Abnormal Psychology – Phase 1 Comprehensive Study Notes

Core Definitions and Foundational Concepts

  • Psychological Disorder – A pattern of psychological dysfunction within an individual that is associated with distress or impairment and is not typically or culturally expected.
    • Psychological Dysfunction – Breakdown in cognitive, emotional, or behavioral functioning.
    • Distress / Impairment – Extreme upset and inability to function adequately in social, occupational, or other areas.
    • Atypical / Not Culturally Expected – Behavior deviates from cultural norms or statistical averages.
  • Psychopathology – Scientific study of psychological disorders.
  • Scientist–Practitioner Model
    • Clinicians integrate the latest research, evaluate their own practices, and conduct new research to improve treatment efficacy and avoid clinical “fads.”
  • Key Clinical Terms
    • Presenting Problem – Initial symptom or set of symptoms that bring a client to therapy.
    • Clinical Description – Unique constellation of behaviors, thoughts, and feelings that define a disorder and differentiate it from normal functioning.
    • Prevalence – “How many people have ever had this disorder?”
    • Incidence – “How many new cases emerge in a given period?”
    • Course – Typical pattern a disorder follows (chronic, episodic, time-limited).
    • Onset – Acute (sudden) vs. Insidious (gradual).
    • Prognosis – Anticipated course or outcome.
    • Etiology – Study of origins or causes of a disorder.
    • Ego-Syntonic – Behavior aligns with self-image; Ego-Dystonic – Behavior clashes with self-image.

Professional Roles in Mental Health

  • Clinical / Counseling Psychologists – Ph.D. (≈ 5-year graduate training) combining research & clinical work.
  • Psy.D. – Emphasizes clinical training; minimal research.
  • Psychiatrists – M.D. + psychiatric residency; can prescribe medication.
  • Psychiatric Social Workers – Master’s in social work; focus on social & family context.

Historical Perspectives on Abnormal Behavior

Supernatural Tradition

  • Middle Ages: Disorders viewed as demonic possession or witchcraft.
    • Treatments: exorcism, confinement, torture (e.g., hanging over snake pits), shaving crosses into hair, chaining sufferers near churches.
  • Mass Hysteria – Collective outbreaks of bizarre behavior (e.g., Saint Vitus’s Dance, Tarantism) demonstrate social influence on symptom expression.
  • Paracelsus – Proposed that movements of the moon and stars (lunacy) affect psychological functioning.
  • Nicholas Oresme – Early biological interpretation of melancholy.

Biological Tradition

  • Hippocrates – “Father of Modern Medicine.”
    • Proposed that psychological disorders are brain diseases influenced by heredity & trauma.
    • Coined Hysteria (now Somatic Symptom Disorders); attributed to “wandering uterus.”
  • Galen’s Humoral Theory
    • Imbalance among four bodily fluids causes temperament:
    • Blood (heart) – Sanguine, cheerful.
    • Black bile (liver) – Melancholic, depressed.
    • Yellow bile (spleen) – Choleric, irritable.
    • Phlegm (brain) – Phlegmatic, calm.
    • Treatments: bloodletting, induced vomiting (e.g., Robert Burton’s tobacco & half-boiled cabbage).
  • Ancient China: Blocked “wind/qi” (yin vs. yang) treated with acupuncture.
  • Syphilis & General Paresis – Demonstrated biological basis of psychosis; cured by penicillin, cementing medical model.
  • John P. Grey – Championed physical causes; improved hospital conditions (ventilation fans).
  • Early 1900s biological interventions: insulin-shock therapy (Sakel), electroconvulsive therapy (Franklin, Meduna), psychosurgery (lobotomy).
  • Emil Kraepelin – Systematic classification; coined Dementia Praecox (schizophrenia).

Psychological Tradition

Moral Therapy (late 18^{\text{th}}–19^{\text{th}} C.)

  • Emphasized humane, normalized environments.
    • Leaders: Pinel & Pussin (France), William Tuke (England), Benjamin Rush & Dorothea Dix (U.S.).

