ABNORMAL PSYCHOLOGY

BOOK: Abnormal Psychology: An Integrative Approach |Compiled/organized by: MARY-ANN SEVILLA

AUTHOR: David H. Barlow, V. Mark Durand, Stefan G. Hofmann | *Do not reproduce w/o consent esp. for monetary
CHAPTER: 1 – Abnormal Behavior in Historical Context gain/purposes :>

CHAPTER 1: ABNORMAL BEHAVIOR IN HISTORICAL CONTEXT

PSYCHOLOGICAL DISORDER

Definition A psychological dysfunction within an individual associated with distress or impairment in functioning
and a response that is not typically expected or culturally expected.
DSM 5, 2013 Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and
associated with present distress and impairment in functioning, or increased risk of suffering, death,
pain, or impairment.
Prototype How the apparent disease or disorder matches a “typical” profile of a disorder.
• The patient may have only some features or symptoms of the disorder (a minimum number) and
still meet criteria for the disorder because his or her set of symptoms is close to the prototype.

1 PSYCHOLOGICAL DYSFUNCTION
A breakdown in cognitive, emotional, or behavioral functioning.

2 DISTRESS OR IMPAIRMENT
Distress The behavior must be associated with distress to be classified as a disorder.
• The criterion is satisfied if the individual is extremely upset.
Impairment If you are so shy that you find it impossible to date or even interact with people and you make every
attempt to avoid interactions even though you would like to have friends.

3 ATYPICAL OR NOT CULTURALLY EXPECTED

Behavior that it deviates from the average or violating social norms.
Robert Sapolsky Worked closely with the Masai people in East Africa.
• A woman had been acting aggressively and had been
hearing voices and killed a goat with her own hands.
• Only men killed goats and hearing voices in a wrong
time.

THE SCIENCE OF PSYCHOPATHOLOGY

Psychopathology
• The scientific study of psychological disorders.
Counseling Counseling Psychologists: Tend to study and treat adjustment and vocational issues
Psychologists vs encountered by relatively healthy individuals.
Clinical Psychologists Clinical Psychologists: Concentrate on more severe psychological disorders.
Psy.D. vs Ph.D. Psy.D.: Focus on clinical training and de-emphasize or eliminate research training.
Ph.D.: Integrate clinical and research training.
Psychiatrists First earn an M.D. degree in medical school and then specialize in psychiatry during residency
training that lasts 3 to 4 years.
Psychiatric Social Earn a master’s degree in social work as they develop expertise in collecting information
Workers relevant to the social and family situation of the individual with a psychological disorder.
Psychiatric Nurses Have advanced degrees (master’s or Ph.D.) and specialize in the care and treatment of patients
with psychological disorders, usually in hospitals as part of a treatment team.
Marriage and Family Spend 1 to 2 years earning a master’s degree and are employed to provide clinical services by
Therapists and Mental hospitals or clinics, usually under the supervision of a doctoral-level clinician.
Health Counselors

1 THE SCIENTIST-PRACTITIONER
• 1 Keep up with the latest scientific developments in their field and therefore use the most
current diagnostic and treatment procedures.
• 2 Evaluate their own assessments or treatment procedures to see whether they work.
• 3 Scientist-practitioners might conduct research that produces new information about
disorders or their treatment.

2 CLINICAL DESCRIPTION
Presenting Problem
Patient “presents” with a specific problem or set of problems.
Presents: Traditional shorthand way of indicating why the person came to the clinic.
Population
1 Prevalence How many people in the population as a whole have the disorder.
2 Incidence How many new cases occur during a given period.
Course
1 Chronic Course Tend to last a long time, sometimes a lifetime.
2 Episodic Course The individual is likely to recover within a few months only to suffer a recurrence of the disorder at
a later time.
3 Time-Limited The disorder will improve without treatment in a relatively short period with little or no risk of
Course recurrence.
Onset
1 Acute Onset Begin suddenly.
2 Insidious Onset Develop gradually over an extended period.
Prognosis
The anticipated course of a disorder.
Branches of Psychology
Developmental Psychology Study of changes in behavior over time.
Developmental Study of changes in abnormal behavior.
Psychopathology
Life-Span Developmental Study of abnormal behavior across the entire age span.
Psychopathology

3 CAUSATION, TREATMENT, AND ETIOLOGY OUTCOMES

Etiology The study of origins and has to do with why a disorder begins (what causes it) and includes biological,
psychological, and social dimensions.

