● In the 19th century, Dorothea Dix led reform efforts for

Module 1: Understanding Abnormal mental health care in the United States

Behavior
Emil Kraepelin: founder of modern scientific psychiatry,
Mental disorder psychopharmacology, and psychiatric genetics and believed
the chief origin of psychiatric disease to be biological and
● a condition characterized by thoughts, feelings, and genetic malfunction
behaviors that create dysfunction.
● Dementia praecox: Kraepelin’s definition for what we
● Can impair a person’s relationships and disrupt their now call schizophrenia; the "sub-acute development
ability to live their life productively, think clearly, of a peculiar simple condition of mental weakness
communicate with others, hold a job or deal with occurring at a youthful age”
stressful events
● Syndrome: common patterns of symptoms over time
Psychopathology: the study of psychological disorders and (rather than by simple similarity of major symptoms)
their symptoms
Current Mental Health Services
Etiology: the causes of disorders
1. Biopsychosocial model: model emphasizing the
“Four D’s”: criteria in defining psychological disorde rs various factors influencing disorders. While some
have a genetic predisposition for a certain
1. Deviance psychological disorder, certain psychological
stressors need to be present for them to develop the
2. Dysfunction disorder.
3. Distress
4. Danger: ● Involuntary treatment: therapy that is not the
individual’s choice. Other individuals might voluntarily
Psychological disorder consists of: seek treatment.
● Voluntary treatment: the individual chooses to attend
● Significant disturbances in thoughts, feelings, and therapy to obtain relief from symptoms
behaviors which: ● 18.9% of U.S. adults experienced mental illness in
2017
● reflect some kind of biological, psychological, or ● Similar for teens
developmental dysfunction ● Approximately 13% of children ages 8–15 experience
● lead to significant distress or disability in one’s life mental illness in a given year
● do not reflect expected or culturally approved
responses to certain events

Ancient Views of Mental Illness 2. DSM-V Basic Features: Diagnostic and Statistical
Manual of Mental Disorders (DSM-5):
Etiological Theories:
● Published by the American Psychiatric Association
1. Supernatural theories: attribute mental illness to ● The DSM-5 includes many categories of disorders
possession by evil or demonic spirits, displeasure of (e.g., anxiety disorders, depressive disorders, and
gods, eclipses, planetary gravitation, curses, and sin. dissociative disorders).
● Each disorder is described in detail, including an
2. Somatogenic theories: identify disturbances in overview of the disorder (diagnostic features), specific
physical functioning resulting from either illness, symptoms required for diagnosis (diagnostic criteria),
genetic inheritance, or brain damage or imbalance. prevalence information (what percent of the
3. Psychogenic theories: focus on traumatic or population is thought to be afflicted with the disorder),
stressful experiences, maladaptive learned and risk factors associated with the disorder
associations and cognitions, or distorted perceptions
Comorbidity: the co-occurrence of two disorders
Trephination: as early as 6500 BC has identified surgical
drilling of holes in skulls to treat head injuries and epilepsy as Major Disorder Categories of DSM-V
well as to allow the evil spirits trapped within the skull, that
were presumed to be causing the symptoms of mental disorder The DSM-5 begins with neurodevelopmental disorders and is
divided into 22 chapters that include sets of related disorders.
Deinstitutionalization
1. Internalizing problems: depression, anxiety, social
Asylums: the first institutions created for the specific purpose anxiety, somatic complaints, post-traumatic
of housing people with psychological disorders symptoms, and obsession-compulsion

● The focus was ostracizing them from society rather 2. Externalizing problems: disruptive, impulse-control,
than treating their disorders conduct disorders and substance use

● Late 1700s, a French physician, Philippe Pinel, International Classification of Diseases: ICD-11:
argued for the more humane treatment of the mentally
ill
 ● the 11th revision of the International Classification of ● The inclusion of dimensions in diagnoses; for
Diseases and will eventually replace the ICD-10 as example, how severely ill is a patient with
the global standard for coding health information and schizophrenia or depression
causes of death.
Negative:
● Will officially come into effect on January 1, 2022
● In conjunction with changes in DSM-5, the ICD-11 will ● Limitations reflected in the terminology related to
help harmonize the two classification systems diagnosis itself
● A study that compared the use of the two
classification systems found that worldwide, the ICD ● Since the DSM III, the goal was to improve the
is more frequently used for clinical diagnosis, whereas uniformity and validity of psychiatric diagnosis in the
the DSM is more valued for research wake of a number of critiques
● Most research findings concerning the etiology and ● Critics believe the DSM needs to become more
treatment of psychological disorders are based on sensitive to the importance of cultural and ethnic
criteria set forth in the DSM factors in diagnostic assessment
● DSM is the classification system of choice among
U.S. mental health professionals, and the modules in Classification and Labeling Problems
this course are based on the DSM paradigm.
1. Labeling: occurs when information about a person's
Steps of the Diagnostic Process diagnostic classification is communicated in a
negative manner that leads to stigma for the individual
1. Diagnosis: commonly refers to the identification of with a mental disorder
the nature and cause of an illness
● The labeling theory was first applied to the term
2. Clinician: a professional who works directly with "mentally ill" in 1966 when Thomas J. Scheff
patients or clients and may diagnose, treat, and published Being Mentally Ill.
otherwise care for them ● Labeling theory: posits that self-identity and the
3. Mental status examination: where evaluations are behavior of individuals may be determined or
made of appearance and behavior, self-reported influenced by the terms used to describe or classify
symptoms, mental health history, and current life them
circumstances ● Labeling theory is associated with the concepts of
4. Principal diagnosis: determining the single self-fulfilling prophecy and stereotyping.
diagnosis that is most relevant to the person's chief
complaint or need for treatment
- this will be the main focus of clinical attention
or treatment 2. Mental Illness Stigma: Some negative stereotypes
5. Comorbidity: the presence of more than one about individuals with mental health problems are that
diagnosis occurring in an individual at the same time they are considered dangerous, unpredictable, and
6. Clinical formulation: a theoretically-based difficult to talk to.
explanation of the information obtained from a clinical
assessment 3. Stereotype: an expectation that people might have
7. Cultural formulation: the systematic review of a about every person of a particular group.
person's cultural background and the role of culture in 4. Public stigma: a set of negative attitudes and beliefs
the manifestation of symptoms and dysfunction that motivate individuals to fear, reject, avoid, and
8. Treatment plan: type of contract that specifies the discriminate against people with mental illness.
goals of treatment, treatment procedures, and a 5. Self-stigma: is thought to be particularly damaging,
regular schedule for the time, place, and duration of and is said to occur when individuals internalize
their treatment sessions stigmatizing social attitudes, and come to believe the
negative societal conceptions and stereotypes
Arguments for/against DSM-5 associated with their condition
6. Stigma expectations: “the extent to which individuals
Positive: believe that ‘most people’ will devalue and
discriminate against a mental patient” do not differ
● Wide acceptance and use of the DSM system between individuals with and without mental health
problems or history of treatment
● Revisions of the DSM from the 3rd Edition forward
have been mainly concerned with diagnostic Types and Purposes of Psychological Assessment
reliability—the degree to which different
diagnosticians agree on a diagnosis 1. Psychological tests: written, visual, or verbal
● Useful to insurance companies who adopt its use to evaluations administered to assess the cognitive and
establish coverage for certain clinical disorders emotional functioning of clients or patients.
● Helpful in allowing researchers and clinicians to have
a common language with which to discuss clients 2. Standardized tests: are administered and scored in
● DSM-IV organized diagnoses using five separate a consistent manner and the questions, conditions for
axes (clinical disorders, personality disorders, general administering, scoring procedures, and interpretations
medical disorders, and then sections on psychosocial are consistent and are administered and scored in a
and environmental factors, and the global assessment predetermined, standard manner
of functioning)
 3. Psychological assessments are most often used in a. IQ or Intelligence Quotient: the score derived by
the psychiatric, medical, legal, educational, or dividing a child’s mental age by their chronological
psychological clinic settings age to create an overall quotient (Stanford-Binet is
4. Intelligence & achievement tests: Designed to well known and was standardized)
measure certain specific kinds of cognitive functioning b. Wechsler Adult Intelligence Scale (WAIS): made up
(often referred to as IQ) in comparison to a norming of a pool of specific abilities and assesses people's
group ability to remember, compute, understand language,
5. Personality tests: aim to describe patterns of reason well, and process information quickly
behavior, thoughts, and feelings c. Wechsler Intelligence Scale for Children (WISC):
6. Neuropsychological tests: consist of specifically an individually administered intelligence test for
designed tasks used to measure psychological children between the ages of 6 and 16
functions known to be linked to a particular brain d. Kaufman Assessment Battery for Children
structure or pathway (KABC): a clinical instrument for assessing cognitive
7. Diagnostic Measurement Tools: Clinical development and incorporates several recent
psychologists are able to diagnose psychological developments in both psychological theory and
disorders and related disorders found in the DSM-5 statistical methodology.
and ICD-10
8. Clinical observation: Clinical psychologists are also
trained to gather data by observing behavior

