Chapter 1 Introduction and Historical overview
Psychopathology
Study of why people think, behave, and feel in abnormal,
unexpected ways.
“something wrong with a person’s psychology”
A search by clinicians for the reasons why people behave, think, and
act in abnormal ways. Focus is on
• Description
• Causes
• Treatment
Chapter 1 Introduction and Historical overview
Stigma
Having a negative connotation – how we think about mental illness.
Labeling someone based on our assumptions, and negativity is
attached in a big way.
Apply label
refers to undesirable attributes
people seen as
different
discrimination
Chapter 1 Introduction and Historical overview
Freud
• Influenced by Bruer
• Emphasized stages of psychosexual development
• Importance of unconscious processes
Repression and defense mechanisms
Influenced psychoanalytic theory:
• Free association
• Analysis of transference
• Understand conflicts and find healthier ways dealing with
them,.
Chapter 1 Introduction and Historical overview
Cultural Relativism
Says that behavior is determined by culture and society, and that
there is no universal for human behavior.
• Think of gender roles in different parts of the world
Chapter 1 Introduction and Historical overview
Demonology
Earliest idea of mental illness. Believed that demons and evil spirits
possessed the mind to cause mental illness, and that exorcism was
the only treatment. They drilled holes in the skull to let the, escape
(trepanning)
Chapter 1 Introduction and Historical overview
Abnormal Behavior
Given social, cultural, and situational factors, any behavior or
thought that is maladaptive or has a negative affect
Characteristics:
• Personal Distress (emotional pain and suffering)
• Disability (impairment in a key area)
• Violation of Social Norms (makes others uncomfy)
Cultural relativism: behavior determined by culture and
society
• Dysfunction: Wakefield’s harmful dysfunction
DSM-IV-TR includes all these characteristics
Chapter 1 Introduction and Historical overview
What are the three historical views?
(guiding perspectives over time)
Supernatural: mental illness is due to supernatural forces
(demonology, God, possession, etc)
Biological: originated with Hippocrates, says that psychopathology is
due to dysfunction in the brain, it is similar to physical disease
Psychological: says that psychopathology is due to something in the
environment like stress or trauma
These views dictated how mental illness has been treated, and how
people with mental illness were treated
Chapter 1 Introduction and Historical overview
Behaviorism
Suggests that behavior develops through classical conditioning,
operant conditioning, or modeling. People with symptoms just need
to reinforce OTHER behaviors. Shift was towards observing things that
we can see, and moving away from unconscious
• John Watson father of behaviorism, focused on learning
and observable behavior
• BF Skinner: positive and negative reinforcement, showed
that operant conditioning can shape behavior
Chapter 1 Introduction and Historical overview
Wakefield’s Harmful Dysfunction
Says that must be harmful to the self or society, and must be an
element of dysfunction, something operating in a way that deviates
from how it should operate.
Someone might deny harm to themselves or society but actually be
doing harm!
Chapter 1 Introduction and Historical overview
Hippocrates
Gave earliest biological explanation
Thought that mental illness was caused by natural as opposed to
supernatural causes, and that it was located In the brain
• Imbalance of four humours of the body
Black bile (infection)
Yellow bile (anxiety)
Phlegm
Blood
Chapter 1 Introduction and Historical overview
Timeline of Psychopathology
Supernatural
Biologicacl (Hippocrates)
Dark Ages (supernatural)

Witches
Lunacy Trials
Aslyums (Priory of St Mary of Bethlehelm

Pinel (humanitarian treatment)
William Tuke and Society of
Friends
Dorthea Dix
NAME
can be inherited (Behavioral
genetics)
Eugenics
Psychological Approaches
Mesmer