HISTORICAL CONCEPTIONS OF ABNORMAL BEHAVIOR

1 THE SUPERNATURAL TRADITION

A. Demons and Witches
• Psychological disorders were seen as the work of the devil and witches in the last quarter of 14th century.
o Individuals possessed by evil spirits were probably responsible for any misfortune experienced by people in the
local community.
• Treatment
o Magic and sorcery.
o Exorcism: Various religious rituals were performed in an effort to rid the victim of evil spirits.
o Shaving the pattern of a cross in the hair of the victim’s head.
o Securing sufferers to a wall near the front of a church so that they might benefit from hearing Mass.
B. Stress and Melancholy
• Insanity was a natural phenomenon, caused by mental or emotional stress, and that it was curable.
• Treatments
o Rest, sleep, and a healthy and happy environment, bath, ointments, and various potions.
o Moved from house to house in medieval villages as neighbors took turns caring for them.
• Nicholas Oresme (14th century)
o Chief advisers to the king of France
o The disease of melancholy (depression) was the source of some bizarre behavior, rather than demons.
C. Treatments for Possession
• Exorcisms
o If exorcism doesn’t work, people were subjected to confinement, beatings, and other forms of torture to make
the body unhabitable by evil spirits
• Hanging people over a pit full of poisonous snakes might scare the evil spirits right out of their bodies.
• Dunkings in ice-cold water.
D. Mass Hysteria
• Characterized by large-scale outbreaks of bizarre behavior.
• Saint Vitus’s Dance / Tarantism
o In Europe, whole groups of people were simultaneously compelled to run out in the streets, dance, shout, rave,
and jump around in patterns as if they were at a particularly wild party late at night.
E. Modern Mass Hysteria
Emotion Contagion The experience of an emotion seems to spread to those around us.
Mob Psychology A shared response.
If one person identifies a “cause” of the problem, others will probably assume that their own
reactions have the same source.
F. The Moon and the Stars
Paracelsus (1493 to 1541)
• Swiss physician
• The movements of the moon and stars had profound effects on people’s psychological functioning.
o Cause of mental disorders is the gravitational effects of the moon on bodily fluids.
o Inspired the word lunatic: ‘luna’ – moon.

