Unit 5: Comprehensive Study Notes on Mental Health and Clinical Psychology
Survey of Mental Health and Psychological Disorders
Clinical psychology encompasses a vast array of conditions and diagnostic terms. The field addresses disorders such as apiphobia, Obsessive-Compulsive Disorder (OCD), phonological disorder, sleep terror, gynophobia, pyromania, herpetophobia, psychosis, ispareunia, aquaphobia, relational disorder, bibliomania, insomnia, depression, hedonophobia, neurocysticercosis, emetophobia, narcolepsy, Munchausen Syndrome by Proxy, dysthymia, histrionic disorder, encopresis, social anxiety disorder, erotomania, substance-related disorders, zoophobia, desynchronosis, pathological gambling, ADHD, dissociative identity disorder, bipolar disorder, orthoxia, factitious disorder, frigophobia, entomophobia, denial, anorexia, Tardive dyskinesia, trypanophobia, oppositional defiant disorder, Geschwind syndrome, phasmophobia, Ekbom syndrome, hypomania, anosognosia, hypochondriasis, sleep paralysis, chronophobia, panic, neophobia, persecutory delusion, tomophobia, hypersomnia, stereotypic movement disorder, arachnophobia, Fregoli delusion, algophobia, ophidiophobia, binge eating disorder, mathematics disorder, haphephobia, Capgras syndrome, somatization, catatonia, Shared Psychotic Disorder, bulimia, anterograde amnesia, trichotillomania, acrophobia, dementia, Couvade syndrome, androphobia, somniphobia, parasomnia, necrophobia, triskaidekaphobia, exhibitionism, Posttraumatic Stress Disorder (PTSD), Stockholm syndrome, sleepwalking disorder, Pica, hemophobia, misophonia, radiophobia, pain disorder, chiroptophobia, narcissistic personality disorder, Borderline Personality Disorder, neurasthenia, De Clerambault syndrome, pornophobia, addiction, Pseudologia fantastica, nyctophobia, dyspraxia, myrmecophobia, lacunar amnesia, nightmare disorder, cyclothymia, barbiturate dependence, PDD-NOS, schizophrenia, Othello syndrome, grandiose delusions, depersonalization, avoidant personality disorder, transient tick disorder, ichthyophobia, fugue state, seasonal affective disorder, ornithophobia, globophobia, antisocial personality, kleptomania, exercise bulimia, astraphobia, EDNOS, psychalgia, hexakosioihexekontahexaphobia, oneirophrenia, Cotard delusion, malingering, Ganser disorder, alcohol abuse, claustrophobia, dermatillomania, hoplophobia, solastalgia, and hippophobia. These conditions are categorized and described within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association.
Understanding Stress and Stressors
Stress is defined as the process of appraising and responding to a threatening or challenging event. The specific events that cause stress are known as stressors and fall into three primary categories: catastrophes, significant life changes, and daily hassles. Catastrophes involve unpredictable large-scale events such as natural disasters. Significant life changes include events like moving, marriage, divorce, pregnancy, or the death of a loved one. Daily hassles include routine irritations like traffic, a dead cell phone, lack of Wi-Fi, strained budgets, or deadlines. Stress also arises from internal motivational conflicts known as approach and avoidance motives. Approach-Approach conflict occurs when an individual likes two things but they are incompatible with each other. Avoidance-Avoidance conflict involves disliking two things and attempting to avoid them for as long as possible. Approach-Avoidance conflict occurs when an individual likes and dislikes different aspects of a single person, place, or thing, causing them to be torn.
The General Adaptation Syndrome (GAS)
Hans Selye’s research into animal reactions to stressors, such as electric shock and surgery, established stress as a critical concept in psychology and medicine. Selye proposed the General Adaptation Syndrome (GAS), which suggests that the body's adaptive response to stress is general and follows a three-phase process regardless of the nature of the stressor. In Phase 1, the alarm reaction, the sympathetic nervous system is suddenly activated, heart rate increases, and blood is diverted to skeletal muscles, mobilizing the body to fight back. In Phase 2, resistance, the body remains fully engaged with high temperature, blood pressure, and respiration. The adrenal glands pump hormones into the bloodstream to meet the challenge; however, if the stressor persists, resources begin to dwindle. In Phase 3, exhaustion, the individual becomes increasingly vulnerable to illness, collapse, or even death in extreme cases.