Bruer
Freud (psychoanalytic theory)
Neo-freudians
Adler

Behaviorism (Watson, Thorndike, skinner)
Modeling (Bandura and
Menlove)
Behavior therapy
Chapter 1 Introduction and Historical overview
Priory of St. Mary of Bethlehelm
• One of the first mental institutions
• Exploited those with mental illness
• Origin of term bedlam
• Treatment non-existent or harmful
Chapter 1 Introduction and Historical overview
Moral Treatment
• William Tuke and Sociey of Friends, York Retreat
• Provided a calming environment
• Gave patients purposeful activity
• Talked with attendants
Chapter 1 Introduction and Historical overview
Kraepelin
• Pioneered classification of mental illness based on
biological cause
• Noticed groups of symptoms tended to co-occur, called it
a syndrome, evidence of a biological cause
• Published first psychiatry text
Dementia Praecox (schizo) and manic depressive
psychosis (bipolar disorder)
Chapter 1 Introduction and Historical overview
Psychological Approaches
View mental illness as due to psychological functions
Dysfunctional thinking patterns, behavior determined by
reward/punishment, things in the brain that couldn’t be understood
due to biology
Mesmer: used animal magnetism and hypnosis to treat hysteria
Bruer: Used hypnosis to facilitate catharsis
Chapter 1 Introduction and Historical overview
Lunacy Trials
Organized by the government (13th century England) to determine
sanity. Lunacy refers to theory that attributes insanity to misalignment
of the room and stars
Chapter 1 Introduction and Historical overview
Phillipe Pinel
Pioneered humanitarian treatment
Took Control of Aslyum
Wanted to treat people with dignity, like humans, to cure
Chapter 1 Introduction and Historical overview
Dorthea Dix
Crusaders for prisoners and mentally ill in the United States
Urged improvements in institutions
Established 32 new public hospitals,
But too large to maintain moral treatment
Hospitals staffed with physicians
Chapter 1 Introduction and Historical overview
Behavioral Genetics - emergence
“The extent to which behavioral differences are due to genetics”
After Kraepelin noticed that symptoms tended to co-occur and
termed this a syndrome, was noted that these syndromes ran in
families and could be inherited, so investigated causes
Eugenics: only those with desirable traits should be allowed to
“breed” (period of enforced sterilization”
Chapter 1 Introduction and Historical overview
Freud
Psychoanalytic theory: Human behavior is determined by
unconscious forces, things we aren’t aware o that an observer
cannot see
Psychopathology results from conflicts among these unconscious
forces
ID: unconscious, energy is libido, operates according to pleasure
principle, reduces tension through wish fulfillment and fantasies
EGO: develops to consciously control the ID, conscious and operates
according to reality principle
SUPEREGO: our conscience, societal influence
Chapter 1 Introduction and Historical overview
**Stages of Psychosocial Development
Oral Stage
Anal Stage
Phallic Stage
Latency period
Genital Stage
Chapter 1 Introduction and Historical overview
**Conflict between ID,EGO,Superego
• ID vs EGO
• EGO vs Superego
• Superego vs ID
Chapter 1 Introduction and Historical overview
Conditioning
Classical Conditioning: Pavlov, learning by temporal association
When two events repeatedly occur close together in time, they
become fused in mind before long, respond in same way to both
events
US (meat) --> UR (salivate)
US (meat) + bell --> UR (salivate)
CS (bell) --> CR (salivate)
Operant Conditioning: (Thorndike) Looked at learning through
consequences.
Law of Effect: any behavior followed by a pleasurable consequence
will be repeated, unpleasant consequence will be discouraged.
Chapter 1 Introduction and Historical overview
Modeling and Shaping
Modeling: Learning without any reinforcement
• Bandura and Menlove (children and fear of dogs)
Shaping: reward a sequence of responses that approximate a final
response (rats and pushing a lever)
Chapter 1 Introduction and Historical overview
Defense Mechanisms
Rationalization: justifying with socially acceptable reasons over real
Repression: blocking threatening memory from consciousness
Regression: return to more primitive levels of behavior
Denial: refusing to admit something unpleasant happening
Reaction formation: transforming anxious thoughts into opposite
Displacement: taking it out on someone/something else
Chapter 1 Introduction and Historical overview
Neo-Freudians (Jung and Adler)
Jung: Analytical psychology
Collective unconscious
Archetypes
Adler: individual psychology
Striving for superiority
Inferiority complex
Move towards rational thinking
Chapter 1 Introduction and Historical overview
Conditioning continued (Skinner)
Skinner Box
Positive and Negative Reinforcement and Punishment
(provide definitions and examples)
Positive Reinforcement: something added increases behavcior
Negative reinforcement: something taken away increases behavior,
so behaviors that terminate a negative stimulus are strengthened
Positive punishment: something added decreases behavior
Negative punishment: something removed decreases behavior
Chapter 1 Introduction and Historical overview
Behavioral Therapy
“Application of procedures and principles used in operant
conditioning”
• Must identify problems causing behavior and replace
them with better ones. Therapist is like a coach
Counterconditioning: causing same stimulus to elicit a different
response (instead of fearing the bridge, being able to drive over it)
Systematic Desensitization: used often in treatment of phobias and
anxiety disorders. Identify phobia and then use relaxation
techniques and expose to what afraid of at different levels, lead up
to ultimate fear
**Aversive Conditioning**
Chapter 2 Current Paradigms in Psychopathology
Paradigm
A conceptual framework or general perspective.
Ways that people think about mental disorder, how we organize
information around it, has implications for how people are treated
Helps shape what we investigate treat and how we define abnormal
behavior
Chapter 2 Current Paradigms in Psychopathology
Neuroscience Paradigm
Emphasizes the role of the brain, neurotransmitters and other systems like the
HPA axis in psychopathology. View that behavior can best be understood by
reducing it to its basic biological components. Ignores more complex views of
behavior.
Axon includes:
Cell body, dendrites, axon, and terminal button
Treatment is often via drugs and biological treatments to rectify specific
problems of the brain.
Neurotransmitter: chemical substance released in the synapse of a
presynaptic neuron
Receptor sites on postsynaptic neuron absorb NT (excitatory or inhibitory
reaction)
Reuptake: reabsorption of leftover NT by the presynaptic neuron
Chapter 2 Current Paradigms in Psychopathology
Cognitive Behavioral Paradigm
Behavior is reinforced by consequences!
• Attention, escape or avoidance, sensory stimulation,
access to desired object or events
• To alter behavior, alter the consequences
• Systematic desensitization
Emphasizes schemas, attention, and irrational interpretations and
their influence on behavior as major factors in psychopathology
• Has usually blended cognitive findings with the behavioral
in an approach to intervention that is referred to as the
cognitive behavioral (beck and ellis focused on altering
patients negative schemas and interpretations)
Chapter 2 Current Paradigms in Psychopathology
Diathesis-Stress
Integrates several points of view
Assumes that people are predisposed to react adversely to
environmental stressors.
Diathesis: underlying predisposition: m ay be genetic,
neurobiological, or psychological and may be caused by
Stress the triggering event, like early childhood experience,
genetically influenced personality trait, or sociocultural influences
• Diathesis is within a person (genetic neurobiological) and
stress is external to person
Chapter 2 Current Paradigms in Psychopathology
Epigenetics
Study of how the environment can alter gene expression or function
Rats born to mothers with low parenting skills and RAISED by mothers
with high parenting skills showed lower levels of stress reactivity, AND
increased gene expression implicated in stress response
Graph: having at least one short Allele means greater lilklihood of
developing depression.
Chapter 2 Current Paradigms in Psychopathology
Genetic Paradigm
Says that psychopathology is caused or influenced by heritable
factors. Heredity plays some role in most behavior!
Genes and the environment interact, and this leads to
psychopathology. Think of nature via nurture
Gene Exoression: proteins influence whether the action of a specific
gene will occur
Heritability: extent to which variability is due to genetics. Is a group
rather than an individual indicator
Shared environment: events and experiences family members have
in common
Nonshared environment: events and experiences unique to member
Chapter 2 Current Paradigms in Psychopathology
Psychoanalytic Paradigm
• Derives from the work of Freud
• Contemporary contributions are in treatment, including
ego analysis and brief therapy
• Criticized, but highlights importance of childhood
experience, the unconscious, and that causes of behavior
aren’t always obvious
Chapter 2 Current Paradigms in Psychopathology
Emotion (and factors across paradigms)
Plays a predominant role in a number of disorders
Expression, experience, and physiology of emotion can be disrupted
Expression: showing emotion
Experience: feeling it
Physiological: how the experience of the emotion affects
physiological state
• Disturbance of emotion seen in 90% of disorders
Other factors important in psychopathology: Culture, ethnicity,
gender, social support, relationships. Women more likely depressed
than men, social support determines success of therapy
Chapter 2 Current Paradigms in Psychopathology
Behavior Genetics
Study of individual differences in behavior attributable to differences
in genetic makeup
Genotype: genetic material inherited by an individual, unobservable
Phenotype: expressed genetic material, observable behavior and
characteristics
So phenotype = genotype + environment interaction!
Gene Environment Interaction: ones response to a specific
environmental event is influenced by genes, interaction is recipricol.
Chapter 2 Current Paradigms in Psychopathology
Neurotransmitters and Psychopathology
Norepenephrine: anxiety disorders
Seratonin and Dopamine: depression and schizophrenia
GABA: anxiety
Possible Mechanisms:
• Excessive or inadequate levels
• Insufficient reuptake
• Excessive number or sensitivity of postsynaptic neuron
Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology
Brain Structure and Function Autonomic Nervous System
Sulci: define regions or lobes Responsible for involuntary functions, involved in anxiety disorders
Frontal: thinking and reasoning abilities Sympathetic Nervous System: (fight or flight): excitatory functions
Parietal: touch recognition Parasympathetic Nervous System: quiescent function, except for
gastrointestinal activation
Occipital: recognition of sights and sounds, long term memory
Temporal: integrates visual input
Hemispheres: halves of the brain separated by corpus callosum
LEFT: speech and analytical thought
RIGHT: spatial relations and pattern re cognition