2 THE BIOLOGICAL TRADITION

A. Hippocrates (460–377 b.c.), (Greek physician)
• Father of modern Western medicine.
o Believed that psychological disorders might also be caused by brain pathology or head trauma and could be
influenced by heredity (genetics).
o Considered the brain to be the seat of wisdom, consciousness, intelligence, and emotion.
• Hippocratic Corpus
o Written between 450 and 350 B.C.
o Suggested that psychological disorders could be treated like any other disease.
• Coined the term ‘Hysteria’
o Describe a concept he learned about from the Egyptians: somatic symptom disorders.
▪ The physical symptoms appear to be the result of a medical problem for which no physical cause can be
found, such as paralysis and some kinds of blindness.
 ▪ Wandering Uterus Theory
• Occurred primarily in women so the Egyptians (and Hippocrates) mistakenly assumed that they were
restricted to women.
• Presumed cause: The empty uterus wandered to various parts of the body in search of conception (the
Greek word for “uterus” is hysteron).
• Numerous physical symptoms reflected the location of the wandering uterus.
• Treatment: Marriage or fumigation of the vagina to lure the uterus back to its natural location.
B. Galen (approximately A.D. 129–198), (Roman Physician)
• Adopted the ideas of Hippocrates and his associates.
• 1 Humoral Theory of Disorders
o Disease resulted from too much or too little of one of the humors.
o Blood: Came from the heart.
▪ Sanguine ( “red, like blood”): someone who is ruddy in complexion, presumably from copious blood flowing
through the body, and cheerful and optimistic, although insomnia and delirium were thought to be caused
by excessive blood in the brain.
o Black Bile: Came from the spleen.
▪ Melancholic means depressive.
o Yellow Bile: Came from the liver.
▪ A choleric person (from yellow bile or choler) is hot tempered.
o Phlegm: Came from the brain.
▪ A phlegmatic personality (from the humor phlegm) indicates apathy and sluggishness but can also mean
being calm under stress.
• Treatment
o Regulating the environment to increase or decrease heat, dryness, moisture, or cold.
o Bleeding or Bloodletting: a carefully measured amount of blood was removed from the body.
o Induce Vomiting: Robert Burton recommended eating tobacco and a half-boiled cabbage.
• 2 Movement of Air or Wind Throughout the Body (Chinese)
o Unexplained mental disorders were caused by blockages of wind or the presence of cold, dark wind (yin) as
opposed to warm, life-sustaining wind (yang).
o Treatment: Restoring proper flow of wind through various methods (acupuncture).
C. The 19th Century
1 Syphilis
• Advanced Syphilis
o A sexually transmitted disease caused by a bacterial microorganism entering the brain.
o Symptoms: believing that everyone is plotting against you (delusion of persecution) or that you are God (delusion
of grandeur), as well as other bizarre behaviors.
• Germ Theory of Disease (Louis Pasteur, 1870)
o Facilitated the identification of the specific bacterial microorganism that caused syphilis.
• General Paresis
o Consistent symptoms and a consistent course that resulted in death unlike syphilis.
o Deteriorated steadily, becoming paralyzed and dying within 5 years of onset.
o Discovery of Cure for General Paresis
▪ Physicians observed a surprising recovery in patients with general paresis who had contracted malaria, so
they deliberately injected other patients with blood from a soldier who was ill with malaria.
2 John P. Grey (American Psychiatrist)
• Asserts that causes of insanity were always physical.
o Mentally ill patient should be treated as physically ill.
o Treatments
▪ Rest, diet, and proper room temperature and ventilation.
▪ Invented the rotary fan to ventilate his large hospital.
o The conditions in hospitals greatly improved and they became more humane, livable institutions.
D. The Development of Biological Treatments
1 Insulin Shock Therapy
• Discovered as it was occasionally given to stimulate appetite in psychotic patients who were not eating, but it also
seemed to calm them down.
• Manfred Sakel (Viennese Physician, 1927)
o Began using increasingly higher dosages until, finally, patients convulsed and became temporarily comatose.
o Recovery was attributed to the convulsions.
2 Electroconvulsive Therapy
• Benjamin Franklin (1750s)
o Discovered that a mild and modest electric shock to the head produced a brief convulsion and memory loss (amnesia).
• Dutch Physician (Friend and Colleague of Benjamin Franklin)
o Tried it on himself and discovered that the shock also made him “strangely elated” and wondered if it might be a useful
treatment for depression.
• Joseph von Meduna (Hungarian Psychiatrist, 1920s)
o Observed that schizophrenia was rarely found in individuals with epilepsy.
o Some of his followers concluded that induced brain seizures might cure schizophrenia.
3 Drugs for Disorders
• Rauwolfia Serpentine (Later Renamed Reserpine) And Neuroleptics (Major Tranquilizers)
o Hallucinatory and delusional thought processes could be diminished in some patients and also controlled
agitation and aggressiveness.
• Benzodiazepines (Minor Tranquilizers)
o Used to reduce anxiety.
• Bromides
o A class of sedating drugs.
 o Used at the end of the 19th century and beginning of the 20th century to treat anxiety and other psychological
disorders.
4 Emil Kraepelin (1856–1926)
• Major contribution is in the areas of diagnosis and classification.
• One of the first to distinguish among various psychological disorders.
o Each may have a different age of onset and time course, with somewhat different clusters of presenting
symptoms, and probably a different cause.