Clinical Interviews and Mental Status Exam

4. Personality Testing
1. Clinical interview: a face-to-face encounter between
a mental health professional and a patient in which a. Self-report inventories: a kind of objective test used
the former observes the latter and gathers data about to assess personality
the person’s behavior, attitudes, current situation, - standardized questions with fixed response
personality, and life history. categories that the test-taker completes
independently.
Types of Interviews: b. Minnesota Multiphasic Personality Inventory
(MMPI): The original MMPI was based on a small,
a. Unstructured: questions are open-ended and not limited sample, composed mostly of Minnesota
prearranged. farmers and psychiatric patients.
- Now the responses are scored to produce a clinical
- More informal and free flowing than a profile composed of 10 scales: hypochondriasis,
structured interview, much like an everyday depression, hysteria, psychopathic deviance,
conversation. masculinity versus femininity, paranoia,
b. Structured: a specific set of questions according to psychasthenia, schizophrenia, hypomania, and social
an interview schedule are asked introversion.
- Can provide a diagnosis or classify the
client’s symptoms into a DSM-5 disorder
c. Semi-structured: a list of questions are pre-set but
clinicians are able to follow up on specific issues that 5. Projective testing: sometimes called
catch their attention. performance-based testing

2. Mental status examination: a medical process 6. Rorschach Inkblot Test: a series of symmetrical
where a clinician working in the field of mental health inkblot cards that are presented to a client by a
systematically examines a patient’s mind and the way psychologist
they look, think, feel and behave.
- what the test-taker sees reveals unconscious feelings
- a structured way of observing and describing a and struggles.
patient’s psychological functioning at a given point in
time, under the domains of appearance, attitude,
behavior, mood, and affect, speech, thought process,
thought content, perception, cognition, insight, and 7. Thematic Apperception Test (TAT): a person taking
judgment. the TAT is shown 8–12 ambiguous pictures and is
asked to tell a story about each picture the stories
give insight into their social world, revealing hopes,
fears, interests, and goals
3. Intelligence Testing

● Intelligent testing is important for children who seem

to be experiencing learning difficulties or severe 8. Rotter Incomplete Sentence Blank (RISB): there
behavioral problems. are three forms of this test for use with different age
● can be used to ascertain whether the child’s groups: the school form, the college form, and the
difficulties can be partly attributed to an IQ score that adult form.
is significantly different from the mean for her age
group
 - People are asked to complete as quickly as possible,
and it is presumed that responses will reveal desires, Descriptive Research
fears, and struggles.
studies used to describe general or specific behaviors and attributes
Cognitive and Behavioral Assessments that are observed and measured

1. Cognitive assessments: are useful to test for

cognitive or neurological impairments, deficiencies in 1. Case studies: intensive studies of individuals
knowledge, thought process, or judgment ● Fruitful way to come up with hypotheses and generate
theories.
a. MMSE: usually takes less than ten minutes to ● Do not lend themselves to generalizability.
administer but is now used less frequently due to
copyright laws and additional costs. 2. Single-case experimental design: the same research
b. MoCA: a popular screening tool that evaluates participant
visuospatial skills, attention, language, abstract ● serves as the subject in both the experimental and control
reasoning, delayed recall, executive function, and conditions.
orientation ● Particularly useful for studies of treatment effectiveness
c. Mini-Cog: one of the faster cognitive assessment
screens used. Tests memory, while the clock drawing 3. Naturalistic observation:observing behavior in its natural
test evaluates cognitive function, language, executive setting
function, and visuospatial skills
4. Surveys: lists of questions to be answered by research
2. Behavioral assessment :involves the identification participants
and measurement of particular behaviors and the variables ● Can be delivered as paper-and-pencil
affecting their occurrence questionnaires,administered electronically, or conducted
verbally
a. Child Behavior Checklist (CBCL): a widely used
caregiver report form identifying problem behavior in 5. Sample: is a subset of individuals selected from a
children and examines: Aggressive Behavior, population, which is the overall group of individuals that the
Anxious/Depressed, Attention Problems, researchers are interested in.
Rule-Breaking Behavior, Somatic Complaints, Social
Problems, Thought Problems, Withdrawn/Depressed

Module 2: Research and Ethics in

Archival, Longitudinal, Cross-Sectional and
Abnormal Psychology Epidemiological Research

Scientific Research and the Scientific Method

The basic steps in the scientific method are: 1. Archival research: relies on looking at past records or data
sets to look for interesting patterns or relationships.
1. Observe a natural phenomenon and define a question
about it 2. Longitudinal research: a research design in which
data-gathering is administered repeatedly over an extended
2. Make a hypothesis, or potential solution to the period of time.
question
3. Test the hypothesis
3. Cross-sectional research: a researcher compares multiple
4. If the hypothesis is true, find more evidence or find
segments of the population at the same time
counter- evidence
5. If the hypothesis is false, create a new hypothesis or
try again 4. Epidemiological method: examines rates of occurrence of
6. Draw conclusions and repeat--the scientific method is abnormal behavior in the population as a whole and in
never- ending, and no result is ever considered various subgroups classified according to factors such as
perfect race, ethnicity, gender, or social class

A theory is a well-developed set of ideas that propose an

explanation for observed phenomena that can be used to
make predictions abou future observations. Prevalence and Incidence

A hypothesis is a testable prediction that is arrived at logically Often, occurrence of a single disease entity is set as an event.
from a theory Events can be characterized by:

1. Incidence rates: the number of new cases occurring

during a specific period of time
2. Prevalence rates: the overall number of cases of a
disorder existing in the population during a given
period of time
 Ethical Standards and Concerns in Abnormal
Correlational Research
Psychology

1. Correlation: there is a relationship between two or more Human and Animal Research Regulations
variables (such between the variables of negative thinking
and depressive symptoms), but this relationship does not
necessarily imply cause and effect 1. Institutional review board (IRB): is a committee of
individuals often made up of members of the institution’s
2. Correlation coefficient: is a number from -1 to +1 that administration, scientists, and community members
indicates the strength and direction of the relationship - The purpose of the IRB is to review proposals for research
between variables that involves human participants

3. A positive correlation means that the variables move in the 2. Informed consent: form provides a written description of
same direction what participants can expect during the experiment,
including potential risks and implications of the research
4. A negative correlation means that the variables move in
opposite directions 3. Deception: involves purposely misleading experiment
participants in order to maintain the integrity of the
experiment, but not to the point where the deception could
be considered harmful.

Experimental Process in Abnormal Psychology 4. Debriefing: complete, honest information about the
purpose of the experiment that participants must receive
upon conclusion of the study

1. Scientific Experiment: the only way to establish that there is

a cause-and-effect relationship between two variables Institutional Animal Care and Use Committee (IACUC): committee
is charged with ensuring that all experimental proposals require the
2. independent variable: manipulated or controlled by the humane treatment of animal research subjects
experimenter.

3. Dependent variable: what the researcher measures to see

how much effect the independent variable had
APA Ethics Code
4. Experimental group: gets the experimental manipulation or
the treatment or variable being tested Competencies: a measurable pattern of knowledge, skill, abilities,
behaviors, and other characteristics that an individual needs to
5. Control group: does not get experimental manipulation perform work roles or occupational functions successfully

6. Operational definition: a description of how we will measure Core competency: a harmonized combination of multiple resources
our variables\ and skills that distinguish a firm in the marketplace
- important in allowing others to understand exactly how and
what a researcher measures in a particular experiment
Principle A: Beneficence and Non- maleficence
7. Placebo effect: occurs when people's expectations or beliefs
influence or determine their experience in a given situation
Principle B: Fidelity and Responsibility

Principle C: Integrity
Reliability and Validity

Reliability and validity are two important considerations that Principle D: Justice
must be made with any type of data collection.