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology

HPA Axis (Neuroendocrine System) Contemporary Psychodynamic Paradigms
Involved in the stress response EGO ANALYSIS:
• emphasis on the ego vs ID
1) Hypothalamus triggers release of CRF
• focus on interaction with the environment
2) Pituitary gland releases ACTH through blood
3) Adrenal cortex triggers release of cortisol, stress hormone • current experience (vs childhood events)
• Proponents were Horney, Freud, Erikson, Rapaport, etc
Blood sugar elevated and metabolic rate increases

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology

Brief Psychodynamic Therapy Criticism of Psychoanalysis
• Time limited • No formal research
• Active therapist involvement • Inadequate and non-representative samples
• Concrete goals • Continuing impact
• Development of coping skill
• Current life and experiences GOOD POINTS…
• Transference downplayed Personality shaped by early childhood
Most in response to criticism from insurance companies that it takes Behavior influenced by unconscious
too long! Must have diagnosis within three sessions
Causes of behavior not always apparent or obvious

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology

Systematic Desensitization
Expose someone who has fear of object or event to what they fear in
combination with relaxation techniques
• Important treatment for anxiety disorders
Cognitive Science
Cognition: a mental process which includes perceiving, judging,
reasoning, conceiving, and recognizing
Schema: Organized network of previously accumulated knowledge
Role of attention in psychopathology: anxious individuals more likely
to attention to threatening stimuli

Chapter 2 Current Paradigms in Psychopathology Chapter 2 Current Paradigms in Psychopathology

