Text book notes
Chapter 5 - OCD
As defined by the DSM-V, what are obsessions? What are compulsions?
Obsessions can be defined as individuals who experience intrusive thoughts, ideas, images, impulses, and/or doubts. This can evoke a sensation of senselessness and anxiety within the individual.
They must be persistent or recurring
The individual must try to ignore, suppress, or neutralize
Compulsions can be defined as individuals who have the urge to preform easily observable (checking & washing) or mental (praying) rituals as a response to the obsessive thoughts. This urge of action decreases the individuals anxiety and/or distress.
Repetitive behaviors or mental acts
With intent of decreasing an individuals anxiety or distress, or to prevent an event that the individual feels driven to do.
May not have a reasonable relation to the obsession or are extremely excessive actions.
What are the general themes around which researchers have classified obsessions in Obsessive-Compulsive Disorder (OCD)?
Obsessions can be classified into general categories
Contamination: germs and illnesses
Guilt and responsibility for harm or mistakes: what if I called someone a slur without meaning to?
Uncertainty: Did I lock the door, car, etc
Taboo thoughts about sex, Violence, Blasphemy: Images of grandparents having sex, Stabbing someone
Need for order and symmetry: nothing can be out of place, odd numbers only,
In what ways are obsessions differ from other types of repetitive thoughts?
Obsessions differ because they are uncontrollable thoughts that intrude on an individuals daily life which are most likely triggered by something in the environment.
What are the typical categories used to classify compulsions?
Some categories that classify compulsions are:
Decontamination: washing/cleaning
Checking: including asking others for reassurance
Repeating routine activities: going back and fourth through a hallway
Ordering and arranging: everything has a place it must be in
Mental rituals: knock on wood 10 times every time you see it, no stepping on cracks
What are the four separate subtypes of OCD identified by research?
Contamination & cleaning
Intense fear of germs, dirt, or illness
Excessive cleaning, handwashing, or avoidance of contaminated areas
Resposibility for harm and mistakes
Harm and checking
Intense fear of causing harm to other or oneself
Incompleteness
Symmetry & Ordering
Things need to just right
Unacceptable taboo violent, sexual, or blasphenous thoughts with mental rituals
Intrusive thoughts about taboo subjects which leads to the mental compulsion of excessive behavior to stop those thoughts.
What is symptom accommodation, why might it occur, and in what ways does it contribute to the maintenance of OCD symptoms?
Symptom accommodation is when a friend or family member go along with the individuals excessive and compulsive behavior because it lessens the anxiety felt in that moment.
It might occur when the individual who suffers from OCD request or demands a friend or family member them deal with these behaviors and situations. In some cases the friend or family member volunteer to help and accommodate their behavior.
It contributes to the maintenance of OCD because it interferes with the individuals learning to mange the anxiety which can also act as a form of conditioning the behavior. Over time it may become worse considering this is a short term fix.
Why is hoarding no longer considered a form of OCD, but rather a related disorder?
Hoarding is no longer considered a subtype of OCD because many individuals with hoarding do Not meet the diagnostic criteria for OCD. Thoughts about hoarding stuff are often not considered extremely intrusive or unwanted; they tend to be positive and emotional thoughts.
Excessive saving has not been categorized as a compulsive or ritualistic behavior because it does not lessen or provide escape of an obsessional anxiety.
What is the difference between ego-syntonic and ego-dystonic symptoms?
Ego-syntonic is when an individual believe their behavior and urges are appropriate and completely justified.
Ego-dystonic is when an individual has unwanted, upsetting, or personally repugnant obsessive thoughts.
The difference is ego-syntonic feels natural and justified while ego-dystonic feel unwanted and anxious
How does two-factor theory purport to account for OCD symptoms?
The operant conditioning plays a role in the maintenance of OCD symptoms. The compulsive behaviors act as a form of conditioning which leads to an individual believing that every time the situations happens in order of the anxiety to decrease they must complete those compulsive behaviors. Creating the cycle that furthers the individual into a negative reinforcement.