1. Reliability refers to the ability to consistently produce Principle E: Respect for People's Rights and Dignity
a given result and any instruments or tools used to
collect data do so in reproducible ways.
2. Validity refers to the extent to which a given
instrument or tool accurately measures what it’s
supposed to measure Ethics and Expectations of Psychologists

Ethics Code also describes ethical standards related to

situations many psychologists may encounter in their
professional roles.
 Epigenetics: a newer field of study shedding light on how
social, psychological, and environmental influences can
actually change which genes in a person's DNA may activate
or may be turned off, having significant implications for the
Ethics Code (Ten Standards): development of disorders

1. Resolving ethical issues Biopsychosocial Model in Psychopathology

2. Competence
3. Human relations Biopsychosocial model (BPS): instead of the medical model
4. Privacy and confidentiality that emphasizes mental illness as disease, this model strives
5. Advertising and public statements for a more holistic approach by recognizing that each patient
6. Record keeping and fees has their own thoughts, feelings, and history
7. Education and training
8. Research and publication 1. Biological: genetic inheritance related to risk of
9. Assessment developing a disorder, malfunctions or disruptions of
10. Therapy the system of neural transmission between neurons in
the brain
Forensic Issues in Treatment - potential damage to parts of the brain, infections or
diseases that might affect brain or nervous system
1. Tarasoff v. Regents of the University of California functioning, and hormonal influences or
(1976): brain-hormone interactions, etc.
- The Supreme Court of California held that mental 2. Psychological: thoughts, feelings, and behaviors
health professionals have a duty to protect individuals including learned behaviors (conditioning or observed
who are being threatened with bodily harm by a behaviors), thought patterns that increase or intensify
patient. emotions like sadness or anxiety
2. Involuntary commitment: a mental illness impairs a - can include events occurring during key
person’s ability to reason to such an extent that the developmental stages in life, strengths and
agents of the law, state, or courts determine that weaknesses, inability to cope with different life
decisions will be made for the individual stressors, sense of confidence or self- efficacy,
3. Right to treatment: federal minimum standards for the personality development, etc.
care of people with mental illness or intellectual 3. Social/cultural: external situations that can shape how
development disorders (intellectual disabilities) who people respond to events and other people, often by
reside in institutional settings. influencing the degree of stress a person experiences
4. Insanity defense: an affirmative defense by excuse in in their life
a criminal case, arguing that the defendant is not
responsible for their actions due to an episodic or Diathesis-Stress and Gene-Environment Models
persistent psychiatric disorder at the time of the
criminal act 1. Diathesis-stress model: helps us understand why one
5. American Law Institute Model Penal Code rule: person might develop a disorder, or why two people
recommended rule for instructing juries how to find a from similar backgrounds might develop different
defendant in a criminal trial is not guilty by reason of disorders
insanity - diathesis (usually genetic or biological) and
6. Incompetent: used to describe persons who should environmental stress, are necessary in the
not undergo or partake in certain judicial processes, development of a disorder
and also for those who lack mental capacity to make 2. Threshold: a point at which the person's coping
contracts, handle their financial and other personal abilities and social, psychological, and biological
matters such as consenting to medical treatment, and defenses cannot manage their level of life stress
need a legal guardian to handle their affairs - when the combination of a diathesis/vulnerability and
life stress exceeds the person's threshold, they will
Module 3: Etiology and Treatment of 3.
develop a disorder that aligns with their vulnerability
Gene-environment correlation model (rGE): is defined
Mental Disorders as the tendency of individuals to select and generate
their environment based on genetic features that
Insufficient Unidimensional Explanations of Mental influence behavior, thoughts, and feelings
Disorders
Polygenic Inheritance and Genetic Heritability
System: a set of elements that interact or are interdependent
on one another, but form a coherent whole that interacts with ● All mental disorders have polygenic inheritance; there
its environment and/or other systems is no single gene that causes depression,
schizophrenia, or anorexia nervosa
Multidimensional models: consider how multiple systems ● There are multiple (poly) genes that interact to
interact in contributing to mental disorders contribute to the development of mental disorders.
● Heritability is a statistic that estimates the degree of
Unidimensional: explanations of mental disorders such as that variation of a phenotypic trait in a population, such as
they are caused by a "chemical imbalance" or alternatively, that the presence of a mental disorder, that is due to
they are caused by a negative relationship with one's mother genetic variation between individuals from that
are inadequate to fully understand the disorder and its causes population.
- calculated by comparing individual variation among
related individuals in a population using various
 methods and is helpful in seeking to understand the referred to as governing "feed and breed" and then
impact of genetics versus environmental influences "rest and digest”
for a given disorder. 8. Endocrine system: consists of a series of glands that
produce chemical substances known as hormones

Neural Communication and Neurotransmitters

Areas and Lobes of the Brain
The soma has branching extensions known as dendrites.
The two hemispheres of the cerebral cortex are part of the
These signals are transmitted electrically across the soma and forebrain, which is the largest part of the brain, accounting for
down a major extension from the soma known as the axon, about 80% of the neurons in the central nervous system
which ends at multiple terminal buttons.
1. Hindbrain: the lower part of the brainstem and
Receptors, proteins on the cell surface where regulates ongoing, mostly automatic systems in the
neurotransmitters attach, vary in shape, with different shapes body including heart rate, breathing, digestion, and
“matching” different neurotransmitters other processes we don't often consciously think
about
The neuron exists in a fluid environment—it is surrounded by 2. Midbrain: handles input from our senses and uses this
extracellular fluid and contains intracellular fluid to help coordinate movement and parts of the reticular
activating system which is involved in managing our
Between signals, the neuron membrane’s potential is held in a sleep/wake cycle and other processes related to
state of readiness, called the resting potential tension and arousal
3. Frontal lobe: located in the forward part of the brain
This positive spike constitutes the action potential: the and is involved in reasoning, abstract thinking and
electrical signal that typically moves from the cell body down planning, creativity, motor control, emotion, and
the axon to the axon terminals language.
- also has the prefrontal cortex, which is responsible for
1. Dopamine: related to movement, memory, and as part higher-level cognitive functioning including major
of the brain's pleasure or reward center inhibitory pathways of neurons that help us regulate
2. Serotonin: a neuromodulator, meaning that serotonin our behaviors and reactions; and Broca’s area, which
appears to influence the functioning of other is essential for language production.
neurotransmitter systems; serotonin is also relevant to 4. Parietal lobe: located immediately behind the frontal
pain, sleep, digestion, and mood lobe and is involved in processing information from
3. Norepinephrine: also related to mood, pain, heart rate the body’s senses
and blood pressure 5. Temporal lobe: associated with hearing, memory,
4. GABA: a major inhibitory neurotransmitter, often emotion, and some aspects of language.
believed to be related to calming down or relaxation; it - The auditory cortex, the main area responsible for
has links and connections to alcohol and other processing auditory information, is located within the
substances temporal lobe.
5. Glutamate: an excitatory neurotransmitter, related to - Wernicke’s area, important for speech
learning and memory and other functions comprehension, is also located here
6. Occipital lobe: located at the very back of the brain,
Functions of Areas of the Brain and Endocrine and contains the primary visual cortex, which is
System responsible for interpreting incoming visual
information
1. Central nervous system (CNS): consists of the brain
and spinal cord Biomedical Therapies and Brain Stimulation
2. Peripheral nervous system: further subdivided into the Treatment
somatic and autonomic nervous systems
3. Somatic nervous system: transmits sensory and 1. Lobotomy: a form of psychosurgery in which parts of
motor signals to and from the central nervous system; the frontal lobe of the brain are destroyed or their
it is how we control our "voluntary" muscle connections to other parts of the brain severed
movements. 2. Biomedical therapy: medications used to treat mental
4. Autonomic nervous system: controls the functioning of disorders are called psychotropic or psychoactive
our organs and glands including "involuntary' muscle medications
movement 3. Psychotropic or psychoactive drugs are any type of
- usually things that we are unaware of most of the time drug or chemical that alters the way a person thinks,
like breathing, our heart beating, the movement of the feels, or behaves
muscles that pushes our food through the intestines - Agonists: chemicals that mimic a neurotransmitter at
and is part of digestion and elimination the receptor site and, thus, strengthen its effects.
5. Sympathetic activation: related to energy use and - Antagonists: impede the normal activity of a
maintaining homeostasis such as our body neurotransmitter at the postsynaptic receptor
temperature 4. Electroconvulsive therapy: the best-studied brain
6. its major purpose, though, is to enable us to respond stimulation therapy and has the longest history of use.
to emergencies or threats through fight or flight by 5. Repetitive transcranial magnetic stimulation (rTMS):
mobilizing energy quickly. uses a magnet to activate neurons in the brain
7. Parasympathetic activation: associated with normal 6. Deep brain stimulation (DBS): first developed as a
functioning under relaxed conditions, sometimes treatment for Parkinson's disease to reduce tremor,
 stiffness, walking problems and uncontrollable
movements Transference: the patient transfers all the positive or negative
emotions associated with the patient’s other relationships to the
psychoanalyst

