Treatments

PS 101: General Psychology

Psychopathology & Treatments

Fall 2025

Understanding Abnormal Behavior

  • Definition Complexity: There is no universally accepted definition of what constitutes "abnormal" behavior.

  • Psychologists Definition: Abnormal behavior is categorized as:

    • Culturally atypical or socially unacceptable

    • Dysfunctional or maladaptive

    • Emotionally distressful

    • (Sometimes) Dangerous

  • Limitations: None of the aforementioned characteristics alone is sufficient to define a mental health condition.

  • Statistics: Over 50% of the U.S. population will experience a diagnosable mental health disorder in their lifetime.

Classifying Mental Health Disorders

  • The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM).

  • Current Version: The most recent version, DSM-5-TR, was published in 2022.

  • Provides comprehensive diagnostic criteria for all mental health conditions diagnosed in the U.S.

Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Characteristics: ADHD is marked by a pattern of inattention and hyperactivity that interferes with educational, social, and/or occupational functioning.

  • Diagnosis Criteria: The symptoms required for an ADHD diagnosis vary by age group:

    • Six or more symptoms for individuals up to age 16.

    • Five or more symptoms for individuals age 17 and older.

  • Context Requirement: Symptoms must be present in two or more contexts and must interfere significantly with social, school, or work functioning. Symptoms cannot be better explained by another mental disorder.

Anxiety Disorders

  • Fear vs. Anxiety:

    • Fear: Has a clear cause and subsides when that cause is removed.

    • Anxiety: A general feeling of dread or apprehension that includes various physiological reactions such as:

    • Elevated heart rate

    • Rapid or shallow breathing

    • Sweating

    • Muscle tension

    • Dry mouth

    • Quality of Anxiety: Anxiety is less defined than fear, often more pervasive, and longer-lasting.

Types of Anxiety Disorders

  • The DSM-5-TR includes the following anxiety disorders:

    • Panic Disorder

    • Agoraphobia

    • Social Anxiety Disorder

    • Specific Phobias

    • Generalized Anxiety Disorder

  • Prevalence: Anxiety disorders are highly prevalent worldwide.

Panic Disorder

  • Diagnosis: Panic disorder is characterized by recurrent panic attacks and concern over potential additional episodes.

  • Panic Attack Details: A panic attack consists of intense fear accompanied by physical reactions; it is not life-threatening but can be quite distressing.

  • Symptoms of Panic Attacks:

    • Palpitations or pounding heart

    • Sweating

    • Trembling or shaking

    • Shortness of breath or smothering sensations

    • Feelings of choking

    • Chest pain or discomfort

    • Nausea or abdominal distress

    • Dizziness or faintness

    • Derealization (feelings of unreality)

    • Depersonalization (detachment from oneself)

    • Fear of losing control or “going crazy”

    • Intense fear of dying

    • Paresthesias (numbness or tingling)

    • Chills or sensations of heat.

Panic Disorder with or without Agoraphobia

  • Agoraphobia: Defined as a marked fear or anxiety about two or more of the following situations:

    • Using public transportation

    • Being in open spaces

    • Being in enclosed spaces (like shops or theaters)

    • Standing in line or being in crowds

    • Being outside the home alone.

  • Characteristics of Agoraphobia: Situations will either be avoided or endured with distress, and the anxiety is disproportionate to actual danger; symptoms typically last for 6 months or longer.

Social Anxiety Disorder

  • Definition: Involves marked fear or anxiety related to social situations where individuals might be scrutinized.

  • Forms: It can take two forms:

    • Performance Anxiety: Fear limited to situations involving an audience.

    • General Social Anxiety: Fear of many social situations, affecting both personal and professional interactions.

  • Criteria:

    • Anxiety almost always provokes fear.

    • Fear is disproportionate to reality.

    • Situations are actively avoided or endured with intense fear.

    • Symptoms must last for at least 6 months and cannot be attributed to other disorders or substances.