Physiological and Psychological Impacts of Prolonged Stress
While the human body manages temporary stress effectively, prolonged exposure can lead to significant damage. Severe childhood stress is linked to greater adult stress responses and higher disease risk, while also slowing the production of new neurons and causing neural circuit degeneration. Research indicates that severe stressors can lead to shortened telomeres, which are DNA segments at the ends of chromosomes. Telomere shortening is a normal part of aging, but when they become too short, cells can no longer divide and eventually die, meaning severe stress prematurely ages individuals. Behavioral responses to stress vary by gender; women often exhibit a "tend-and-befriend" response, gaining or providing support, while men may withdraw socially, become aggressive, or turn to alcohol. Health psychology serves as a subfield contributing to behavioral medicine, while psychoneuroimmunology studies how psychological, neural, and endocrine processes affect the immune system. Stress inhibits the activity of B lymphocytes (which fight bacterial infections), T lymphocytes (which attack cancer cells and viruses), macrophages (which ingest harmful invaders), and Natural Killer (NK) cells (which attack diseased cells).
Stress and Chronic Health Conditions
Stress does not directly cause illness, but it alters immune functioning, making the body more vulnerable and influencing the progression of diseases. Coronary heart disease, the leading cause of death in the United States, is linked to the Type A personality—characterized as competitive, hard-driving, impatient, verbally aggressive, and anger-prone. Type A individuals secrete more stress hormones than the relaxed, easygoing Type B personalities. While catharsis, or the release of aggressive energy, is often suggested to relieve frustration, it generally does not reduce the harmful health effects of anger; instead, waiting, distracting, and distancing are more effective. Chronic stress contributes to persistent inflammation, associated with heart problems and depression. Furthermore, stressed individuals are more susceptible to the common cold, and stress can accelerate the speed at which diseases move through the body.
Coping Strategies and Personal Control
Coping with stress involves various mechanisms, primarily divided into problem-focused coping and emotion-focused coping. Problem-focused coping involves attempting to alleviate stress directly by changing the stressor or the interaction with it. Emotion-focused coping involves avoiding or ignoring a stressor and attending to the emotional needs related to the stress reaction. A person's sense of personal control affects their stress levels. Those with an internal locus of control believe they control their own fate, while those with an external locus of control believe outside forces determine their fate. Self-control, or willpower, is the ability to delay short-term gratification for long-term rewards. Individuals with strong self-control generally experience less stress and better health. Additionally, optimism and pessimism play roles in health; optimists have stronger immune systems, lower blood pressure responses to stress, and longer life expectancies. Pessimists operate under the belief that things will inevitably go badly, whereas optimists believe things will go well if they actively try to change them.
Subjective Well-Being and Positive Psychology
Social support promotes health by reducing blood pressure and stress hormones while fostering immune functioning. Subjective well-being refers to an individual's perception of being happy or satisfied with life; happiness is often relative to personal experiences and the success of others. The "feel-good, do-good phenomenon" describes how happy people are more willing to help others. Positive psychologists use scientific methods to study human flourishing, promoting virtues and strengths that allow communities to thrive. Happiness is impacted by the adaptation-level phenomenon, the tendency to form judgments relative to a neutral level based on prior experience. It is also affected by relative deprivation, the perception that one is worse off than those they compare themselves to. The Broaden and Build Theory suggests that positive emotions broaden awareness and help build resilience. Character strengths identified by researchers include Wisdom (love of learning), Courage (honesty), Humanity (kindness), Justice (fairness), Temperance (humility), and Transcendence (humor and hope). Factors related to happiness include high self-esteem, optimism, close relationships, engaging work, religious faith, and good sleep, whereas factors like age, gender, and physical attractiveness are not strongly related.