Psychodynamic perspective: approach to therapy remains centered

Key Concepts and Treatment Methods on the role of people’s internal drives and forces, but treatment is
less intensive than Freud’s original model

A. Freud’s Unconscious Theory

D. Humanistic Approach- Psychopathology
Freud said that only about one-tenth of our mind is conscious or
self-aware, and the rest of our mind is unconscious. Existentialism: a philosophical approach emphasizing a holistic
view of human beings, validating the nature of human emotions,
Our unconscious refers to mental activity (emotional reactions, thought, behavior, and choices
motivations) of which we are unaware and are unable to access
- The goal of person-centered therapy (PCT), created by
1. Id: contains our most primitive drives or urges, and is Carl Rogers, is to create conditions under which clients
present from birth. It directs impulses for hunger, thirst, can discover their self-worth, feel comfortable exploring
aggression, and sex their own identity, and alter their behavior to better reflect
2. Superego: develops as a child interacts with others, this identity
learning the social rules for right and wrong 1. Unconditional positive regard: refers to the fact that the
3. Ego: the rational part of our personality therapist accepts their client for who they are, without
condition
2. Nondirective therapy: the therapist does not give advice or
B. Psychosexual Development and Defense Mechanisms provide interpretations but helps the person to identify
conflicts and understand feelings so they can take
Psychosexual Development States: responsibility for their own direction in life and for their
choices
Oral stage (birth to 1 year): pleasure is focused on the mouth

1. Anal stage (1–3 years): In this stage, children experience

pleasure in their bowel and bladder movements, so it
Cognitive and Behavioral Methods
makes sense that the conflict in this stage is over toilet
training
1. Behavioral Approach: emphasize actual behaviors by
2. Phallic stage (3–6 years): corresponding to the age when
animals and human beings rather than trying to study
children become aware of their bodies and recognize the
or evaluate things that could not be seen or tested
differences between boys and girls
2. Classical conditioning:
3. Latency period (6 years to puberty): This period is not
3. Unconditioned stimulus (UCS): a stimulus that elicits
considered a stage, because sexual feelings are dormant
a reflexive response in an organism.
as children focus on other pursuits, such as school,
4. Unconditioned response (UCR): a natural (unlearned)
friendships, hobbies, and sports
reaction to a given stimulus
4. Genital stage (from puberty on): In this stage, there is a
- example: the dogs’ salivation
sexual reawakening as the incestuous urges resurface
5. Neutral stimulus: presented immediately before an
unconditioned stimulus
6. Conditioned (learned) stimulus (CS): a stimulus that
elicits a response after repeatedly being paired with
● Defense Mechanisms: Freud believed that feelings of
an unconditioned stimulus
anxiety result from the ego’s inability to mediate the
7. Conditioned response (CR): the behavior caused by
conflict between the id and superego.
the conditioned stimulus
● Freud believed that the ego seeks to restore balance by
8. Operant conditioning: organisms learn to associate a
reducing anxiety through various protective measures
behavior with its consequence
9. Reinforcement/Reinforcer: consequences that
increase the frequency of a behavior
C. Psychoanalysis and Psychodynamic Treatment 10. Punishment/Punishers: consequences that decrease
how often a behavior occurs
Psychotherapy: a type of treatment for mental disorders that is 11. Observational learning: is essentially a cognitive
mostly focused on psychogenic models of the etiology of process involving perception and interpretation of
psychopathology behaviors and is important because not all forms of
learning are accounted for entirely by classical and
Free association: the patient relaxes and then says whatever
operant conditioning
comes to mind at the moment without attempting to edit or worry
how the therapist might react

Dream analysis: dreams contain not only manifest (or literal)

Exposure Treatment and Systematic Desensitization
content, but also latent (or symbolic) content
1. Counterconditioning: a client learns a new response
to a stimulus that has previously elicited an
undesirable behavior
 2. Aversive conditioning: uses an unpleasant stimulus to Technical eclecticism: the specific and intentional use of
stop an undesirable behavior different psychotherapy techniques and methods, seeking to
3. Exposure therapy: a therapist seeks to treat clients’ match the client's unique struggles and background with
fears or anxiety by presenting them with the object or treatments that have been shown to be effective in that context
situation that causes their anxiety with the idea that
due to extinction they will eventually get used to it Theoretical integration: this approach blends two or more
4. Extinction: the gradual disconnection of the models of therapy, both theory and techniques, in an attempt to
relationship between the unconditioned stimuli and find a more effective approach to helping clients
the conditioned stimuli
- or in operant conditioning, the disconnection between Combination therapy: used to describe situations where
the operant behavior and a reinforcer physicians or psychiatrists prescribe several different
5. Systematic desensitization: wherein a calm and medications in a patient's treatment
pleasant state is gradually associated with increasing
levels of anxiety-inducing stimuli Mindfulness: a process that tries to cultivate a nonjudgmental,
yet attentive, mental state
Cognitive Approach to Psychotherapy
There are two important components of mindfulness: (1)
Rational-emotive-behavioral therapy (REBT): "irrational self-regulation of attention, and (2) orientation toward the
thinking" or irrational thoughts to refer to dysfunctional thoughts present moment
that tended to produce significant negative emotions and
consequently, maladaptive behaviors Emerging Forms in Psychotherapy

An REBT therapist would help the client analyze the situation 1. Internet- and mobile-delivered therapies make
this way, A -> B -> C: psychological treatments more available, through
smartphones and online access using specific
● A = the Activating Event, the situation or stressor that technologies that encrypt communication and ensure
triggered the emotion privacy.
● B = the Beliefs or negative thought patterns (irrational 2. Clinician-supervised online CBT modules allow
thinking) patients to access treatment from home on their own
● C = the emotional Consequence of the Belief schedule—an opportunity particularly important for
patients with less geographic or socioeconomic
Aaron Beck used the term "automatic thoughts" to refer to the access to traditional treatments
thoughts these patients reported experiencing spontaneously 3. Cognitive bias modification: patients are given
exercises, often through the use of video games,
Cognitive therapy: a form of psychotherapy that focuses on aimed at changing their problematic thought
how a person’s thoughts lead to feelings of distress processes
4. CBT-enhancing pharmaceutical agents: drugs used to
1. The self – "I'm worthless and ugly", "I wish I was improve the effects of therapeutic interventions
different", or "I can't do anything right"
2. The world – "No one values me", "people ignore me Treatment Modalities in Psychopathology
all the time", or "life is so unfair"
3. The future – "Things will never change", "things can Benefits of Different Treatment Modalities
only get worse!" or "I'll never feel good again”
Treatment modalities are not based on any specific theory or
Cognitive-behavioral therapy (CBT) is a very large group of model of psychotherapy; instead, they are different
psychotherapeutic approaches that help clients examine how environments in which treatment takes place
their thoughts affect their behavior
Intake assessment: therapist gathers specific information to
- aims to change cognitive distortions and self- address the client’s immediate needs and to arrive at a
defeating behaviors diagnosis, such as the presenting problem, symptoms, the
- help people make adaptive, instead of maladaptive, client’s support system, and insurance status
appraisals
- sessions are very interactive between the client and 1. Confidentiality: means the therapist cannot disclose
the therapist, and treatment involves between-session confidential communications to any third party without
homework assignments the client's consent unless mandated or permitted by
law to do so
Persons with medical conditions may also benefit from CBT 2. Individual therapy: also known as individual
psychotherapy or individual counseling, the client and
- use with chronic back pain, fibromyalgia, post spinal clinician meet one-on-one
cord injuries, insomnia, and pain management in a 3. Group therapy: a clinician meets together with several
variety of conditions including breast cancer clients with similar problems
4. Psychoeducation group: a group for children who
Results of Psychotherapy and Integrative/Ecclectic have a parent with cancer
- might discuss in depth what cancer is, types of
Interpersonal psychotherapy (IPT): focuses on coping with or treatment for cancer, the side effects of treatments
improving relationships, dealing with grief, life transitions such such as hair loss, as well as ways to support the
as retirement or divorce, and resolving conflict with others family member, and ways to cope with the emotional
impact on themselves
 5. Couples therapy: involves two people in an intimate
relationship who are having difficulties and are trying sensations) and intense anxiety and avoidance for
to resolve them at least one month.
6. Family therapy: a special form of group therapy, - Panic Attack: a period of extreme fear or discomfort
consisting of one or more families that develops abruptly and reaches a peak within
10 minutes.
Impact of Culture on Treatment Availability
Symptoms of Panic Disorder
● Cultural competence: the ability to understand and
● Accelerated heart rate
honestly and openly address issues of race, culture,
● Sweating
and ethnicity
● Trembling
● Sociocultural perspective: accepts and integrates the
● Choking sensations
impact of cultural and social norms, starting at the
● Hot flashes or chills
beginning of treatment
● Dizziness or lightheadedness
● Therapists who use this perspective work with clients
● Fears of losing control or going crazy
to obtain and integrate information about their cultural
● Fears of dying
patterns into a unique treatment approach based on
their particular situation
Treatments for Panic Disorder