Beck’s Cognitive Therapy Ellis’s Rational-Emotive Behavior Therapy

• Therapy that helped to identify and then change
maladaptive thought patterns.
“Nothing ever goes right for me!”
• Originally developed for depression (BDI) – depression
caused by information processing biases. Made patients
search for evidence as support of their biases
Identified and challenged patients’ irrational beliefs
Irrational beliefs: Internal, repetitive thoughts that reflect assumptions
abot the self
“in order to be happy, I must be loved!”
• Musts or shoulders that are commonly unrealistic
demandws that we place on ourselves and others
Eg people shouldn’t make mistakes”
Chapter 2 Current Paradigms in Psychopathology Chapter 3 Diagnosis and Assessment
Paradigms of Psycopathology Diagnosis and Classification
Diagnosis: provides the first step into thinking about causes of
symptoms and in planning treatment
Psychodynamic
Advantages:
Neurobiological
• Communication among professionals, clinical care
Cognitive-Behavioral
• Advances search for causes and treatments
Genetic
• Diagnosis is important – must be made within 3 sessions
Diathesis-Stress
Classification: of disorders is by symptoms and signs so the diagnosis
is a cluster of symptoms
**only in psychopathology does classification and diagnosis get hazy
because we don’t have discrete tests

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment

Reliability
Consistency of measurement
Inter-rater reliability: agreement of observers or clinicians. Why we
have the DSM – so two doctors from different backgrounds can
look at same patient and make same diagnosis (.7 is acceptable)
Test-retest reliability: similarity of scores across repeated test
administrations or observations (mood may not have it)
Alternate forms: similarity of scores on tests that are similar, but not
identical. Similar forms meant to test same thing should have
similar results… trying to test the same thing in a different way
Internal Consistency: extent to which items on a test are related to
one another
Validity
ACCURACY How well test measure what we are trying to find out
Content Validi: extent to which measure samples domain of interest
Criterion Validity: extent to which a measure is associated with
another measure
Concurrent means that two measures are given at same time
(Hopelessness and depression)
Predictive means the ability of the measure to predict another
variable measured at some future point in time (GPA and salary)
Construct Validity: correlating multiple indirect measures of the
attribute to give abstract construct legitimacy (if we find correlation)
DIAGNOSES in DSM are constructs, strong one predicts many char.

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment

DSM-IV-TR History of the DSM
Manuel used for making diagnoses
Diagnostic and Statistical Manual of Mental Disorders DSM-1952: Called “reactions” because thought that soldiers came
back from WWII and reacted to trauma
In the 4th edition, 5th by 2010, multiaxial system
DSM II 1968: Neuroses (disorders) and psycos (categories)
Published by American Psychological Association (APA)
DSM III (1980) major revision (disorders and multiaxial system)
Axis I: Clinical Disorders (come and go)
DSM III-R 1987
Axis II: Mental and Personality Disorder (permanent)
DSM IV TR background of disorders added
Axis III: general medical conditions
DSM V 2010?
Axis IV: Psychosocial and environmental factors
** Most concerned with inter-rater reliability and construct validity
Axis V: GAF Score (global assessment of functioning)

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment

Axis I Disorders
Childhood/Infancy/Adolescent Disorders: Learning and
Developmental Disorders
Substance related disorders
Schizophrenia and Psychotic disorders
Anxiety Disorders (GAD, Panic disorder, OCD
Mood Disorders (major depression and bipolar)
Eating Disorders (Anorexia nervosa and Bulimia Nervosa)
Improvements in DSM-IV-TR
Specific Diagnostic Criteria: less vague!
More extensive descriptions
• Essential features
• Associative features (lab findings)
• Differential diagnoses (helps to distinguish 2 disorders from
one another)
Increasing number of categories: comorbidity 45%
Issues and diagnostic categories in need of further study
Increased cultural sensitivity (cultura bound syndromes)