Definitions and History of Psychological Disorders
A psychological disorder is defined as a syndrome marked by a clinically significant disturbance in cognition, emotion regulation, or behavior, categorized by the "3 D's": dysfunctional (interfering with daily life), deviant (abnormal behavior), and distressing (causing harm). Historically, Stone Age skulls showing trephination indicate early attempts to release "evil spirits." In the Middle Ages, mental illness was viewed as demonic possession, leading to caging, mutilation, and exorcisms. In the , Philippe Pinel promoted "moral treatment," arguing that disorders were caused by environmental factors like stress rather than demons. In the , the mentally ill were housed in barbaric hospital conditions, such as Bedlam in England, where the public paid admission to see patients. Dorothea Dix began a crusade in to reform these institutions, leading to worldwide shifts toward fair and equal treatment. In legal contexts, the term "insanity" is used to determine criminal responsibility, though it is a legal designation rather than a medical or psychological one.
Models and Perspectives of Mental Illness
The discovery that syphilis causes mental symptoms suggested the medical model, which views psychological disorders as physical illnesses that can be diagnosed, treated, and cured. This model views disorders as psychopathology. Beyond the biological view, other schools of thought exist: Psychoanalytic (internal, unconscious drives), Humanistic (failure to strive for potential), Behavioral (reinforcement history and environment), Cognitive (irrational thoughts), and Sociocultural (dysfunctional society). The biopsychosocial approach led to the stress vulnerability model, suggesting individual characteristics combine with environmental stressors to determine disorder likelihood. Epigenetics studies how environment influences gene expression without DNA changes. Some disorders are culture-bound, such as Susto (fear of black magic in Latin America), Taijin-kyofusho (social anxiety about appearance in Japan), eating disorders in the USA, and Amok (violent outbursts in Malaysia).
The DSM-5 and Diagnostic Ethics
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the authoritative guide for diagnosing mental disorders, containing descriptions and symptoms. Comorbidity refers to the presence of more than one disorder, such as anxiety and depression. Criticisms of the DSM-5 include concerns that it over-diagnoses normal behavior as "disordered," that diagnostic boundaries are arbitrary, and that it relies on value judgments. Labels can create stigma, as negative cultural views of mental illness often lead to individuals being seen as tainted or weak. Diagnostic criteria are specific; for example, a phobia diagnosis requires marked fear about a specific object, immediate anxiety upon exposure, active avoidance, andpersistence for at least . ADHD is marked by extreme inattention, hyperactivity, and impulsivity, though debate remains regarding whether it is truly deviant or dysfunctional in all cases.
Anxiety and Obsessive-Compulsive Disorders
Anxiety disorders involve persistent anxiety or maladaptive behaviors to reduce anxiety. Generalized Anxiety Disorder (GAD) involves constant tension and autonomic nervous system arousal without a clear cause. Panic disorder is characterized by unpredictable episodes of intense dread, often accompanied by chest pain. Some individuals develop agoraphobia, fearing situations where escape might be difficult. Specific phobias are persistent, irrational fears of objects like spiders (arachnophobia), heights (acrophobia), or thunder (astraphobia). Obsessive-Compulsive Disorder (OCD) involves repetitive thoughts (obsessions) and actions (compulsions). Common obsessions include contamination, pathological doubt, and violent thoughts, while common compulsions include washing, checking, counting, and maintaining symmetry. PTSD is marked by haunting memories, nightmares, and social withdrawal lingering for or more after a trauma.
Depressive and Bipolar Disorders
Major Depressive Disorder requires two or more weeks with five or more symptoms, involving depressed mood or loss of interest (anhedonia). Symptoms include weight changes, insomnia or hypersomnia, fatigue, feelings of worthlessness, and suicidal ideation. Depression affects approximately of men and of women annually. Postpartum depression occurs after childbirth, while Seasonal Affective Disorder (SAD) occurs during winter months due to lack of sunlight. Bipolar disorder involves swings between depression and mania (a euphoric, hyperactive state). Bipolar I is severe mania and depression, while Bipolar II involves hypomania. In children, those with cycles of rage rather than mania are diagnosed with Disruptive Mood Dysregulation Disorder. Risk factors for these disorders include genetics, neurotransmitter imbalances (serotonin/norepinephrine), and nutrition.