Module 4: Anxiety Disorders a. Panic disorder is generally treated with

psychotherapy, medication, or both.gad
b. CBT teaches different ways of thinking, behaving,
Types of Anxiety Disorders and reacting to the feelings that come on with a
panic attack, which can begin to disappear once a
patient learns to react differently to the physical
1. Generalized Anxiety Disorder sensations of anxiety and fear that occur during
- Generalized anxiety disorder is marked by panic attacks.
excessive anxiety or worry for most days (for at c. Selective serotonin reuptake inhibitors (SSRIs)
least 6 months) about personal health, work, social d. Serotonin-norepinephrine reuptake inhibitors
interactions, and daily routines. (SNRIs)
- People must experience at least three symptoms e. Beta-blockers
that are not associated with another anxiety f. Benzodiazepines
disorder.
3. Specific Phobias
Symptoms of GAD - A person diagnosed with a specific phobia
(formerly known as simple phobia) experiences
● Feeling restless, wound-up, or on- edge excessive, distressing, and persistent fear or
● Being easily fatigued anxiety about a specific object or situation (such as
● Having difficulty concentrating; mind going blank animals, enclosed spaces, elevators, or flying)
● Being irritable
● Having muscle tension Etiology of Specific Phobias
● Difficulty controlling feelings of worry
● Having sleep problems, such as difficulty falling or a. The first pathway is through classical conditioning.
staying asleep, restlessness, or unsatisfying sleep Classical conditioning is a form of learning in which
a previously neutral stimulus is paired with an
Fear involves an instantaneous reaction to an imminent unconditioned stimulus (UCS) that reflexively elicits
threat an unconditioned response (UCR), eliciting the
same response through its association with the
Anxiety involves apprehension, avoidance, and unconditioned stimulus. The response is called a
cautiousness regarding a potential threat, danger, or other conditioned response (CR).
negative event. b. The second pathway of phobia acquisition is
through vicarious learning, such as modeling.
Treatment of GAD
Treatments for Specific Phobias
a. Cognitive-behavioral therapy (CBT) has shown to
be effective in treating GAD a. Cognitive behavioral therapy (CBT) and exposure
b. Psychotropic Medications (such as SSRIs, SNRIs, therapy are commonly used to treat specific
and anti-anxiety medications) have been shown to phobias. CBT: helps to diffuse unhelpful emotional
be effective in reducing anxiety. responses by helping people consider them
c. A comparison of overall outcomes of CBT and differently or change their behavior effective in
medication on anxiety did not show statistically treating specific phobias
significant differences (i.e. they were equally b. Exposure therapy: is a particularly effective form of
effective in treating anxiety). CBT for specific phobias.

2. Panic Disorder 4. Social Anxiety Disorder

- Panic Disorder: a person must experience both - Social anxiety disorder (formerly called social
panic attacks (e.g., extreme physiological phobia) is characterized by extreme and persistent
fear or anxiety and avoidance of social situations in
 which the person could potentially be evaluated a. behavioral (e.g., exposure therapy)
negatively by others. b. CBT, contingency (e.g., contingency management)
- Social anxiety disorder is common in the United c. psychodynamic
States; a little over 12% of all Americans d. psychotherapy
experience social anxiety disorder during their e. family therapy
lifetime.

Etiology of Social Anxiety Disorders

6. Selective Mutism
- It is highly probable that the fears inherent to
social anxiety disorder can develop through - Selective mutism (SM), also known as situational
conditioning experiences. mutism, is an anxiety disorder in which a person
- A child who is subjected to early unpleasant social normally capable of speech cannot speak in
experiences (e.g., bullying at school) may develop specific situations or to specific people if triggered.
negative social images of herself that become - Selective mutism usually coexists with social
activated later in anxiety- provoking situations. anxiety disorder.
- One of the most well-established risk factors for - People with selective mutism stay silent even when
developing social anxiety disorder is behavioral the consequences of their silence include shame,
inhibition. social ostracism, or punishment.
- Behavioral inhibition is thought to be an inherited
trait, and it is characterized by a consistent Selective Mutism: Diagnostic Criteria
tendency to show fear and restraint when
presented with unfamiliar people or situations. Consistent failure to speak in specific social situations (in
which there is an expectation for speaking, e.g., at school)
Treatment for Social Anxiety Disorder despite speaking in other situations.

a. SSRIs (Zoloft or Paxil) The duration of the disturbance is at least 1 month (not
b. CBT limited to the first month of school).
c. Exposure-based Cognitive Therapy
The failure to speak is not due to a lack of knowledge of the
spoken language required in the social situation.

5. Separation Anxiety Disorder The disturbance is not better accounted for by a

- The duration of this problem must persist for at communication disorder (e.g., childhood-onset fluency
least four weeks and must present itself before a disorder) and does not occur exclusively in people with
child is eighteen years of age to be diagnosed as a autism spectrum disorders or psychotic disorders such as
separation anxiety disorder in children, but can now schizophrenia.
be diagnosed in adults with a duration typically
lasting six months in adults Treatment of Selective Mutism

Separation Anxiety Disorder: Diagnostic Criteria There are two primary domains for treatment of selective
mutism: non-medication and medication-based
a. Recurrent excessive distress when anticipating or interventions.
experiencing separation from home or from major
attachment figures a. The non-medication based treatment focuses on
b. Persistent and excessive worry about losing major therapeutic approaches including
attachment figures psychotherapeutic, psychodynamic, behavioral,
c. Persistent and excessive worry about experiencing and family therapies. Specific strategies used in
an untoward event therapy also feature self-modeling, self-
d. Persistent reluctance or refusal to go out, away reinforcement, and contingency management.
from home, to school, to work, or elsewhere b. Children with selective mutism who were given
because of fear of separation SSRIs have shown improvements in their
e. Persistent and excessive fear of or reluctance communication and anxiety.
about being alone
f. Persistent reluctance or refusal to sleep away from
home or to go to sleep
g. Repeated nightmares
Perspective of Anxiety Disorders
h. Repeated complaints of physical symptoms
1. Examine various perspectives and treatment methods
for anxiety disorders
Treatments for Separation Anxiety Disorder
2. Describe and compare viewpoints from the major
The first choice of treatment for people with a separation psychological perspectives related to anxiety
anxiety disorder are non-medication based methods, disorders
including psychoeducational intervention for the child and 3. Explain common treatment methods for anxiety
their family and psychotherapeutic intervention. disorders
4. Explain how behavior therapy can be used to treat
Common psychotherapeutic interventions include: anxiety
A. Biological Perspective on Anxiety
 - The biological perspective seeks to understand the maintained until the anxiety associated with the
neurological and biological connections to anxiety. contact subsides.
1. Researchers have concluded that several specific 3. Systematic desensitisation (SD) is on the gentler part
neurotransmitters are also connected with anxiety: of the spectrum. SD is based on the idea of reciprocal
GABA, serotonin, and norepinephrine (noradrenalin). inhibition proposing that two opposite emotions can
2. Anti-anxiety medications help reduce the symptoms of not co-exist (e.g. fear and relaxation are mutually
anxiety, such as panic attacks, or extreme fear and exclusive).
worry.