In general, what do cognitive deficit models of OCD propose as the root of the disorder and from what problems do these models collectively suffer?
Cognitive defect Models of OCD claims that the roots of the “disorder” are memory, reality monitoring, and inhibitory deficits.
These models collectively suffer from lack of research support
Research suggests that much of the content underlying obsessions in OCD are normal (i.e., occur in the thoughts of non-OCD individuals). What does the cognitive-behavioral model suggest is the reason that these thoughts pose such a problem for those with OCD?
Cognitive-behavioral model suggest that everyone has such unwanted thoughts but it depends on how the individual interprets these thought, mainly those with OCD will consider them as extremely significant and harmful, which is why they pose a problem for individuals with OCD.
“Normal” people do not over think these thoughts, however people with OCD develop maladaptive beliefs about their thoughts and use compulsions to cop which reinforces the anxiety caused by unwanted thoughts to be reinforced.
In what two ways are compulsive rituals reinforcing in OCD?
Compulsive rituals reinforce OCD through these two ways:
Negative reinforcement from the way they mange stress/anxiety. (Short term solution)
Prevents individuals from learning that those anxieties aren’t as dangerous as they are made out to be in their mind. (Perceived safety)
Extra Notes:
Typically begins by the age of 25
Symptoms often interfere in individuals lives such as school/work, interpersonal relationships, and daily activities of living.
OCD is among the most complex psychopathology of the psychological “disorders”
Individuals can experience a variety of different symptoms that vary others which can make it difficult to diagnose them.
Diagnosis qualifications:
Must have either obsessions, compulsions, or both
Obsessions: Unwanted thoughts, doubts, ideas, images that are recurring within the individual
Compulsions: repetitive behaviors to reduce anxiety induced thoughts
Time-consuming (more then an hour a day.
No relation to other medical conditions or medication
Can not be explained by any other psychological “disorder”
OCD is the obsession and/or compulsion that causes significant distress for the individual and causes noticeable interference among a variety of aspects within their daily living.
Overt: done or shown openly; not a secret
Covert: not openly acknowledged or displayed
Obsessive-Compulsive Related Disorder (OCRD)
Body dysmorphic disorder
Is limited to one’s apperance
Hair pulling disorder (Trichotillomania)
Skin picking disorder
Hoarding disorder
Chapter 7 - Depressive Disorders
How do depressive disorders rank in terms of overall global disease burden?
1st among disorders responsible for global disease burden with all concomitant economic costs to society
1st among disabilities of 15-44 years old U.S. citizens
Very strongly correlated to suicide attempts and completions
According to Figure 7.1, a person must endorse at least one of which two depressive symptoms in order to qualify for a diagnosis of major depression? What are the remaining symptoms of major depression (MDD) and how many does a patient need to exhibit (and for how long) in order to receive a diagnosis of major depression?
The DSM-V has 8 symptoms for MDD. A person must meet at least 5 of these symptoms to have a diagnosis.
Of those 5 symptoms a person must have on or both
Dysphoric mood (sad, empty, or tearful)
Anhedonia (loss of interest or pleasure in almost all activities)
A person must also experience at least 4 additional symptoms ( 3 additional if the individual has both Dysphoric mood & Anhedonia)
Significant weight gain/loss or change in appetite
Insomnia or hypersomnie
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Decreased concentration or indecisiveness
Recurrent thoughts of death or suicidal ideation, plan, or attempt
Symptoms must be most or nearly everyday for 2 weeks
Significant distress or decrease in functioning
What do the following specifiers mean: Chronic MDD, Atypical MDD, & Peripartum MDD?
Chronic MDD: occurs continuously without remission for at least 2 years.
