not effective for long-term treatment alone.