B. Cognitive and Behavioral Perspective on Anxiety

- Because anxiety disorders are connected to the way

Module 5: Obsessive Compulsive
people perceive situations, cognitive therapies are Disorder and Stressor Related
particularly effective in thinking about and treating
anxiety disorders. Disorders
- Cognitive theories suggest that anxiety disorders
develop through thought patterns that overestimate Features of OCD:
threats to safety, therefore anxiety is caused by
cognitive misinterpretations and can be treated by ● Obsessive-compulsive disorder (OCD): experiencing
developing strategies to combat these thoughts. thoughts and urges that are intrusive and unwanted
(obsessions) and/or the need to engage in repetitive
C, Humanistic Perspective on Anxiety behaviors or mental acts (compulsions).
● Obsessions are characterized as persistent,
- According to the humanistic perspective, anxiety may unintentional, and unwanted thoughts and urges that
develop if people do not see themselves honestly or are highly intrusive, unpleasant, and distressing.
do not practice self-acceptance. ● Compulsions often include such behaviors as
- Client-centered therapy is encouraged to help repeated and extensive hand washing, cleaning,
patients accept themselves and not be so checking (e.g., that a door is locked), and ordering
self-judgemental. (e.g., lining up all the pencils in a particular way)
- One humanistic type of treatment for anxiety is ● also include such mental acts as counting, praying, or
motivational interviewing. reciting something to oneself

D. Sociocultural Perspective on Anxiety OCD- brushing your teeth 47 times left to right and becoming
very anxious when you only brushed your teeth 45, which
- Globally, in 2010, approximately 273 million (4.5% of meant you would have to start again
the population) had an anxiety disorder. Anxiety is
more common in females (5.2%) than males (2.8%). OCD Tendencies- you prefer to brush your teeth left to right
- In Europe, Africa, and Asia, lifetime rates of anxiety and then top to bottom, but you don’t feel anxiety or compelled
disorders are between 9 and 16%, and yearly to start over if you get out of sync.
- rates are between 4 and 7%.
- In the United States, the lifetime prevalence of anxiety Development of OCD
disorders is about 29% and between 11 and 18% of
adults have the condition in a given year. - The symptoms of OCD have been theorized to be
learned responses, acquired and sustained as the
Treatment For Anxiety Disorders result of a combination of two forms of learning:
classical conditioning and operant conditioning.
A. Cognitive Behavioral Therapy (CBT) is an example of - Acquisition of OCD may occur first as the result of
one type of psychotherapy that can help people with classical conditioning, whereby a neutral stimulus
anxiety disorders. CBT teaches people different ways becomes associated with an unconditioned stimulus
of thinking, behaving, and reacting to anxiety that provokes anxiety or distress.
producing and fearful objects and situations.
Obsessive Compulsive Disorder and Stressor
In the case of panic disorder or social anxiety disorder,
benzodiazepines are usually second-line treatments, behind
Related Disorders
SSRIs or SNRIs or other antidepressants. They include:

1. Clonazepam 1. Body dysmorphic disorder (BDD) involves being

2. Alprazolam preoccupied with a perceived flaw in one’s physical
3. Lorazepam appearance that is either nonexistent or barely
noticeable to other people. These perceived
physical defects cause the person to think they are
unattractive, ugly, hideous, or deformed.
B. Behavioral Therapies - The preoccupation with imagined physical
1. Cognitive therapy (CBT) and exposure therapy, a type flaws drives the person to engage in
of behavior therapy, are the two most commonly used repetitive and ritualistic behavioral and
interventions in the treatment of anxiety disorders. mental acts, such as:
2. Exposure therapy has its roots in classical a. constantly looking in the mirror
conditioning. In exposure therapy, patients make b. trying to hide the offending body part
contact with the feared stimuli and this contact is c. comparisons with others
 d. in some extreme cases, cosmetic surgery. - A common hypothesis is that excoriation disorder is
often a coping mechanism to deal with elevated
levels of turmoil, arousal or stress within the
individual, and that the individual has an impaired
- Patients often are unaware that effective stress response.
treatments are available and will hide symptoms - One survey of patients with excoriation disorder
because of feelings of shame or guilt. found that 56.7% also had a DSM-IV Axis-I
- The prevalence of BDD in the general population is disorder and 38% had alcohol- or drug-abuse
approximately 2% and is strongly associated with a problems.
history of cosmetic surgery and higher rates of
suicidal ideation and suicide attempts.
- BDD has been reported to occur in children as
young as 5 and in adults as old as 80.
Trauma and Stress-Related Disorders
Causes Potentially Include

a. Chemicals in the Brain Types of Stressors and Trauma

b. OCD
c. GAD 1. Chronic stressors include events that persist over
d. Childhood Abuse and/or Trauma an extended period of time, such as caring for a
parent with dementia, long-term unemployment, or
imprisonment.
Hoarding disorder (HD): an inability to part with personal 2. Acute stressors involve brief focal events that
possessions, regardless of how valueless or useless these sometimes continue to be experienced as
possessions are. Below are characteristics of those with HD: overwhelming well after the event has ended, such
as falling on an icy sidewalk and breaking your leg
a. Do not allow visitors in, such as family and friends, 3. Daily Hassles: the minor irritations and annoyances
or repair and maintenance professionals, because that are part of our everyday lives (e.g., rush hour
the clutter embarrasses them traffic, lost keys, obnoxious coworkers)—can build
b. Are reluctant or unable to return borrowed items on one another and leave us just as stressed as life
c. Keep the shades drawn so that no one can look change events
inside 4. Eustress: Many life events that most people would
d. Have arguments with family members regarding consider pleasant (e.g., holidays, retirement,
the clutter marriage) may be stressful according to the Social
e. Are at risk of fire, falling, infestation, or eviction Readjustment Rating Scale (SRRS)
f. Feel depressed or anxious due to the clutter
g. Have suspicions of other people touching items Stressors and Trauma
h. Fear they’ll run out of an item or need it in the
future - Some stressors involve traumatic events or
i. Check the garbage for accidentally discarded situations in which a person is exposed to actual or
objects threatened death or serious injury.

SMen, non-whites, and individuals in lower socioeconomic

Trichotillomania (TTM), also known as hair-pulling disorder status (SES) groups report experiencing a greater number
or compulsive hair pulling, is a psychological disorder of traumatic events than do women, whites, and individuals
characterized by a long-term urge that results in the pulling childhoodin higher SES groups (Hatch & Dohrenwend,
out of one's hair. 2007).

- Trichotillomania is usually confined to one or two

areas of the body, but can involve multiple sites. 1. Post-Traumatic Stress Disorder (PTSD): extremely
- The scalp is the most common pulling site, followed stressful or traumatic events, such as combat,
by the eyebrows, eyelashes, face, arms, and legs. natural disasters, and terrorist attacks, place the
- TTM affects approximately 3.5% of women, or 3.7 people who experience them at an increased risk
million people in the United States. for developing psychological disorders.

PTSD was called shell shock and combat neurosis because

Excoriation disorder: an obsessive-compulsive spectrum its symptoms were observed in soldiers who had engaged in
disorder that is characterized by the repeated urge or wartime combat.
impulse to pick at one's own skin to the extent that either
psychological or physical damage is caused. By 1980, it had become clear that people who had
experienced sexual traumas (e.g., rape, domestic battery,
- Episodes of skin picking are often preceded or and incest) often experienced the same set of symptoms as
accompanied by tension, anxiety, or stress. During did soldiers.
these moments, there is commonly a compulsive
urge to pick, squeeze, or scratch at a surface or Symptoms of PTSD include:
region of the body, often at the location of a
perceived skin defect. a. intrusive and distressing memories of the event
b. flashbacks
 c. avoidance of stimuli connected to the event c. do not meet the criteria for another mental disorder,
d. persistently negative emotional states (e.g., fear, and
anger, guilt, and shame) d. do not represent normal bereavement.
e. feelings of detachment from others
f. irritability
g. proneness toward outbursts 4. Attachment style or pattern refer to the various types of
h. exaggerated, startled responses (jumpiness) attachment arising from early care experiences, known as
either secure, insecure-avoidant, resistant, or disorganized.