Atypical MDD: about 15% of depressed patients and is marked by mood reactivity, hypersomnia, extended fatigue, weighted sensitivity to criticism, and a significant increase in appetite and weight gain
Peripartum MDD (postpartum depression): MDD episode occurs during the pregnancy or within 4 weeks of giving birth. 3%-6% of women have a depressive episode either during their pregnancy or the month following the birth.
What is required for a formal diagnosis of Persistent Depressive Disorder?
The DSM-V identified 6 symptoms.
Two of the six must be met as well having a depressive mood for most of the day ir more days then not over the passed 2 years
Poor appetite/overeating
Insomnia / hypersomnia
Low energy/fatigue
Low self-esteem
Poor concentration/difficulty making decisions (indecisiveness)
Feelings of hopelessness
2 of these symptoms must be continuously present during the 2 years
The patient must report the symptoms have been consistent for 2 months without them faltering during the 2 years.
An individual must report having an experience of distress or impairment in a social, occupational, or daily areas of functioning.
What are the four specifiers that indicate the course of chronic depression and how are they characterized?
Pure dysthymic syndrome
The complete criteria has not been met in the past 2 years for MDD
Persistent depressive episode
The complete criteria has been met at some point in the past 2 years for major depressive episode
Intermittent major depressive episode with current episode
Individuals who have episode depression but it isn’t long-lasting or constant.
Intermittent major depressive episode without current episode
The complete criteria is met at some point during the past 2 years for non chronic major depressive episode.
What factors differentiate chronic depression from major depression in terms of comorbidity, personality and cognitive characteristics, and early learning/attachment history?
Comorbidity (Other Mental Health Issues)
Chronic Depression: More likely to occur with anxiety disorders, personality disorders (especially avoidant and borderline traits), and substance use disorders.
Major Depression: Often occurs with anxiety disorders but is less commonly tied to personality disorders compared to chronic depression.
Personality & Cognitive Characteristics
Chronic Depression: People tend to have negative self-views, low self-esteem, and a pessimistic thinking style that is deeply ingrained. They often struggle with chronic guilt and excessive self-criticism.
Major Depression: People may have similar negative thoughts but typically experience a sharper decline in mood and cognition during an episode rather than as a constant state.This leads to significant functional impairment in daily life, including difficulties in maintaining relationships and fulfilling work responsibilities
Early Learning & Attachment History
Chronic Depression: More often linked to childhood neglect, emotional abuse, or insecure attachments with caregivers. These early experiences shape a long-term pattern of feeling unworthy or unloved.
Major Depression: Can also be influenced by early adversity, but it is often triggered by recent stressful life events rather than long-standing attachment issues.
In simple terms, chronic depression is like a long-lasting, low-level sadness that feels like part of a person’s personality, while major depression is more like a deep, intense sadness that comes and goes in episodes. Chronic depression tends to be more tied to long-term personality traits, negative self-perceptions, and childhood experiences, whereas major depression is often more situational and episodic.
Evidence for Increasing Rates of Major Depressive Disorder (MDD) in Recent Cohorts
Studies show that younger generations (especially those born after the mid-20th century) have higher rates of MDD than older generations. Reasons may include:
Increased stressors (economic pressures, social media, loneliness)
Reduced social support (weaker community ties, family changes)
Greater awareness & diagnosis (mental health is more recognized now)
Skinner’s (1953) View on Depression
B.F. Skinner, a behaviorist, believed depression happens when reinforcement (rewards from the environment) decreases. If people stop experiencing positive reinforcement, they become less active and more withdrawn.
Ferster’s (1965) Expansion on Skinner’s Idea
Ferster added three key points:
Loss of important reinforcers – Losing a job, relationship, or meaningful activity can reduce rewards and lead to depression.
Avoidance behaviors – People may withdraw from situations that could bring rewards, worsening depression.
Disruptions in behavior patterns – When life changes, old habits may no longer be reinforced, leading to inactivity and low mood.
Ferster’s (1973) Additional Idea
He suggested people may engage in self-punishing behaviors (negative self-talk, guilt, or self-blame), making depression worse.