Psychoanalytic Theory

  • Freud & Breuer – Discovered the unconscious; used hypnosis & catharsis.
  • Structural Model: Id (pleasure), Ego (reality), Superego (morality).
  • Defense mechanisms protect ego (repression, projection, etc.).
  • Psychosexual stages: Oral, Anal, Phallic (Oedipus/Electra, castration anxiety, penis envy), Latency, Genital; fixation leads to adult pathology.
  • Extensions: Anna Freud (ego psychology), Heinz Kohut (self-psychology), Object-Relations (internalized images of caregivers), Carl Jung (collective unconscious), Alfred Adler (inferiority complex).
  • Therapeutic tools: free association, dream analysis, transference/counter-transference.

Humanistic Theory

  • Self-Actualization (Rogers, Maslow) – Drive to reach full potential.
    • Hierarchy of Needs (Maslow) – From physiological needs to self-actualization.
    • Person-Centered Therapy (Rogers): unconditional positive regard & empathy.
  • Thomas Szasz – Critique: mental illness is a social construction used for control.

Behavioral Tradition

  • Classical Conditioning (Pavlov; applied by Watson — Little Albert).
    • Key terms: unconditioned/conditioned stimulus & response, extinction, stimulus generalization.
  • Operant Conditioning (Thorndike’s Law of Effect; B. F. Skinner).
    • Behavior shaped by reinforcement & punishment; shaping reinforces successive approximations.
  • Systematic Desensitization (Joseph Wolpe) – Gradual exposure + relaxation to extinguish phobias.
  • General Adaptation Syndrome (Hans Selye) – Physiological stress model: Alarm → Resistance → Exhaustion.

Genetic Models & Gene–Environment Interaction

  • Genes – DNA segments on 46 chromosomes ( 23 pairs: 22 autosomes + 1 sex-chromosome pair).
    • Dominant vs. recessive inheritance.
  • Diathesis–Stress Model – Inherited vulnerability (diathesis) + environmental stress ⇒ disorder. Greater diathesis ⇒ less stress needed.
  • Gene–Environment Correlation Model – Genetic predisposition influences likelihood of encountering stressors (active, evocative, passive correlations).
  • Epigenetics – Environmental factors (e.g., trauma, learning) turn genes on/off without altering DNA sequence (Erik Kandel).
  • Adverse life events can override genetic influence, underscoring plasticity.

Neuroscience Foundations

Neuron Anatomy & Communication

  • Neurons – Dendrites receive signals, axon sends; synaptic cleft separates neurons; information travels via action potentials to terminal buttons where neurotransmitters are released.
  • Glial Cells – Support cells; modulate neurotransmission.

Neurotransmitters

  • Glutamate – Primary excitatory; high levels linked to neurodegeneration (Parkinson’s, Alzheimer’s, Huntington’s); low → learning deficits.
  • GABA (Gamma-Aminobutyric Acid) – Primary inhibitory; benzodiazepines ↑ GABA efficacy; low levels associated with anxiety, mood disorders, ASD.
  • Serotonin – Regulates mood, behavior, thoughts; low → impulsivity, aggression, suicide risk; treated with SSRIs; high interacts with GABA to dampen glutamate.
  • Norepinephrine – Alpha & beta adrenergic receptors; low → depression, ADHD; high → hypertension, arrhythmia.
  • Dopamine – Reward & movement; excess → schizophrenia-like symptoms & impulsivity; deficit → low motivation.
  • Endorphins – Endogenous opiates; analgesic & mood-elevating.
  • Pharmacology terms: Agonist (↑ activity), Antagonist (↓ activity), Inverse Agonist (opposite effect), Reuptake (NT re-absorption).

Central Nervous System (CNS)

  • Brain Stem – Autonomic functions (breathing, HR).
    • Hindbrain – Medulla, pons, cerebellum (coordination; cerebellar anomalies in autism).
    • Midbrain – Movement + sensory input; reticular activating system (arousal, tension).
    • Thalamus & Hypothalamus – Relay & homeostasis; part of HPA axis.
  • Limbic System – Emotion, impulse control, learning (hippocampus, amygdala, septum, cingulate gyrus).
  • Basal Ganglia – Motor regulation; damage → tremors, posture changes.
  • Cerebral Cortex – Higher cognition; left hemisphere (verbal, analytic), right (spatial, imagery).
    • Lobes: Frontal (executive), Parietal (somatosensory), Temporal (auditory, memory), Occipital (vision).
    • Prefrontal Cortex – Planning, decision making.
  • HPA Axis – Hypothalamus → Pituitary → Adrenal cortex (cortisol) – central to stress response.