Four Types of Attachment Styles

Diagnosis of PTSD
a. Secure: Toddlers prefer their parent over a
she/he be must exposed to, witness, or experience the stranger. The attachment figure is used as a secure
details of a traumatic experience (e.g., a first responder), base to explore the environment and is sought out
one that involves “actual or threatened death, serious injury, in times of stress.
or sexual violence.” b. Avoidant: Children are unresponsive to the parent,
do not use the parent as a secure base, and do not
For example: care if the parent leaves.
c. Resistant: Children tend to show clingy behavior,
a. combat but then reject the attachment figure’s attempts to
b. threatened or actual physical attack interact with them
c. sexual assault d. Disorganized: Children behave oddly in a Strange
d. natural disasters Situation. Children freeze, run around the room in
e. terrorist attacks an erratic manner, or try to run away when the
f. automobile accidents caregiver return

2. Acute stress disorder is similar to PTSD, but describes a 5. Reactive Attachment Disorder & Disinhibited Social
disorder that lasts between 3 days and 1 month of a Engagement Disorder
traumatic event.
Reactive Attachment Disorder (RAD): a stressor-related
- After one month, a diagnosis of Acute Stress disorder caused by social neglect during childhood
Disorder would be considered PTSD. (meaning a lack of adequate caregiving).

The diagnostic symptoms are similar to that of PTSD. - RAD is characterized by markedly disturbed and
Diagnosis requires at least nine of the symptoms from any developmentally inappropriate ways of relating
of the following five categories, beginning or worsening after socially in most contexts.
the traumatic event(s) occurred:
Disinhibited Social Engagement Disorder (DSED): the
a. intrusion uninhibited form, which manifests as a lack of inhibitions or
b. negative mood externalizing behavior are consistent.
c. dissociation
d. avoidance
e. arousal

Perspectives on OCD
3. Adjustment disorder (AD) represents an abnormal stress
response that is different from normal adaptive reactions a. Biological Perspective:
that occurs within three months of the onset of a stressor. - As you already learned, results of family and twin
studies suggest that obsessive-compulsive disorder
AD usually follows a stressful event such as: has a moderate genetic component
- The disorder is five times more frequent in the
a. losing a job first-degree relatives of people with OCD than in
b. ending a relationship people without the disorder.
c. financial conflict
d. changing environments
e. feeling overwhelming
f. school or job stress b. Sociocultural Perspective
g. living in a dangerous situation - Some cultures in which religion and customs are held
h. death of friends or family to a very high standard may be connected to OCD
i. illness, etc. - These factors are so ingrained and so varied that they
can influence the onset, outcome, and response to
DSM-V categorization is: treatment for OCD.

a. emotional or behavioral symptoms in response to

an identifiable stressor that
b. are of clinical significance and c. Humanistic Perspective
- Emphasis on the potential for good and
self-actualization in all people
- Those suffering OCD and PTSD are likely undergoing to move forward because of the difficulty with never
an existential crisis. truly feeling safe.
d. Psychodynamic Perspective
- suggests that there are 3 areas at work in determining
a person's personality and behavior: the id, superego,
and ego. e. Cognitive Perspective
- The id represents our unconscious, primitive drives or - traumatic events disrupt a person's perspective on life
urges. and the world around them, which ultimately creates a
- The superego is what we learn as we grow: societal negative viewpoint that has lasting damage, resulting
rules, what is or isn't acceptable—our "moral in chronic stress symptoms seen in PTSD.
compass" essentially.
- When we fail to live up to the standards of the
superego, we may experience shame or guilt.
f. Behavioral Perspective
- suggests that some symptoms are developed and
maintained through classical conditioning. The
e. Cognitive Perspective traumatic event may act as an unconditioned stimulus
- OCD falsely assumes that: that elicits an unconditioned response characterized
- thinking about an action is the same as doing it by extreme fear and anxiety.
- failing to prevent harm is morally equivalent to
causing harm Treatments of OCD and Related Disorders
- responsibility for harm is not diminished by
extenuating circumstances OCD is typically treated with medication,
- failing to ritualize in response to a thought about harm
is the same as an intention to harm 1. psychotherapy, or a combination of the two.
- one should exercise control over one's thoughts. 2. Serotonin reuptake inhibitors (SRIs), which include
selective serotonin reuptake inhibitors (SSRIs), are
used to help reduce OCD symptoms.
3. SSRIs often require higher daily doses in the
f. Behavioral approach treatment of OCD than of depression and may take 8
- a neutral event comes to elicit fear or stress when it to 12 weeks to start working, but some patients
is paired with a stressful event (a UCS) experience more rapid improvement.
4. Research shows that certain types of psychotherapy,
including cognitive behavior therapy (CBT) and other
related therapies (e.g., habit reversal training) can be
as effective as medication for many individuals.
Perspectives on Stress Related Disorders
5. Habit reversal training (HRT) is a "multicomponent
behavioral treatment package originally developed to
a. Biological Perspective
address a wide variety of repetitive behavior
- Researchers have found that genetics and
disorders."
environment play an important role in one's risk for
developing PTSD due to trauma
- estimates for the genetic influences for PTSD account Treatments for PTSD
for 30% to 73% of vulnerability for the disorder.
1. Perhaps the most widely practiced approach for
treating PTSD is cognitive behavioral therapy (CBT).
The goal is that patients identify the sources of their
b. Sociocultural Perspective trauma and cope with them thereby eliminating
- different cultures and belief systems may help or negative emotional reactions associated with the
hinder the prevalence of the disorder memories.
- Cultural beliefs may influence an individual's personal 2. Eye movement desensitization and reprocessing
meanings of trauma and their attempts to come to (EMDR): a form of psychotherapy in which the person
terms with trauma memories in helpful and unhelpful being treated is asked to recall distressing images
ways. 3. the therapist then directs the patient in one type of
bilateral stimulation, such as side-to-side eye
movements or hand tapping.
4. Virtual Reality Therapy (VRT) is currently being used
c. Psychodynamic perspective as treatment for various psychological disorders.
- attempts to bring repressed traumatic experiences out 5. Ranging from anxiety disorders to stroke
of the unconscious, where they are perceived as rehabilitation, VRT is being utilized to eliminate
more toxic, and address them by helping patients to debilitating symptoms associated with each of these
understand the relationship between hidden impulses, situations.
anxiety, and defense mechanisms. 6. Memory Reconsolidation Treatment
- Nader et al. (2000) taught their animals a fear
memory by pairing a particular sound with a mild, but
unpleasant shock using classical conditioning.
d. Humanistic Perspective - The changed memories can be disrupted (e.g., by
- One in which a basic need was severely threatened trauma to the brain, by drugs, and by other means),
(i.e., their life), and therefore, they may feel helpless but once they have reconsolidated, they become the
new version of the memory.
 - The newer theory of memory says that our memories
are not really like books, which don’t change after the 3. Dissociative Identity Disorder
print has dried. - Dissociative Identity Disorder (DID):experiencing two or
more distinct identities that recurrently take control over
one’s behavior
Module 6: Somatic Symptom - People with dissociative identity disorder exhibit two or
more separate personalities or identities, each well-defined
Disorders and Dissociative Disorders and distinct from one another. DSM-V diagnostic criteria for
DID are the following:
Dissociative disorders a. Disruption of identity characterized by two or more distinct
personality states marked by the discontinuity in the sense
are characterized by an individual becoming split off, or dissociated, of self and agency and accompanied by related alterations
from their core sense of self. Memory and identity become disturbed; in affect, behavior, consciousness, memory, perception,
these disturbances have a psychological rather than physical cause. cognition, and/or sensory-motor functioning.
b. Recurrent gaps in the recall of everyday events, important
a. Depersonalization: a feeling of detachment or personal information, and/or traumatic events that are
estrangement from one’s self inconsistent with ordinary forgetting.
b. Derealization: an alteration in the perception of one’s c. The symptoms cause significant distress or impairment in
surroundings so that a sense of reality of the external world social, occupational, or other important areas of
is lost functioning.
c. Dissociative amnesia: does not refer to permanent memory d. The disturbance is not a normal part of a broadly accepted
loss, similar to the erasure of a computer disk, but rather to cultural or religious practice.
the hypothetical disconnection of memories from conscious
inspection Sleep-Dissociation Model
d. Identity confusion: thoughts and feelings of uncertainty and
conflict a person has related to their identity a. Watson’s (2001) basic findings have been reproduced time
e. Identity alteration: the behavioral acting out of this and again.
uncertainty and conflict - This means that the same results (namely that dissociation
and sleep problems are related) have been found in lots of
different studies, using different groups, and different
materials.
1. Dissociative Amnesia and Fugue b. The connection between sleep and dissociation is specific.
- Dissociative Amnesia: inability to recall important personal - It seems that unusual sleep phenomena that are difficult to
information, usually following an extremely stressful or control, including nightmares and waking dreams, are
traumatic experience such as combat, natural disasters, or related to dissociative symptoms, but lucid
being the victim of violence. dreaming—dreams that are controllable—are only weakly
- Dissociative Fugue: suddenly wandering away from one's related to dissociative symptoms.
own home, experiencing confusion about their identity, and c. The sleep-dissociation link is apparent not only in general
sometimes even adopting a new identity. population groups but also in patient groups.
- Most fugue episodes last only a few hours or days, but - Accordingly, one group of researchers reported nightmare
some can last longer. disorder in 17 out of 30 DID patients (Agargun et al., 2003).
- People with dissociative fugue may travel far distances
during the fugue, as far as several thousand miles, and
could remain in the fugue state for a couple of days,
several weeks or even months. Somatic and Related Disorders