Chapter 3 Diagnosis and Assessment Chapter 3 Diagnosis and Assessment

Diagnosis: Cultural/Ethnic Influences Criticisms of the DSM
Culture can influence: Categorical vs Dimensional Diagnosis:
• Risk factor for disorder Categorical Classification: Yes or no, it’s there or not
• Symptoms experienced and how described Dimensional Classification: having more of a gradation, degree to
which a symptom is present
• Willingness to seek help
DIMENSIONAL better capture an individuals functioning
• Availability of treatments
CATEGORICAL has advantages for research and understanding, but
clinicians don’t like because a person might be impaired in certain
New DSM-IV-TR includes framework for evaluating role of culture and areas, but doesn’t meet full criteria
doesn’t get funded for
ethnicity, and a description of the cultural factors of each disorder treatment
Chapter 2 Current Paradigms in Psychopathology
Should we Classify in the first place?
Criticisms of classification:
• Label
stigma
Treated differently by others
Difficulty finding a job
Never goes away, changes to “in-remission”
• Categories don’t capture uniqueness of person, and don’t
define the person. Classification may emphasize trivial
similarities, and relevant information might be overlooked
Chapter 3 Diagnosis and Assessment
Psychological Assessment Methods
Interviews Clinical (pay attention to how questions answered, if
there is appropriate emotion) and Structured (on paper) Paradigm
influences information sought in interview. Good rapport is
essential.
Psychological Tests
Personality Tests (MMPI) self report measure yields profile of
psychiatric functioning with a subscale to catch fakers,
Projective Tests,: response to ambiguous stimuli reflect unconscious
process
Intelligence Tests: good for detecting mental retardation
Direct Observation Antecedents
consequence unit
Self Observation self monitoring, problem is reactivity
Chapter 3 Diagnosis and Assessment
Neurotransmitter Assessment
Post Mortum studies: look at brain after someone has died
Metabolite Assays: (byproduct of NT deactivation) can measure this
amount in the person’s body – but not great reflection of NT in brain
because is also gives NT in the entire body. Limited measure of
causation
Neuropsychologist: someone who studies how abnormalities in the
brain affect aa perons’s cognition, and behavior
Neuropsychological Tests: interviews that measure brain or cognitive
functioning (batteries)
Chapter 3 Diagnosis and Assessment
Cultural Bias and Assessment
Measures developed for one culture or ethnic group my not be valid
or reliable for another clture. Most are developed for white men, not
just a language barrier. But also a factor
Not just a matter of translation, meaning may be lost in translation
Cultural bias can lead to minimizing or exaggerating psychological
problems in people that come in for help
Chapter 4 Research Methods
Research Methods in Psychopathology
Case Study: Descriptive biographical information about an individual
Correlation: Relationship between two or more variables. No
manipulation by scientists, what is happening in nature. Most
common and easiest to conduct
Experimental Studies: Manipulation of an independent variable and
DV. DV is what we are looking fo9r change. And there is random
assignment
Chapter 3 Diagnosis and Assessment
Psychological Assessment
Techniques employed to:
• Have basis for making decision
• Describe client’s problem
• Determine causes and come to diagnosis
• Develop treatment strategy
• Monitor progress of treatment
Ideal assessment involves many measures and methods
(interviews, personality assessment, inventories)
Chapter 3 Diagnosis and Assessment
Neurobiological Assessment
Brain Imaging:
CT or CAT scan (computerized axial tomography): reveals structural
abnormalities by detecting differences in tissue density
MRI (magnetic resonance imaging): higher quality than CT
fMRI: allows to look at blood flow (blood oxygenation levels) as an
indication of neural activity. Structure and function
PET Scan: Positron Emission Tomography: Brain function, less
common, inject radioactive isotope, radioactively tagged glucose
emits positrons that are picked up from scanner
** not good methods for diagnosing disorder
Chapter 3 Diagnosis and Assessment
Psychophysiology
study of bodily changes that accompany psychological
characteristics or events. How behaviors and cognitions are linked
to these bodily changes
Electocardiogram (EKG): heart rate measured by electrodes placed
on chest
Electrodermal responding (skin conductance) : sweat gland activity
measured by electrodes placed on hand
Electroencephalogram (EEG): Brain’s electrical activity measured by
electrodes placed on scalp
Chapter 4 Research Methods
Terms of Research
Science: The systematic pursuit of knowledge
Theory: method of explaining and predicting phenomena that is
supported by empirical evidence taken as fact, set up to be
disproven
• A good theory is falsifiable
• A set of prepositions developed to explain what is
observed
Hypothesis Specific testable predictions about what will occur if a
theory is correct
Chapter 4 Research Methods
Case Study
Detailed biographical description of an individual
Family history, Medical history
Ethnicity, Gender, Personality and adjustment issues
Social support around them, day to day environment
Childhood
Educational background, and experience with therapy
Usefulness: rich description, good for hypothesis, rare disorders, good
for disproving hypothesis, also good hypothesis generator
Limitations: BIAS (paradigm may influence observations) Cannot rule
out altere explanations, and generalizability is limited
Chapter 4 Research Methods
Correlational Method
Correlational Coefficient ranges from -1 to 1
Direction Negative relationship: variables move in opposite directions
Positive relationship/correlation: variables move in same direction
Constant: no relationship
Strength (magnitude): the higher the absolute value, the stronger the
relationship
Statistical Significance: probability less than .05% something other
than chance is happening here! Larger samples increase likelihood
that result is significant
CORRELATION DOES NOT IMPLY CAUSATION (confounding variable)
Chapter 4 Research Methods
Correlational: Epidemiological Research
Study of the distribution of disorders in a population
Three features of a disorder
• Prevalence: number of cases that are here long
• Incidence: number of new cases that occur
• Risk Factors: associated with higher chance of having a
disorder (men vs women)
Chapter 4 Research Methods
The Experiment
Provides information about ausal relationships (does x cause y?)
involves Independent variable, DV, Random assignment
Can evaluate treatment effectiveness – most often used in
psychopathology research
Internal validity: extent to which experimental effect is due to
independent variable (so if groups differ too much, bad thing!
GOOD internal validity means that change is probably due to
experiment
Control Group: People that don’t receive treatment, the standard
against which treatment effectiveness is judged (placebo)
External Validity: extent to which results generalize beyond study
Chapter 4 Research Methods
Single Subject Experimental Research
Examine how individual participants respond to changes in the
independent variable
Reversal ABAB Design (girl in book that was afraid of sharp foods)
Baseline (A)
Treatment (B)
Withdrawal (A)
Reinstatement (B)
Chapter 5: Anxiety Disorder
Fear vs Anxiety
Anxiety: apprehension about a future threat
Fear: response to an immediate threat – the present oriented mood
state triggers the fight or flight response
**both can be adaptive: May save life (fear) and anxiety can
increase preparedness (improve performance)
Chapter 4 Research Methods
Longitudinal vs Cross Sectional Study