Lewinsohn’s Expansion on Skinner & Ferster
Lewinsohn and colleagues added:
Low rates of positive reinforcement lead to depression – When good experiences are rare, people become more withdrawn.
Depressed people’s behaviors reduce social rewards – Low energy, negativity, and withdrawal can push others away, decreasing social support.
Inactivity and avoidance maintain depression – Instead of problem-solving, depressed individuals avoid challenges, making their situation worse.
The "Vicious Web" of Anhedonia, Amotivation, and Avoidance
Anhedonia (not enjoying things) → Amotivation (not feeling motivated) → Avoidance (avoiding activities)
Avoidance leads to fewer opportunities for positive experiences, which worsens depression.
Function of Avoidance in Depression & Its Negative Consequences
Function: It helps avoid short-term discomfort (e.g., social anxiety, stress).
Negative Consequences:
Missed positive experiences – Avoiding life means missing out on rewards.
Reinforcement of negative beliefs – If you avoid challenges, you never prove to yourself that you can succeed.
Beck’s Concept of Automatic Thoughts & Cognitive Distortions
Automatic thoughts – Negative, involuntary thoughts (e.g., “I’m a failure”) that fuel depression.
Cognitive distortion – Thinking errors, like catastrophizing (“This is the worst thing ever”) or overgeneralizing (“I always fail”). These distortions make depression worse.
Sacco & Beck (1995) – Depressogenic Schemas & the Diathesis-Stress Model
Schemas: Deeply held beliefs (e.g., “I am unlovable”) that shape how we interpret life.
Diathesis-Stress Model: Some people inherit or develop schemas that make them vulnerable to depression, which gets triggered by stress.
Benefit of schemas: They help organize experiences, but negative schemas cause biased, depressive thinking.
Learned Helplessness Model – Three Belief Dimensions in Depression
When bad things happen, depressed people tend to believe:
Internal: “It’s my fault” (vs. external, “It was bad luck”).
Stable: “Things will never change” (vs. unstable, “This is temporary”).
Global: “Everything in my life is bad” (vs. specific, “This one thing went wrong”).
Hopelessness Depression & Hopelessness Theory
Hopelessness depression happens when someone believes nothing they do will change their negative situation.
Hopelessness theory suggests depression is most likely when people feel:
They have no control over bad events.
Their future will always be negative.
Three Key Clinical Points About Depression & Cognitive Processing
Depressed people focus on negative information and ignore positive experiences.
Depression affects memory – People recall negative events more than positive ones.
Depressed thinking patterns reinforce sadness – Negative interpretations keep depression going.
Ruminative vs. Automatic Thoughts
Ruminative thoughts: Repetitive, long-term overthinking (e.g., “Why am I always like this?”).
Automatic thoughts: Quick, reflex-like negative thoughts (e.g., “I’m a failure”).
Difference: Rumination is long-term and deliberate, while automatic thoughts are fast and subconscious.
Chapter 11 - Alcohol use
Moderators vs. Mediators
Moderators affect the strength or direction of a relationship between two variables.
Example: The relationship between alcohol consumption and intoxication is moderated by body weight—people with higher body weight generally experience weaker effects from alcohol than those with lower body weight.
Mediators explain why two variables are related.
Example: Men are more likely to develop Alcohol Use Disorder (AUD), but impulsivity helps explain why. Men tend to be more impulsive, and impulsivity increases the likelihood of problematic drinking.
DSM-IV vs. DSM-V Changes in Alcohol Use Disorder (AUD)
Two major changes:
Merged alcohol abuse and alcohol dependence into one diagnosis (AUD).
Previously, someone could be diagnosed with "alcohol abuse" without being dependent. The new system considers AUD as a spectrum ranging from mild (2–3 symptoms), moderate (4–5 symptoms), to severe (6+ symptoms).
Added "craving" as a symptom.
Craving (a strong urge to drink) was recognized as a critical part of addiction and withdrawal, supported by brain imaging and psychological research.