- Somatic symptom disorder: any mental disorder that

manifests as physical symptoms that suggest illness or
2. Depersonalization/Derealization Disorder injury, but cannot be explained fully by a general medical
- Depersonalization/Derealization Disorder: characterized by condition or by the direct effect of a substance, and are not
recurring episodes of depersonalization, derealization, or attributable to another mental disorder
both - A diagnosis of somatic symptom disorder requires that the
- Depersonalization: may make someone believe their subject have recurring somatic complaints for at least six
thoughts and feelings are not their own months.
- they may feel robotic as though they lack control over their - Symptoms are sometimes similar to those of other illnesses
movements and speech and may last for years. Usually, the symptoms begin
- they may experience a distorted sense of time appearing during adolescence, and patients are diagnosed
- in extreme cases, they may sense an “out-of- body” before the age of 30 years.
experience in which they see themselves from the vantage - Symptoms may occur across cultures and gender. Other
point of another person. common symptoms include anxiety and depression.
- Derealization: conceptualized as a sense of “unreality or
detachment from, or unfamiliarity with, the world, be it
individuals, inanimate objects, or all surroundings.”
- A person who experiences derealization might feel as 1. Illness Anxiety Disorder
though he is in a fog or a dream, or that the surrounding - Illness anxiety disorder does not typically involve somatic
world is somehow artificial and unreal symptoms, meaning that individuals do not experience any
specific physical ailment, but instead are preoccupied with
concern about developing a severe medical condition.
 - The DSM-5 encompasses two types of patients with illness deliberately produces, feigns, or exaggerates the
anxiety disorder: care-seeking type and care- avoidant symptoms of someone in their care.
type.
- In one case study (2016), a seventy-three-year-old Saudi
man started visiting the primary health care center around
twenty-five years ago. With concerns about having cancer,
the patient continuously visited the hospital, which ended Perspectives and Treatment for Dissociative and
up costing over $170,000. Throughout this period, the Somatic Symptom Disorders
patient was exposed to extensive unnecessary imaging
studies and laboratory tests that had effects on his life in all a. Examine various perspectives and treatment methods
aspects with such concerns. Five years ago, a family doctor for dissociative and somatic symptom disorders
put an end to that by directing the patient on the right path. b. Describe and compare viewpoints from the major
The doctor made several actions; most importantly, he psychological perspectives related to dissociative and
directed the patient to cognitive behavioral therapy which somatic symptom disorders
significantly improved a range of hypochondriacal beliefs c. Recommend effective treatment methods for
and attitudes. dissociative disorders and somatic symptom disorders

Perspectives on Dissociative and Somatic Disorders

a. Biological Perspective
- Though researchers have not found a specific genetic
2. Functional Neurological Symptom Disorder (Conversion link for these disorders, there are genetic links to
Disorder) dissociation as it relates to childhood adversity.-
- Functional neurological symptom disorder (Conversion Biological factors may include trauma-induced
disorder): a type of somatic disorder that is sometimes responses.
applied to patients who present neurological symptoms,
such as numbness, blindness, paralysis, or fits, which are
not consistent with a well- established organic cause,
cause significant distress, and can be traced back to a b. Psychodynamic Perspective
psychological trigger. - Freud's model suggested the emotional charge
- DSM-V criteria removed the requirements for a deriving from painful experiences would be
psychological stressor to be present and for feigning to be consciously repressed as a way of managing the
disproved. pain.
- Functional neurological symptom disorder begins with - The idea behind the psychodynamic perspective is
some stressor, trauma, or psychological distress. that someone experiencing dissociation - either of
identity or in functional neurological symptom disorder
Common symptoms include: (conversion disorder) - is using a type of defense
mechanism to guard against negative feelings
a. blindness because of inadequate coping skills
b. partial or total paralysis - This type of emotional conflict becomes overwhelming
c. inability to speak and results in the symptoms one might experience.
d. deafness
e. numbness
f. difficulty swallowing
g. incontinence c. Cognitive Perspective
h. balance problems - Identifies different kinds of memory— iconic, haptic,
i. seizures echoic, short-term, working, long-term, declarative,
j. tremors non-declarative, procedural, semantic, episodic,
k. difficulty walking. implicit, explicit, and more.
- The concepts of retrieval and forgetting are, of
course, central to any discussion of memory and
memory-related disorders. Dissociative amnesia,
3. Factitious Disorder and FD Imposed on Another flashbacks and other dissociative phenomena have
- Factitious disorder: a condition in which a person, without a frequently been observed not only as a result of
malingering motive, acts as if they have an illness by traumatic stress, but also as a result of the use of
deliberately producing, feigning, or exaggerating dissociative drugs such as PCP, ketamine, or LSD.
symptoms, purely to attain (for themselves or for another) a
patient's role.
- People with a factitious disorder may produce symptoms by
contaminating urine samples, taking hallucinogens, d. Sociocultural Perspective
injecting fecal material to produce abscesses, and similar - Those with lower socioeconomic status, education,
behavior. and history of abuse are more likely to develop DID
- Factitious disorder imposed on self (also called and other somatic disorders.
Munchausen syndrome) was for some time the umbrella - Many authors have found the occurrence of
term for all such disorders. conversion to be more frequent in rural, lower
- Factitious disorder imposed on another (also called socio-economic groups, where technological
Munchausen syndrome by proxy, Munchausen by proxy, or investigation of patients is limited and individuals may
factitious disorder by proxy) is a condition in which a person be less knowledgeable about medical and
psychological concepts.
Treatments for Dissociative and Somatic Disorders

1. Dissociative disorders are generally treated with

long-term psychotherapy. Common treatment
methods include an eclectic mix of psychotherapy
techniques, including CBT, insight-oriented therapies,
dialectical behavioral therapy (DBT), hypnotherapy,
and EMDR.
2. Treatment of dissociative disorders is associated with
improvements in symptoms of dissociation,
depression, general distress, anxiety, and PTSD, as
well as decreased use of medications and improved
work and social functioning.
3. Treatment for functional neurological symptom
disorder (conversion disorder) can include hypnosis,
psychotherapy, physical therapy, occupational
therapy, stress management, and transcranial
magnetic stimulation (TMS).
4. TMS: a form of brain stimulation in which a changing
magnetic field is used to cause an electric current at a
specific area of the brain through electromagnetic
induction.
5. In treating somatic symptoms (such as functional
neurological symptom disorder, factitious disorder,
etc), the provider may need to avoid colluding with the
patient, but also avoid denying the reality of the
symptoms.