Longitudinal: study done over many years with the same people to
see if causes are present before disorder develops
High Risk Model: include only those who are at greatest likelihood of
developing a disorder – reduces the cost of longitudinal research
Cross Sectional Design: looking at simultaneous factors, taking data
at one point in time and looking at two different things, causes at
effects measured at the same time.
Chapter 4 Research Methods
Correlational: Behavioral Genetics
Index cases/Probands: people who actually have the illness, a
sample of individuals with psychopathology
Concordance: Co-occurencec or similarity of diagnosis (concurrent
people have the same diagnosis)
Family studies: degree to which people are related in a family, and
relationship of degree of relatedness and degree of disorder
Twin Studies Monozygoric twins : 100% genes Dizygotic twins 50%
Adoptee Method: Study of adoptees who have biological parents
with psycopathology
Cross Fostering: Study of adoptees who have adoptive parents with
psychopathology
Chapter 4 Research Methods
Analogue Experiment
Experiments that aren’t possible in psychopathology (if not ethnical)
we can examine related or similar behavior in the lab… people with
a certain diagnosis may come into the lab, and then there is a
manipulation done…
• Elicit symptoms
• Select samples with similar attributes
• Animal research
Chapter 4 Research Methods
Integrating Findings from Multiple Studies
Meta Analyses: allows us to come to some conclusion about if
hypothesis supported
• Identify relevant studies
• Compute effect size (transform to common scale)
• Smith et al meta analyzed 475 outcome studies and said
that psychotherapy is effective
Chapter 5: Anxiety Disorder
Anxiety Disorders
Deal with atypical, maladaptive levels of anxiety. As a group are the
most common psychiatric disorders. 25% of people report anxiety at
some point, phobias most common
Major Anxiety Disorders:
• Specific phobia or social phobia
• Panic Disorder
• GAD
• OCD
• PTSD
• Acute Stress Disorder
Chapter 5: Anxiety Disorder
Phobia
Disruptive fear of a particular object or situation that causes concern
• Fear out of proportion to actual threat
• Realization that is excessive
• Symptoms must interfere with job or social life
Two types: specific and social
Animals (snake most common)
Situations
Blood, infection, injury (only parasympathetic response)
Natural environment - Comorbid with physical disorders
Chapter 5: Anxiety Disorder
Social Phobia
Persistent, intense fear of social situations
• Fear of attention, scrutiny, evaluation
• 33% also diagnosed with avoidant personality disorder
• Often beings in adolescence
• Depends on range of situations avoided, could be
Generalized or specific
Chapter 5: Anxiety Disorder
Treatment of Phobias
Psychological treatments that emphasize exposure procedure – fqce
what triggers anxiety, and see that it’s not so bad
Systematic desensitization: relaxation plus imagined exposure to
feared object. For social phobia, might be exposure in small group
setting/interaction.
Also use social skills training to reduce use of safety behaviors
Cognitive Therapy: good for social phobias but not specific phobias,
because specific phobia people KNOW they have distorted beliefs,
and most of cognitive therapy is figuring that out.
Medication: but if affect fear response system not as great because
we don’t get symptoms when exposed to what we fear.
Chapter 5: Anxiety Disorder
Etiology of Panic
Neurobiological Factors LC (norepenephrine)
Genetic predisposition (identical twins: 30% chance)
Interoceptive conditioning: classical conditioning response to
somatic symptoms
Cognitive Factors: fear of bodily changes and fear of fear hypothesis
Exoectations about negative consequences of attack in public
Chapter 5: Anxiety Disorder
War Article
Greater Risk: those with greater threat of loss or actual loss
Those with fewer coping resources
Chapter 5: Anxiety Disorder
Etiology of specific phobia
Mowrer’s Two Factor Model:
Step 1: Classical Conditioning: pairing of stimulus with aversive UCS
leads to fear (classical conditioning) so we are attaching fear to an
unconditioned stimulus based on a bad experience
UCS = dog bite (seeing, hearing about, experiencing)
Step 2: Operant conditioning: avoidance maintained through
negative reinforcement… avoiding what we are afraid of to ease
anxiety and feel good
Problems: many people never experience interaction with aversive
object (what if they dob’t remember?) specific types alludes to
prepared learning (innate)
Chapter 5: Anxiety Disorder
Etiology of Social Phobia
Two Factor Model
• Avoidance and safety behaviors
Safety behaviors may actually make other person uncomfortable
(looking away, fidgeting) to make first person even more awkward
• Cognitive factors
Negative self evaluation
Fear of negative evaluation by others
High standards and performance in front of others
Chapter 5: Anxiety Disorder
Panic Disorder
Marked by frequent panic attacks that are unrelated to specific
situations… bouts of unexplainable anxiety
• Must also be worried about having attacks in the future
• At least one month after the first case
Sudden intense episode of apprehension, fear, impending doom.
• Sweating, nausea, labored breathing, dizziness, heart
palpitations,
Depersonalization: feeling like out of own body
Derealization: feel like things around you aren’t real. Can be cued or
uncued
Chapter 5: Anxiety Disorder
Treatment of Panic and Agoraphobia
PCT (panic control therapy)
• Exposure to somatic sensations with relaxation and
hierarchy
Cognitive Behavioral Therapy: Increase awareness of thoughts about
physical sensations, patients learns to challenge maladaptive beliefs
Chapter 5: Anxiety Disorder
Symptoms of Anxiety Disorders
Somatic, emotional, cognitive, and behavioral
Chapter 5: Anxiety Disorder
Generalized Anxiety Disorder (GAD)
Trademark symptom: constant worry, lasts at least 6 months
• Restlessness, fatigue, interferes with daily life, often begins
in adolescence
Etiology of GAD: GABA deficits
Borkovec’s cognitive model: worry is reinforcing because it distracts
from negative emotions and images that may be more painful for a
person to confront – worry is tolerable compared to this. There is no
exposure, so anxiety never distinguishes.
Treatment: cognitive behavioral models, challenge and modify
negative thoughts, increase ability to tolerate uncertainty, worry only
during scheduled times
\
Chapter 5: Anxiety Disorder
Treatment of OCD
Exposure plus response prevention (ERP): most widely used treatment
– enduce something to cause to perform compulsion, then NOT let
them do that, then gradually expose t anxiety, and extinguish
compulsion.
Cognitive Therapy: challenge beliefs about anticipated
consequences of not engaging in compulsion
Medication
Chapter 5: Anxiety Disorder
Obsessive Compulsive Disorder (OCD)
Obsessions: intrusive, recurring and uncontrollable thoughts or urges
that are experienced as irrational. Most common are
contamination, sexual, and aggressive
Compulsions: impulse to repeat certain behaviors or mental acts.
Extremely difficult to resist the impulse, may involve elaborate ritual
Etiology: Hyperactive regions of the brain (Anterior cingulate,
orbitofrontal cortex, Caudate nucleus). Operant reinforcement:
compulsions are negatively reinforced by reduction of anxiety.
Person wants to engage in compulsion to get rid of anxiety
generated by obsessions.
Chapter 5: Anxiety Disorder
PTSD (Post traumatic stress disorder)
Extreme response to severe stressor, event leads to intense fear of
helplessness, for diagnosis symptoms must be present for at least a
month
Symptoms
1) Reexperiencing the traumatic event
2) Avoidance of stimuli (avoid situations or numbing)
3) Increased arousal (startle response, hypervigilance)