Why was craving added?
Studies showed that craving predicts relapse, making it essential for diagnosing and treating AUD.
Early vs. Sustained Remission in DSM-V
Early remission: No symptoms (except cravings) for at least 3 months but less than 12 months.
Sustained remission: No symptoms (except cravings) for 12 months or longer.
Why differentiate?
The longer someone remains sober, the lower the likelihood of relapse.
Dividing remission into early vs. sustained helps track progress and identify who may still be at risk.
Gender Differences in Alcohol Use Disorder
Men have historically had higher rates of AUD than women.
However, the gap is closing due to changing social norms and increased alcohol consumption among women.
Biological differences (e.g., women metabolize alcohol differently and may experience health risks at lower levels of consumption) also play a role.
Immigrant Paradox
What is it?
Immigrants to the U.S. tend to have lower rates of alcohol use and AUD than U.S.-born individuals, despite facing stressors like cultural adaptation and economic challenges.
Why is this surprising?
Stress is often linked to higher alcohol use, so it would be expected that immigrants, who face many stressors, would have higher rates of AUD.
Possible explanations:
Strong cultural or religious norms discouraging drinking.
Stronger family and community support among immigrant groups.
Over time, as immigrants become more assimilated into U.S. culture, their drinking rates often increase, making this a time-sensitive phenomenon.
Alcohol Use on U.S. College Campuses
Prevalence:
College students have higher rates of binge drinking than their non-college peers.
Binge drinking (4+ drinks for women, 5+ for men in a short period) is common in social settings like parties and tailgates.
Why is early alcohol use concerning?
Increases risk of AUD later in life—the earlier someone starts drinking, the greater the likelihood they will develop alcohol-related problems.
Impairs brain development—the brain is still developing until around age 25, and alcohol use can negatively affect cognitive functions like memory and decision-making.
Leads to risky behaviors—early alcohol use is linked to higher chances of unsafe sex, accidents, and academic struggles.
Theories of Alcohol Use Disorder
Expectancy Theory:
People drink because they expect positive effects, such as increased confidence, relaxation, or social success.
Expectations are shaped by personal experiences, cultural influences, and media portrayals.
Tension-Reduction Theory:
Alcohol is used as a way to cope with stress, anxiety, or negative emotions.
People who frequently drink to "self-medicate" may be at a higher risk of developing AUD.
Personality Theory:
Certain personality traits make people more vulnerable to AUD.
The most relevant trait is impulsivity, which is linked to poor self-control, sensation-seeking, and risk-taking behaviors.
Social Learning Theory:
People learn drinking behaviors from their environment, including family, friends, and media.
Example: If someone grows up seeing their parents use alcohol to relax, they may develop the same habit.
Greeley & Oei (1999) on Tension-Reduction Theory
Found mixed evidence for the idea that people drink to relieve stress.
While alcohol can temporarily reduce tension, not everyone who experiences stress drinks excessively.
Other factors (like personality and learned behaviors) also play a role in AUD.
Key Personality Factor for AUD
High neuroticism (emotional instability) is the broad personality trait most linked to AUD.
Impulsivity, a key aspect of neuroticism, is the strongest predictor of alcohol problems because it leads to risk-taking, poor decision-making, and difficulty controlling urges.
Marlatt & Gordon’s (1985) Relapse Model
Relapse happens in stages, not all at once.
A person in recovery faces a high-risk situation (e.g., stress, peer pressure, negative emotions).
If they lack coping skills, they may have a "lapse" (one-time use).
If they feel guilt, shame, or hopelessness, they are more likely to fall into a full relapse.
Key idea: Teaching people coping strategies and ways to handle high-risk situations can help prevent relapse.
study guide
1. Serotonin Hypothesis of OCD & Psychodynamic Models
Serotonin Hypothesis: This idea suggests that OCD happens because of problems with serotonin, a brain chemical that affects mood and behavior. Medications that increase serotonin (like SSRIs) often help with OCD symptoms, which supports this theory.