Suicide Risk and Prevalence
Approximately people die by suicide annually worldwide. The risk is tripled for those with anxiety and quintupled for those with depression, particularly as they begin to rebound from a depressive state. In the US, whites and Native Americans have suicide rates twice as high as African Americans and Hispanics. Men are more likely to complete suicide, while women are more likely to attempt it. Rates peak among those aged and are statistically higher in April, May, and on Wednesdays. Helping a person at risk requires taking them seriously, listening, and connecting them with professionals or trusted adults.
Schizophrenia and Psychotic Disorders
Schizophrenia, meaning "split mind," involves delusions, hallucinations, disorganized speech ("word salad"), and inappropriate emotions. Positive symptoms include the addition of behaviors (hallucinations, delusions), while negative symptoms include the absence of behaviors (flat affect, alogia, catatonia). It affects about people, with onset typically between ages . Subtypes include Paranoid, Catatonic (motionless or frenzied), Disorganized (jumped topics), and Undifferentiated. Biological causes include dopamine overactivity and abnormal anatomy in regions like the Basal Ganglia (paranoia/hallucinations), Auditory System (hallucinations in Wernicke’s area), and Frontal Lobe (disorganized thought). Dissociative disorders involve a separation of conscious awareness from memories, including Dissociative Fugue and Dissociative Identity Disorder (DID), the latter of which is often linked to childhood trauma.
Personality, Eating, and Somatic Disorders
Personality disorders are divided into three clusters: Anxious/Avoidant, Eccentric/Odd, and Dramatic/Impulsive. Examples include Avoidant (extreme shyness), Borderline (instability and impulsivity), Schizoid (social detachment), Histrionic (attention-seeking), and Narcissistic (self-importance). Antisocial Personality Disorder involves a lack of empathy; sociopaths are impulsive and erratic, while psychopaths are strategic and calculating. Eating disorders include Anorexia Nervosa (starvation diet), Bulimia Nervosa (binge-purge cycles), Binge Eating Disorder, and Pica (eating non-food items). Somatic symptom disorders involve physical symptoms without physical causes, such as Conversion disorder (e.g., hysterical blindness), Illness Anxiety Disorder (hypochondriasis), and Munchausen syndrome (factitious disorder where illnesses are falsified for sympathy).
Psychological Therapies and Approaches
Psychotherapy involves techniques between a therapist and a client. Psychoanalysis, created by Freud, uses free association and dream interpretation to uncover the unconscious, facing challenges like resistance and transference. Humanistic therapy, championed by Carl Rogers, focuses on self-fulfillment through insight, client-centered therapy, active listening, and unconditional positive regard. Behavior therapy uses classical and operant conditioning, including exposure therapy, systematic desensitization, and aversive conditioning. Cognitive therapy, such as Albert Ellis’s Rational-Emotive Behavior Therapy (REBT) and Aaron Beck’s treatment for depression, aims to change maladaptive thinking patterns. Cognitive-Behavioral Therapy (CBT) integrates these by changing both thinking and actions. Group and family therapies address social systems and interpersonal dynamics.
Biomedical Therapies and Professional Training
Biomedical treatments include psychopharmacology and procedural interventions. Antipsychotics (e.g., Thorazine) treat schizophrenia but carry risks like Tardive dyskinesia. Anti-anxiety drugs (e.g., Xanax) depress CNS activity but can be addictive. Antidepressants (e.g., Prozac) treat depression and OCD. Mood stabilizers like Lithium are used for bipolar disorder. Procedures include Electroconvulsive Therapy (ECT) for severe depression, Transcranial Magnetic Stimulation (TMS), Deep Brain Stimulation (DBS) for Parkinson’s and depression, and historical lobotomies. Professionals in the field include Clinical Psychologists (Ph.D./Psy.D.), Psychiatrists (M.D.s who prescribe medication), Clinical Social Workers, and specialized Counselors for marriage, abuse, or family issues.