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder

Etiology of PTSD Treatment of PTSD
Nature of trauma: highest risk most severe trauma) • Exposure to memories and reminders of original trauma
Neurobiological: Smaller hippocampal volume, increases receptor Either direct (in vivo) or imaginal, treatment may originally
activity to cortisol INCREASE symptoms
Behavioral: two factor model Cognitive Therapy: enhance beliefs about coping abilities
Psychological Medications:
Perception of control Treatment of ASD may prevent PTSD
Avoidance coping, dissociation, memory suppression

Chapter 5: Anxiety Disorder Chapter 5: Anxiety Disorder

Acute Stress Disorder Comorbidity Anxiety Disorder
Symptoms of ASD are similar to PTSD ¾ with anxiety disorder have another disorder
Duration is what is different (short term reaction) 60% meet criteria for major depression
Experienced by 90% of rape victims ½ individuals with anxiety disorder meet criteria for another one
More than 2/3 with ASD develop PTSD General and Sociocultural Factors
Genetics; twin studies suggest heritability for phobias
Neurobiological: overactive fear circuit (and amygdale)
NT: serotonin, gaba, NP

Chapter 5: Anxiety Disorder Chapter 6: Somatoform Disorders

Risk Factors Anxiety Disorder Somatoform Disorders
Cognitive: perceived control (those who believe have little control Pain Disorder
are more vulnerable) and attention to threat (pay more attention)
Body dysmorphic disorder
Social: negative life events often precede disorder onset
Hypochondriasis, Somatization disorder
Conversion Disorder
Psychosomatic Disorders: Physical illness present, psychological
factors contribute to illness
Malingering: Deliberate faking of physical symptoms to avoid
unpleasant situations
Factitous Disorder: Deliberate faking of physical symptoms to gain
medical attention
Chapter 6: Somatoform Disorders
Pain Disorder
Person experiencing severe, prolonged pain
Cannot be accounted for by organic pathology
Is caused or intensified by psychological factors like stress
Individual is unaware of psychological origins
Diagnosis is challenging
Chapter 6: Somatoform Disorders
Body Dysmorphic Disorder
Some sort of defect with the body focus
Preoccupation with and extreme distress over imagined or
exaggerated defect in appearance
Attempt to camoflague or hide defect
½ have suicidal thoughts, onset is adolescence, sluightly more
common in women than men, prevalence less than 1%
High levels of comorbidity:
Some think BDD and OCD are the same thing

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders

Hypochondriasis
Preoccupation with fears of having a serious disease, despite
medical assurance, lasting at least six months
Usually critically of medical professionals
Onset is typically early adulthood, and is comorbid with anxiety and
eating disorders
Somatization Disorder
Someone with physical symptoms (with no apparent cause) that
would warrant medical attention, but are calm, accepting, stoic
about it.
Maybe people feel that distress is more appropriately expressed through
physical symptoms?