Specific Phobias

  • Definition: Specific phobias are extreme fears associated with particular objects or situations.

  • Notable Feature: Rarely seen in clinical practice due to the ability to easily avoid triggers related to the phobia.

Generalized Anxiety Disorder (GAD)

  • Characteristics: GAD is characterized by excessive anxiety or worry about multiple life domains occurring more days than not for over 6 months.

  • Symptoms: Anxiety experienced is disproportionate to any real threat; there is significant difficulty in controlling worry.

  • Associated Symptoms Include:

    • Restlessness or feeling on edge.

    • Easily fatigued.

    • Difficulty concentrating.

    • Irritability.

    • Muscle tension.

    • Sleep disturbances.

Obsessive-Compulsive Disorders (OCD)

  • Definition: OCD is marked by recurrent and persistent intrusive thoughts (obsessions) that provoke anxiety, along with compulsions aimed to relieve this anxiety.

  • Symptoms of OCD:

    • Time-consuming obsessions or compulsions (>1 hour per day).

    • The individual recognizes that these thoughts/behaviors are excessive or unreasonable.

  • Common Behaviors: Examples include repeated hand washing, ordering, checking, or mental acts like praying or counting.

Trauma and Stressor-Related Disorders

  • The DSM-5-TR includes several disorders related to trauma or stressors:

    • Adjustment Disorder: A maladaptive response to a stressor.

    • Acute Stress Disorder: Symptoms similar to PTSD that arise soon after a traumatic event.

    • Prolonged Grief Disorder: Enduring grief that disrupts functioning.

    • Post-Traumatic Stress Disorder (PTSD): Symptoms develop after exposure to traumatic events.

Post-Traumatic Stress Disorder (PTSD)

  • Definition: PTSD develops after exposure to a traumatic event and is characterized by the presence of symptoms within several categories that cause significant impairment.

  • Symptoms Requirements: At least 1-2 symptoms in specified categories must persist for over 1 month.

  • Symptoms Include:

    • Recurrent, involuntary memories or flashbacks.

    • Nightmares related to the trauma.

    • Marked distress following exposure to cues associated with the trauma.

    • Physiological reactions to cues that symbolize the trauma.

    • Avoidance of related thoughts, feelings, or reminders of the trauma.

    • Difficulty remembering key features of the trauma.

    • Negative beliefs about oneself.

    • Feelings of detachment or alienation.

    • Increased arousal, irritability, or self-destructive behaviors.

    • Heightened startle response and concentration difficulties.

    • Sleep disturbances.

Theoretical Perspectives on Anxiety, OCD, and PTSD

  • Various schools of thought attempt to explain these conditions:

    • Psychoanalytic: Views anxiety as stemming from repressed unconscious conflicts.

    • Behavioral: Focuses on learned behaviors and conditioning as causes of these disorders.

    • Biological: Explores genetic, hormonal, and neurobiological elements contributing to the disorders.

Freud’s Case Study on Little Hans

  • Background: Little Hans, a 5-year-old boy, had a severe fear of horses,

    • Freud theorized that Hans unconsciously harbored resentment towards his father, projecting this fear onto horses.

Psychoanalytic Perspectives on Anxiety

  • Freud's Viewpoints:

    • Anxiety results from the ego's attempt to block unacceptable impulses from the id.

  • Clinical Definitions:

    • Generalized Anxiety: Tension from unconscious suppression.

    • Panic Disorders & Agoraphobia: Result from unresolved childhood separation anxiety.

    • Phobias: Displacement or avoidance of anxiety through object association.

    • OCD: Fixation during psychosexual development that manifests in repetitive behaviors.

Revisiting Little Hans with Behaviorism

  • Behaviorist Reanalysis: Bandura's behavioral theories suggest that Hans's fear was specific to large, fast-moving horses due to a traumatic incident witnessed.