Peripheral Nervous System (PNS)

  • Somatic – Skeletal muscles.
  • Autonomic – Sympathetic (fight/flight) vs. Parasympathetic (rest/digest); regulates cardiovascular & endocrine systems.
  • Endocrine Glands & Hormones
    • Pituitary (master), Thyroid (thyroxine), Parathyroid (calcium), Adrenal (epinephrine), Pineal (melatonin), Pancreas (insulin), Gonads (testosterone, estrogen, progesterone).

Diagnostic Classification: DSM Evolution

  • DSM-I (1952) – 106 disorders; psychodynamic language (e.g., “personality disturbance”).
  • DSM-II (1968) – 182 disorders; pursued “atheoretical” stance; homosexuality labeled “Scythian’s Disease.”
  • DSM-III (1980) – 265 disorders; descriptive criteria, multiaxial system (later DSM-III-R =292 disorders).
  • DSM-IV (1994) – 297 disorders; retained 5 axes; distinguished organic vs. psychological etiology.
  • DSM-IV-TR (2000) – Text revision; clarified criteria; re-labeled “Mental Retardation” as Intellectual Developmental Disorder; separate Autism, Asperger’s, Childhood Disintegrative Disorder.
  • DSM-5 (2013) – Eliminated axial system; spectrum approach; aimed to be evidence-based; minimized “NOS.”
  • DSM-5-TR (2022) – Added Prolonged Grief Disorder and updated text.
  • Terminology
    • Other Specified – Subthreshold symptoms with stated reason.
    • Unspecified – Subthreshold, no stated reason.
    • Idiographic Strategy – Tailor treatment to individual.
    • Nomothetic Strategy – Identify disorder class.
    • Taxonomy / Nosology / Nomenclature – Scientific classification and naming systems.
  • Historical cultural syndrome: Amok (SE Asia) – Sudden violent outburst after brooding.
  • Systems concepts: Equifinality (many paths → same outcome); Multifinality (one cause → many outcomes).

Mental Status Examination (MSE)

  • Appearance & Behavior – Dress, facial expression, motor activity.
  • Thought Process – Rate, flow, content (delusions, tangentiality).
  • Mood & Affect – Pervasive emotion vs. moment-to-moment expression.
  • Intellectual Functioning – Vocabulary, abstraction, memory.
  • Sensorium – Orientation to person, place, time ("oriented × 3").

Cultural Concepts of Distress (DSM-5)

  • Ataque de Nervios – Latino; acute anxiety, anger, or grief with screaming, crying, aggression.
  • Dhat Syndrome – South Asian males attributing fatigue & anxiety to semen loss.
  • Koro – SE Asian fear penis will retract & cause death.
  • Khyal Cap – Cambodian panic attacks attributed to “wind attacks.”
  • Kufungisisa – Shona (Zimbabwe) “thinking too much.”
  • Maladi Moun – Haitian sent sickness via envy or sorcery.
  • Nervios – Latinos; chronic vulnerability to stress.
  • Shenjing Shuairuo – Chinese; weakness, emotional lability, insomnia.
  • Susto – Latinos; soul loss after fright causing unhappiness & illness.
  • Taijin Kyofusho – Japanese; fear of offending others via body functions/appearance.

Integrative Themes & Real-World Relevance

  • Historical swings between supernatural, biological, and psychological models show the importance of cultural context and scientific evidence.
  • Modern practice favors biopsychosocial integration, emphasizing gene–environment interplay and neurobiological underpinnings while retaining psychodynamic, cognitive-behavioral, and humanistic interventions.
  • Ethical considerations: humane treatment (Moral Therapy), informed consent for biological interventions, cultural competence, and awareness of stigmatizing labels.
  • Clinical implication: accurate assessment (MSE, DSM criteria), evidence-based treatment, and individualized care remain the cornerstones of effective psychopathology management.