3 THE PSYCHOLOGICAL TRADITION

A. Plato
• Thought that the two causes of maladaptive behavior were the social and cultural influences in one’s life and the
learning that took place in that environment.
o The best treatment was to reeducate the individual through rational discussion so that the power of reason would
predominate.
B. Aristotle
• Emphasized the influence of social environment and early learning on later psychopathology.
C. Moral Therapy
1 Greek Asclepiad Temples of the 6th century B.C.
• Housed the chronically ill, including those with psychological disorders.
• Patients were well cared for, massaged, and provided with soothing music.
2 French psychiatrist Philippe Pinel (1745–1826) and Jean-Baptiste Pussin (1746–1811)
• When Pinel arrived in 1791, Pussin had already instituted remarkable reforms by removing all chains used to restrain
patients and instituting humane and positive psychological interventions.
3 Benjamin Rush (1745–1813)
• Considered the founder of U.S. psychiatry.
• Introduced moral therapy in his early work at Pennsylvania Hospital.
D. Asylum Reform and the Decline of Moral Therapy
• 1 Moral therapy worked best when the number of patients in an institution was 200 or fewer, allowing for a great deal
of individual attention.
• 2 Dorothea Dix (1802–1887)
o Mental Hygiene Movement
▪ A schoolteacher who campaigned endlessly for reform in the treatment of insanity.
▪ Everyone who needed care received it, including the homeless.
o Increase in the number of mental patients > hospitals were inadequately staffed.
E. Psychoanalytic Theory
1 Franz Anton Mesmer (1734–1815)
• Problem was caused by an undetectable fluid found in all living organisms called “animal magnetism,” which could
become blocked.
o Patients sit in a dark room around a large vat of chemicals with rods extending from it and touching them. Dressed
in flowing robes, he might then identify and tap various areas of their bodies where their animal magnetism was
blocked while suggesting strongly that they were being cured.
2 Jean-Martin Charcot (1825–1893)
• Head of the Salpétrière Hospital in Paris.
• Legitimize the fledgling practice of hypnosis.
3 Josef Breuer (1842–1925) and Sigmund Freud
• Asked them to describe their problems, conflicts, and fears in as much detail as they could while in a state hypnosis.
o Breuer and Freud had “discovered” the unconscious mind.
o Catharsis: Release of emotional material.
o Insight: A fuller understanding of the relationship between current emotions and earlier events.
• Case of Anna O (Bertha Pappenheim, 1859– 1936)
o Developed hysterical symptoms five months after her father became ill.
o Blurry vision, difficulty moving her right arm and both legs, difficulty speaking.
4 Sigmund Freud
• Neuroses
o Neurotic disorders, from an old term referring to disorders of the nervous system.
• The Structure of the Mind
o ID (Pleasure Principle): Source of our strong sexual and aggressive feelings or energies.
▪ Goal: Maximizing pleasure and eliminating any associated tension or conflicts.
▪ Primary Process: Type of thinking that is emotional, irrational, illogical, filled with fantasies, and
preoccupied with sex, aggression, selfishness, and envy.
▪ Libido: The energy or drive within the id.
▪ Thanatos: The death instinct.
o Ego (Reality Principle): Executive or manager of our minds.
▪ Mediate conflict between the id and the superego.
▪ Secondary Process: Thinking styles that are characterized by logic and reason.
o Superego (Moral Principles)
▪ Conscience; Instilled in us by our parents and our culture.
▪ Intrapsychic Conflicts: All conflicts within the mind due to the opposing demands of id and superego.
• Defense Mechanisms
o Denial: Refuses to acknowledge some aspect of objective reality or subjective experience that is apparent to
others.
o Displacement: Transfers a feeling about, or a response to, an object that causes discomfort onto another, usually
less-threatening, object or person.
o Projection: Falsely attributes own unacceptable feelings, impulses, or thoughts to another individual or object.
o Rationalization: Conceals the true motivations for actions, thoughts, or feelings through elaborate reassuring or