Behavioral Perspectives on Anxiety

  • Conditioning Effects:

    • Generalized anxiety results from conditioned learning.

    • Panic disorders arise from the fear of having a panic attack, leading to avoidance behaviours.

    • Phobias develop via learned associations between neutral stimuli and frightening experiences.

    • OCD behaviours are maintained through negative reinforcement (removal of aversive stimuli).

    • PTSD involves classical conditioning reinforced by avoidance learning.

Biological Perspectives on Anxiety

  • Evolutionary Aspect: Fear responses may be innate based on threats in the environment.

  • Variability: Not all individuals develop anxiety or PTSD after trauma; individual differences in reaction and resilience exist.

Brain Areas Mediating Anxiety and Fear

  • Amygdala: Responsible for conditioned fear and can be hyper-reactive; its function may not revert after a traumatic event, leading to PTSD symptoms.

  • Prefrontal Cortex (PFC): Inhibits conditioned fear responses and mediates extinction; anxiety may manifest when inhibitory functions fail.

  • Hippocampus: Encodes memories related to emotional cues.

  • Basal Ganglia: Involved in relay functions for sensory cues linked to motor commands, implicated in OCD behaviors.

  • Anterior Cingulate Cortex (ACC): Connects emotion with sensory input; potentially plays a role in OCD by focusing on threatening stimuli.

Neurobiology of Anxiety

  • GABA Neurotransmitter: Effective anxiolytics typically increase or mimic GABA activity; GABA serves as the primary inhibitory neurotransmitter in the brain.

  • Target of Treatments: The modulation of GABAergic activity can reduce hyperactivity within the amygdala and may alleviate anxiety symptoms.

Neurobiology of ADHD

  • Prefrontal Cortex Activity: Autism may be tied to variations in prefrontal cortex function.

  • Medications: Common ADHD medications enhance levels of dopamine and norepinephrine to optimize neural function.

Dissociative Disorders

  • Overview: This group of disorders involves disruptions in consciousness, memory, perception, or identity.

  • Forms:

    • Dissociative Amnesia

    • Depersonalization-derealization disorder

    • Dissociative Identity Disorder.

Dissociative Amnesia

  • Definition: The most common dissociative disorder characterized by sudden memory loss, typically following traumatic events.

  • Features:

    • Amnesia involves the event itself and immediate surrounding context.

    • Less common is complete amnesia; episodic memories often lost while semantic and procedural memories remain intact.

    • Must interfere significantly with daily functioning, unrelated to other conditions or substance use.

Depersonalization-Derealization Disorder

  • Characteristics:

    • Experiences of detachment from one’s thoughts, feelings, or body sensations; may resemble an “out-of-body” experience.

    • Symptoms should be persistent or recurring and impair functioning, not caused by other conditions or substance use.

Dissociative Identity Disorder (DID)

  • Definition: Involves alternating between a primary and one or more secondary personality states;

    • Secondary identities are often aware of the primary but not vice versa.

    • Symptoms must be severe enough that they're not better explained by other conditions or substance use.

Perspectives on Dissociative Disorders

  • Psychoanalytic Theory: Attributes dissociative responses to repression of unacceptable impulses.

  • Behavioral Perspective: Proposes that dissociative behaviors serve as operant avoidance responses, reinforced by escape from distress.

  • Biological Perspective: Investigates environmental and genetic factors leading to changes in brain activity, particularly in the prefrontal cortex and limbic system (including the amygdala).

Depressive Disorders

  • Nature: Depressive disorders are characterized by persistent low mood. Many experience temporary depressive symptoms, but a diagnosis may occur if symptoms last over weeks and disrupt functionality.

  • Types:

    • Major Depressive Disorder

    • Disruptive Mood Dysregulation Disorder

    • Premenstrual Dysphoric Disorder

    • Substance-induced Depressive Disorders.

Major Depressive Disorder

  • Definition: Characterized by profound sadness, loss, and feelings of worthlessness.