Psychodynamic Models: These theories (from Freud's ideas) say that OCD comes from unconscious conflicts or unresolved issues from childhood. For example, a person might have strong guilt or anxiety that they try to control by performing compulsive behaviors (like excessive handwashing).
2. Low Rates of Response Contingent Reinforcement & Depression (Lewinsohn)
What does it mean? "Response contingent reinforcement" just means getting a reward for doing something. If you work hard and get praised, that’s reinforcement!
How does this relate to depression? Lewinsohn says depression happens when people don’t get enough rewards for their actions. If someone stops getting positive feedback from work, friends, or hobbies, they may lose motivation and feel down.
3. Depressed Behavior & Social Environment (Coyne)
Depressed behaviors: People with depression may withdraw from social activities, have low energy, and focus on negative things.
Social response (Coyne’s idea): Depression can make people seek reassurance from others. At first, friends and family try to help, but over time, they may feel exhausted and pull away. This makes the depressed person feel even worse, creating a cycle.
4. Role of Avoidance in Depression
Avoidance behavior: Depressed people may avoid difficult tasks, social situations, or responsibilities because they feel overwhelmed.
Why is this bad? Avoiding things might give short-term relief, but it makes problems worse in the long run. The more someone avoids, the more helpless they feel, deepening the depression.
5. Cognitive Schemas & Attributional Styles in Depression
Cognitive schemas: These are negative thinking patterns that shape how a depressed person views the world (e.g., "I’m worthless" or "Nothing good ever happens to me").
Attributional styles: Depressed people often blame themselves for bad things and see them as permanent (e.g., "I failed this test because I’m stupid and I’ll always be a failure").
6. Cognitive Distortions in Depression
These are common thinking mistakes in depression:
Black-and-white thinking: Seeing things as all good or all bad. ("If I’m not perfect, I’m a total failure.")
Overgeneralization: Believing one bad event means everything will be bad. ("I messed up this project, so I’ll fail at everything.")
Catastrophizing: Expecting the worst outcome. ("If I don’t do well on this test, my whole life is ruined.")
7. Genetic Risk for Addictive Behavior
What’s inherited? People don’t inherit addiction itself, but they may inherit traits that make them more likely to develop addiction, such as:
Impulsivity (acting without thinking)
High need for stimulation
Difficulty handling stress
8. Temporal Discounting & Addiction
Temporal discounting means valuing immediate rewards more than future rewards.
How it relates to addiction: Someone with addiction might focus on the short-term pleasure of using a drug and ignore the long-term negative effects (like health problems or losing a job).
9. Conditioning in Substance Use Disorders
Classical Conditioning: This is when the brain connects drug use with certain people, places, or emotions. Example: If someone always drinks at a bar, just being in the bar might make them crave alcohol.
Operant Conditioning: This happens when behavior is reinforced. Example: A drug makes someone feel good (positive reinforcement), or it takes away stress (negative reinforcement), making them want to use it again.
10. A vs. B Process in Addiction
A-process (initial high): The drug creates a strong positive effect (euphoria, relaxation).
B-process (body’s reaction): Over time, the body pushes back to maintain balance, leading to tolerance (needing more of the drug to feel the same effect) and withdrawal (feeling bad when not using the drug).
Cravings happen because the B-process lingers after the A-process fades, making the person want the drug again.
11. Theories of Alcohol Use Disorder
Disease Model: Addiction is a brain disease, and some people are biologically more prone to it.
Behavioral Model: Drinking is learned behavior—people drink because it relieves stress or is socially rewarding.
Cognitive Model: Thoughts and beliefs (e.g., "Alcohol helps me relax") drive drinking behavior.
Biopsychosocial Model: This combines biological, psychological, and social factors—some people may have a genetic risk, stress, and a drinking-friendly environment that all contribute to alcohol use disorder.