self-serving but incorrect explanations.
 o Reaction Formation: Substitutes behavior, thoughts, or feelings that are the direct opposite of unacceptable
ones.
o Repression: Blocks disturbing wishes, thoughts, or experiences from conscious awareness.
o Sublimation: Directs potentially maladaptive feelings or impulses into socially acceptable behavior.
• Psychosexual Stages of Development
o Oral Stage (Approximately 2 Years from Birth)
▪ Characterized by a central focus on the need for food.
▪ Principal Source of Pleasure: The lips, tongue, and mouth (act of sucking).
• Fixation: Excessive thumb sucking and emphasis on oral stimulation through eating, chewing pencils,
or biting fingernails.
• Adult Personality Characteristics: Dependency and passivity.
o Phallic Stage (From Age 3 to Age 5 or 6)
▪ Characterized by early genital self-stimulation.
▪ The Greek Tragedy Oedipus Rex
• Oedipus is fated to kill his father and, unknowingly, to marry his mother.
• Young boys relive this fantasy when genital self-stimulation is accompanied by images of sexual
interactions with their mothers.
▪ Castration Anxiety: Strong fears develop that the father may punish that lust by removing the son’s penis.
▪ Oedipus Complex: The battle of the lustful impulses on the one hand and castration anxiety on the other
creates a conflict that is internal, or intrapsychic.
▪ Electra Complex: The young girl as wanting to replace her mother and possess her father.
▪ Penis Envy: The girl’s desire for a penis, so as to be more like her father and brothers.
4 Later Developments in Psychoanalytic Thought
• Anna Freud (1895–1982) > Ego Psychology
o Ego and the Mechanisms of Defense (1946)
▪ The individual slowly accumulates adaptational capacities, skill in reality testing, and defenses.
▪ Abnormal behavior develops when the ego is deficient in regulating such functions as delaying and
controlling impulses or in marshaling appropriate normal defenses to strong internal conflicts.
• Heinz Kohut (1913–1981) > Self-Psychology
o The formation of self-concept and the crucial attributes of the self that allow an individual to progress toward
health.
• Object Relations
o The study of how children incorporate the images, the memories, and the values of a person who was important
to them and to whom they were emotionally attached.
o Object: Important people.
o Introjection: The process of incorporation.
• Jung’s Collective Unconscious
o A wisdom accumulated by society and culture that is stored deep in individual memories and passed down from
generation to generation.
• Alfred Adler
o Created the term inferiority complex.
o Focused on feelings of inferiority and the striving for superiority.
• Erik Erikson (1902–1994)
o Theory of development across the life span.
o Described in some detail the crises and conflicts that accompany eight specific stages.
5 Psychoanalytic Psychotherapy
• Free Association
o Patients are instructed to say whatever comes to mind without the usual socially required censoring.
• Dream Analysis
o Therapist interprets the content of dreams, supposedly reflecting the primary-process thinking of the id, and
systematically relates the dreams to symbolic aspects of unconscious conflicts.
• Transference
o Patients come to relate to the therapist much as they did to important figures in their childhood, particularly their
parents.
• Countertransference
o Therapists project some of their own personal issues and feelings, usually positive, onto the patient.
• Classical Psychoanalysis
o Requires therapy four to five times a week for 2 to 5 years to analyze unconscious conflicts, resolve them, and
restructure the personality to put the ego back in charge.
• Psychodynamic Psychotherapy
o Therapists use an eclectic mixture of tactics, with a social and interpersonal focus.
▪ Briefer than classical psychoanalysis.
▪ Deemphasize the goal of personality reconstruction, focusing instead on relieving the suffering associated
with psychological disorders.
F. Humanistic Theory
• Self-Actualizing
o All of us could reach our highest potential, in all areas of functioning, if only we had the freedom to grow.