  • Diagnostic Symptoms: Five or more of the following:

    • Depressed mood significant enough to affect daily activities.

    • Anhedonia: Loss of interest or pleasure in almost all activities.

    • Significant weight or appetite changes.

    • Sleep disturbances.

    • Psychomotor changes (agitation or retardation).

    • Fatigue or low energy.

    • Feelings of worthlessness or inappropriate guilt.

    • Impaired concentration or decision-making ability.

    • Recurrent thoughts of death or suicidal ideation.

Bipolar Disorder

  • Description: Characterized by extreme mood changes from depressive lows to manic highs.

  • Mania: Defined as a mood state with characteristics such as inflated self-esteem, decreased need for sleep, rapid talking, extravagant ideas, and delusions.

  • Types:

    • Bipolar I Disorder: Involves at least one manic episode alongside major depression.

    • Bipolar II Disorder: Involves at least one hypomanic episode (less severe than mania) interspersed with major depression.

  • Symptoms and Duration: Episodes can last weeks to months and recur throughout life.

Perspectives on Depressive Disorders

  • Psychoanalytic Theory: May interpret depression as regression to an earlier psychosexual fixation stage.

  • Behavioral Theory: Links depression to loss of reinforcement sources and learned helplessness, where individuals feel they lack control over their circumstances.

  • Biological Factors: Investigate the genetic predisposition and the role of brain chemistry (e.g., reduced serotonin levels).

The Vulnerability-Stress Model

  • Concept: Biological vulnerabilities combined with environmental stressors may lead to mental health conditions like asthma, major depressive disorder, bipolar disorder, and schizophrenia.

Schizophrenia

  • Definition: A severe mental disorder characterized by significant disruptions in thought, emotion, perception, and behaviors; it differs from dissociative disorders by the lack of a split from reality.

  • Greek Terminology: "Schizo" means split and "phrenia" means mind.

Types of Schizophrenia Symptoms

  • Positive Symptoms: Include delusions and hallucinations.

  • Negative Symptoms: Flat affect and diminished emotional expression.

  • Cognitive Symptoms: Disturbances in memory or sensory perception.

Primary Symptoms of Schizophrenia

  • Core Symptoms: Include delusions, hallucinations, disturbances in thought and speech, motor disturbances, and altered emotional expression. For diagnosis, at least two of these symptoms must be present during the past month and must severely disrupt functioning.

Delusions in Schizophrenia

  • Definition: Fixed beliefs that are resistant to contradictory evidence.

  • Common Types of Delusions:

    • Delusion of Influence: Belief of being influenced by external forces (e.g., media).

    • Delusion of Grandeur: Belief of being a significant figure (e.g., historically relevant leader).

    • Delusion of Persecution: Belief of being targeted or harassed by others.

    • Delusion of Reference: Belief that events or media are related to oneself.

    • Delusion of Bodily Changes: Beliefs about unusual changes in one’s body.

    • Delusion of Nihilism: The belief that nothing exists or the experience of detached observation from one’s reality.

Perceptual Disturbances and Hallucinations

  • Forms: Can manifest as various body sensations, visual changes, or most commonly, auditory hallucinations.

  • Nature of Hallucinations: Typically involve hearing voices that often critique or insult.

Disturbances in Emotion, Motivation, and Speech

  • Emotional Changes: Individuals may exhibit a flat affect, blunted emotional expression, or inappropriate emotions.

  • Speech Patterns:

    • Mutism: Extended periods of silence.

    • Echolalia: Repetition of phrases or words.

    • Incoherence: Disorganized or nonsensical speech.

Disorganized or Catatonic Motor Behavior

  • Disorganized Behavior: Can include inappropriate reactions to situations or unpredictable agitation.

  • Catatonic Behavior: Involves a lack of movement and responsiveness over extended periods while being aware of surroundings.