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders

Etiology of Conversion Disorder Conversion Disorder
Psychoanalyic perspective: Individual experiences distressing Lose functioning in different parts of the body
event, and unable to express emotional distress, so memory of
event pushed into unconscious Sensory or motor function impaired but no known neurological cause
In women linked to electra complex
Vision impairment, seizures, coordination problems, Anesthesia,
No empirical support Aphonia, Anosmia, La Belle Indifference
Social and Cultural Factors: Decrease in incidence since first half of
19th century, does it have to do with more repressed sexuality?
• More prevalent in rural areas and lower SES, and in non Onset: usually occurs after significant stressor
western cultures
Cormorbid with substance abuse, personality disorder, BDD,
Cognitive Behavioral Model: preoccupation with body or physical
health, gross misinterpretation of symptoms/feelings, negative prevalence less than 1%
thoughts exacerbate symptoms
Somatization disorder has symptoms in several areas of body,
conversion is localized to sensory and motor function

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders

Etiology of Conversion Disorder
Psychoanalyic perspective: Individual experiences distressing
event, and unable to express emotional distress, so memory of
event pushed into unconscious
In women linked to electra complex
No empirical support
Social and Cultural Factors: Decrease in incidence since first half of
19th century, does it have to do with more repressed sexuality?
• More prevalent in rural areas and lower SES, and in non
western cultures
Treatment Somatoform Disorder
Pain Disorder: antidepressants and psychotherapy (validate pain,
teach relaxation, and coping strategies)
BDD: Antidepressants and CBT (also for hypochondriosis and
somatization disorder)
Somatization Disorder: validate physical complaints, minimize use
of tests and medicine, avoid prolonging attention, treat underlying
depression and anxiety
Conversion Disorder: Reinforcement of high functioning behavior
may help

Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders

Dissociative Disorders
Disruption of consciousness, but more severe in disorders
Defining feature is disruption in consciousness, memory, or identity
All experience dissociation at some level, like zoning out :P lala…
Dissosicate identity Disorder (DID)
Used to be multiple personality disorder
Each with unique behaviors, relationships, and memories
Memory gaps are common when alters are in control

Dissociative amnesia Rare disorder! Symptoms: headache, hallucination, self harm suicide
attempts
Dissociate fugue
Depersonalization disorder Comorbid with: PTSD, depression, borderline personality disorder,
substance abuse, phobias
Dissociative Identity Disorder DID
More common in women than men
** best way to study is with case study
Chapter 6: Somatoform Disorders Chapter 6: Somatoform Disorders
Epidemiology DID Treatment of DID
Major increase in diagnosis since 1970s because of media attention Mainstays of most treatments:
DSM III (1980) made more explicit diagnostic criteria to address this Empathetic support of therapist REALLY important
surge
Integration of alters into one fully functioning individual
Etiology of DID, Two major theories
Improved coping skills
Posttraumatic model: results from sever psychological and or sexual
Psychoanalytic approach adds Re-experience the traumatic event
abuse as child
thought to underly the disorder (hypnosis)
Sociocognitive model Is a form of roleplay in suggestible individuals
Can be done by hypnotized students
Only partial memory deficit in DID patients
Differs by clinicians, few clinicians diagnose, after therapy starts
gnose the majority of cases
Chapter 6: Somatoform Disorders Chapter 7: Stress and Health
Summary of Somatoform Disorders Defintiions
Features somatoform disorders: physical problems without organic
cause Coping: how people try to deal with problems
Features dissociative disorders: extreme distortions in perception, Social Support
memory, or identity Structural: person’s basic network of social relationships (marital
status and friends)
Functional: quality of a person’s relationships
BOTH rare but we have quote few movies because they are Stress: Body’s alarm reaction
Resistance
Exaustion
interesting
Allostatic load: price body pays in response to stress and high levels
of cortisol, becomes more susceptible to disease

Chapter 7: Stress and Health Chapter 7: Stress and Health

Psychophysiological Disorder Cardiovascular Disease
Include hypertension and coronary heart disease
Physical diseases produced or influenced in part by psychological
factors of stress, social support, and negative emotions Etiiology: tendency to respond to stress with increases in blood
pressure or heart rate Anger, hostility, cynicism, anxiety, are linked to
• Life stress is relevant to all disorder, so appears on Axis III
these conditions
Etiology diathesis: stress in nature, but stress described in
psychological or biological terms
Biological diathesis: emphasize effects of allostatic load or changes
in the immune system caused by stress
Psychological diathesis: emphasize focus on how emotional states,
personality traits, cognitive appraisals, and specific types of coping
with stress

Most successful accounts of etiology are those that integrate both

Chapter 7: Stress and Health Chapter 7: Stress and Health

Asthma AIDS
Respiratory systems overresond to allergies or have been weakened Arises from behavior that appears irrational and generally is
by prior infection preventable by psychological means

Focus of prevention is to change people’s behavior - to promote

Psychological factors are anger, anxiety, depression, stressful life safer sex and discourage sharing of needles
events, and family conflict

Chapter 7: Stress and Health

Treatment Psychophysiological Disorder
Physical dysfunction is valid – so medication used
Primary aim is to reduce stress, anxiety, depression, or anger
Focus is on changing unhealthy behavior, encouraging breast self
exam, intervention, adhering to medical treatment intervention
Stress Management Intervention: help people without diagnosable
problems avail themselves of techniques that allow them to cope
with the inevitable stress of everyday life and ameloriate toll of stress
on body.