1 Abraham Maslow (1908–1970)

• Hierarchy of Needs
o Beginning with our most basic physical needs for food and sex and ranging upward to our needs for self-
actualization, love, and self-esteem.
2 Carl Rogers (1902–1987)
• Person-Centered Therapy (Client-Centered Therapy)
o The therapist takes a passive role, making as few interpretations as possible.
o Give the individual a chance to develop during the course of therapy, unfettered by threats to the self.
 o Unconditional Positive Regard: The complete and almost unqualified acceptance of most of the client’s feelings
and actions.
o Empathy: Sympathetic understanding of the individual’s particular view of the world.
• Helps the individual to be more straightforward and honest with themselves and will access their innate tendencies
toward growth.
G. The Behavioral Model (Cognitive-Behavioral Model or Social Learning Model)
1 Classical Conditioning: Ivan Petrovich Pavlov (1849–1936) of St. Petersburg, Russia
• A type of learning in which a neutral stimulus is paired with a response until it elicits that response.
o Classic study examining why dogs salivate before the presentation of food.
• Stimulus Generalization
o The strength of the response to similar objects or people is usually a function of how similar these objects or
people are.
• Example
o Unconditioned Stimulus (UCS): Food or chemotherapy.
o Unconditioned Response (UCR): Natural or unlearned response to this stimulus (salivation or nausea).
o Conditioned Stimulus (CS): Nurse associated with the chemotherapy.
o Conditioned Response (CR): Nauseous sensation (upon seeing the nurse).
• Extinction: Presentation of the CS without the UCS for a long enough period would eventually eliminate the CR.
• Introspection
o Edward Titchener (1867–1927)
o Subjects simply reported on their inner thoughts and feelings after experiencing certain stimuli.
2 Behaviorism
• John B. Watson (1878–1958)
o American psychologist and the founder of behaviorism.
• Little Albert
o Watson and Rosalie Rayner (his student) presented an 11-month-old boy named Albert with a harmless fluffy
white rat to play with.
o Every time Albert reached for the rat, however, the experimenters made a loud noise behind him.
• Mary Cover Jones (1896–1987)
o Student of John B. Watson who asserted that if fear could be learned or classically conditioned in this way,
perhaps it could also be unlearned or extinguished.
o Peter and Rabbit
▪ Boy named Peter, who at 2 years, 10 months old was already quite afraid of furry objects.
▪ Bring a white rabbit into the room where Peter was playing for a short time each day.
▪ She also arranged for other children, whom she knew did not fear rabbits, to be in the same room.
3 Behavior Therapy: Joseph Wolpe (1915–1997), psychiatrist from South Africa.
• Systematic Desensitization
o Individuals were gradually introduced to the objects or situations they feared so that their fear could extinguish.
o They could test reality and see that nothing bad happened in the presence of the phobic object or scene.
4 Operant Conditioning: Burrhus Frederic (B. F.) Skinner (1904–1990)
• A type of learning in which behavior changes as a function of what follows the behavior.
• Law of Effect: Edward L. Thorndike (1874–1949)
o Behavior is either strengthened or weakened depending on the consequences of that behavior.
• Shaping
o A process of reinforcing successive approximations to a final behavior or set of behaviors.

THE PRESENT: THE SCIENTIFIC METHOD AND AN INTEGRATIVE APPROACH

• Multidimensional and integrative approach.