Lifetime Risks of Developing Schizophrenia

  • Statistics: Risk of developing schizophrenia varies:

    • General population: 1%

    • Second-degree relatives: Average 4%

    • First-degree relatives: Risk ranges from 6% to 17%

    • Monozygotic twins: 48% risk

    • Children of two affected parents: Average 47% risk.

Perspectives on Schizophrenia Disorders

  • Psychoanalytic Theory: Views on lost ego control due to overwhelming internal impulses.

  • Behavioral Theory: A lack of reinforcement for normative behavior contributes.

  • Biological Factors:

    • Genetics: High concordance among identical twins.

    • Brain Chemistry: Overactivity of dopamine signaling.

    • Structural Anomalies: Enlarged brain ventricles and diminished grey matter in critical brain areas.

Brain Scan Observations in Schizophrenia

  • Findings: MRI scans show size differences in ventricles between affected and non-affected twins, indicating physiological changes related to schizophrenia.

Personality Disorders

  • Overview: The DSM-5 identifies 10 distinct personality disorders, categorized by clusters:

    • Cluster A: Odd, eccentric features (e.g. paranoid, schizoid).

    • Cluster B: Dramatic, emotional, or erratic traits (e.g. antisocial, borderline).

    • Cluster C: Anxious or fearful traits (e.g. avoidant, obsessive-compulsive).

Key Features of Personality Disorders

  • Common Features: Develop early in life and become more rigid with age.

  • Characteristics: Individuals typically remain unaware of their disorder. Behaviors are pervasive, self-defeating, and often resist seeking treatment.

Treatment of Mental Health Disorders

  • Categories of Treatment:

    • Psychological Therapies:

    • Psychoanalysis

    • Cognitive therapies

    • Behavioral therapies

    • Biological Treatments:

    • Surgery

    • Electroconvulsive or magnetic stimulation

    • Pharmacotherapy (medication)

  • Treatment Variability: Not every intervention is effective for every patient; often, a combination of treatments is employed.

Psychological Therapies: Psychoanalysis

  • Core Beliefs: Disorders stem from unresolved unconscious conflicts, especially from childhood.

  • Techniques Used:

    • Free Association: A method to explore unconscious thoughts.

    • Dream Analysis: Interpretation of symbolic meanings in dreams.

    • Resistance: Addressing topics clients may be hesitant to discuss.

    • Transference: Exploration of the client’s feelings toward the therapist based on past relationships.

  • Therapeutic Focus: Emphasizes unresolved conflicts as a foundation of psychological distress.

Psychological Therapies: Cognitive Therapies

  • Framework: Cognitive therapies operate on the premise that mental health issues arise from distorted thinking.

  • Goals: Aim to alter detrimental thought patterns to influence behaviors positively.

  • Commonly Combined Approach: Cognitive-Behavioral Therapy (CBT).

Psychological Therapies: Rational-Emotive Therapy

  • Premise: Psychological issues arise from self-defeating or irrational beliefs.

  • Objectives: To dismantle harmful beliefs and improve self-worth.

  • Techniques: Strategies are more interactive than traditional psychoanalysis, including:

    • Confrontation

    • Persuasion

    • Role-playing

    • Interpretation.

Psychological Therapies: Effectiveness of Cognitive Therapies

  • Outcome: Cognitive therapies are highly effective, particularly in treating depression.

  • Cognitive Reframing: Addresses Automatic Negative Thoughts (ANTs) and aids in reinterpreting thoughts to create positive emotions and behaviors.

Psychological Therapies: Behavioral Therapies

  • Systematic Desensitization: A common method for treating fears and phobias, involving:

    • Creating a hierarchy of fears.

    • Teaching relaxation techniques.

    • Gradual exposure to the feared object/situation while practicing relaxation.

  • Exposure Therapy: Involves controlled exposure to fear triggers incrementally to foster a sense of control.

  • Effectiveness: Particularly effective for phobias, with less efficacy in generalized anxiety disorders.