• Adolf Meyer (1866–1950)
o The dean of American psychiatry.
o Emphasized the equal contributions of biological, psychological, and sociocultural determinism.
ABNORMAL PSYCHOLOGY
BOOK: Abnormal Psychology: An Integrative Approach |Compiled/organized by: MARY-ANN SEVILLA
AUTHOR: David H. Barlow, V. Mark Durand, Stefan G. Hofmann | *Do not reproduce w/o consent esp. for monetary
CHAPTER: 2 – An Integrative Approach to Psychopathology gain/purposes :>

Chapter 2: An Integrative Approach to Psychopathology

ONE-DIMENSIONAL VERSUS MULTIDIMENSIONAL MODELS

One-Dimensional
Attempts to trace the origins of behavior to a single cause.
Multidimensional
• Abnormal behavior results from multiple influences.
o The biology and behavior of the individual, the cognitive, emotional, social, and cultural environment.
• 1 Biological Influences
o Ex. Judy’s blood-injection-injury phobia.
o Vasovagal Syncope: Syncope (sinking feeling or
swoon) caused by low blood pressure in the head >
fainting.
o Sinoaortic Baroreflex Arc: Overreaction of this reflex
causes vasovagal syncope as it compensates for
sudden increases in blood pressure by lowering it.
• 2 Emotional Influences
o Rapid increases in heart rate caused by her emotions
may have triggered a stronger and more intense
baroreflex.

GENETIC CONTRIBUTIONS TO PSYCHOPATHOLOGY

Genes
Long molecules of deoxyribonucleic acid (DNA) at various locations on chromosomes, within the cell nucleus.
Huntington’s Disease A degenerative brain disease that appears in early to middle age, usually the early 40s.
A genetic defect that causes deterioration in a specific area of the brain (basal ganglia).
Phenylketonuria (PKU) Caused by the inability of the body to metabolize (break down) phenylalanine, a chemical
compound found in many foods which can cause mental retardation.

1 THE NATURE OF GENES

• Normal Human Cell: 46 chromosomes, 23 pairs.
o One chromosome in each pair comes from the father and one from the
mother.
o 22 Pairs of Chromosomes: Provide programs or directions for the
development of the body and brain.
o 23rd Chromosome: Determines an individual’s sex.
▪ Females: X chromosomes.
▪ Males: XY chromosomes > mother contributes an X chromosome but
the father contributes a Y chromosome.
• Dominant vs Recessive Genes
o Dominant Genes: One of a pair of genes that strongly influences a particular trait.
o Recessive Genes: Must be paired with another recessive gene to determine a trait.
o Polygenic: Traits that are influenced by many genes, each contributing only a tiny effect.
• Genome: An individual’s complete set of genes.
• Procedures To Identify Genes
o Quantitative Genetics: Sums up all the tiny effects across many genes without necessarily telling us which
genes are responsible for which effects.
o Molecular Genetics: Examining the actual structure of genes with increasingly advanced technologies such as
DNA microarrays.
▪ Allow scientists to analyze thousands of genes at once and identify broad networks of genes that may be
contributing to a particular trait.

2 THE INTERACTION OF GENES AND THE ENVIRONMENT

A. The Diathesis–Stress Model
• Individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of
stress.
• Diathesis: A condition that makes someone susceptible to developing a disorder.
B. The Gene–Environment Correlation Model (Reciprocal Gene–Environment Model)
• Genetic endowment may increase the probability that an individual will experience stressful life events.
o A genetically determined tendency to create the very environmental risk factors that trigger a genetic vulnerability.

NEUROSCIENCE AND ITS CONTRIBUTIONS TO PSYCHOPATHOLOGY

1 THE CENTRAL NERVOUS SYSTEM

• Processes all information received from our sense organs and reacts as necessary.
• Consists of spinal cord and brain.
o Spinal cord: Facilitate the sending of messages to and from the brain.
• Neurons
o Transmit information throughout the nervous system.
o Dendrite: Dendrites have numerous receptors that receive messages in the form of chemical impulses from
other nerve cells, which are converted into electrical impulses.
o Axon: Transmits these impulses to other neurons.
o Synapses: Any one nerve cell may have multiple connections to other neurons.
o Terminal Button: End of an axon.
o Synaptic Cleft: The space between the terminal button of one neuron and the dendrite of another.
o Action Potentials: Information is transmitted through electrical impulses.
o Neurotransmitters: The biochemicals that are released from the axon of one neuron and transmit the impulse
to the dendrite receptors of another neuron.
▪ Chemicals stored in vesicles in the terminal buttons.
▪ Excitatory Neurotransmitters: Increase the likelihood that the connecting neuron will fire.
▪ Inhibitory Neurotransmitters: Decrease the likelihood that the connecting neuron will fire.

2 THE STRUCTURE OF THE BRAIN

A. Brain Stem
• Lower and more ancient part of the brain.
• Handles most of the essential automatic functions.
o Breathing, sleeping, and moving around in a coordinated way.
• 1 Hindbrain
o Medulla, the pons, and the cerebellum.
o Regulates many automatic activities (breathing, the pumping
action of the heart, and digestion).
o Cerebellum: Controls motor coordination.
• 2 Midbrain
o Coordinates movement with sensory input and contains parts of
the reticular activating system.
o Reticular Activating System: Contributes to processes of
arousal and tension, such as whether we are awake or asleep.
• 3 Thalamus And Hypothalamus
o Involved broadly with regulating behavior and emotion.
o function as a relay between the forebrain and the remaining lower
areas of the brain stem
B. Forebrain
• More advanced and evolved more recently.
• 1 Limbic System
o Helps regulate our emotional experiences and expressions and,
our ability to learn and to control our impulses.
o Involved with the basic drives of sex, aggression, hunger, and
thirst.
o The hippocampus (sea horse), cingulate gyrus (girdle), septum
(partition), and amygdala (almond).
• 2 Basal Ganglia
o Include the caudate (tailed) nucleus.
o Control motor activity as damage to these structures is involved in changing our posture or twitching or shaking.
• 3 Cerebral Cortex
o Allowing us to look to the future and plan, to reason, and to create.
o Two Hemispheres
▪ Left hemisphere: Responsible for verbal and other cognitive processes.
▪ Right hemisphere: Better at perceiving the world around us and creating images.
C. Four Lobes of the Brain
• 1 Temporal Lobe
o Recognizing various sights and sounds and with long-term
memory storage.
• 2 Parietal Lobe
o Recognizing various sensations of touch and monitoring
body positioning.
• 3 Occipital Lobe
o Integrating and making sense of various visual inputs.
• 4 Frontal Lobe
o Prefrontal Cortex: The front (or anterior) of the frontal
lobe
▪ Responsible for higher cognitive functions such as
thinking and reasoning, planning for the future, and long-term memory.
▪ Synthesizes all information received from other parts of the brain and decides how to respond.

3 THE PERIPHERAL NERVOUS SYSTEM

• Coordinates with the brain stem to make sure the body is working properly.
A. Somatic Nervous System
• Controls the muscles.
B. Autonomic Nervous System
• Sympathetic nervous system and parasympathetic nervous system.
• Regulate the cardiovascular system (the heart and blood vessels) and the endocrine system and to perform various
other functions, including aiding digestion and regulating body temperature.
 • Endocrine System
o Hormone: An endocrine gland that produces its own chemical
messenger.
o Adrenal Glands > Epinephrine (Adrenaline): Produces in response
to stress, as well as salt-regulating hormones.
o Thyroid Gland > Thyroxine: Facilitates energy metabolism and
growth.
o Pituitary: A master gland that produces a variety of regulatory
hormones.
o Gonadal Glands > Sex Hormones: Estrogen and testosterone.
• 1 Sympathetic Nervous System
o Mobilizing the body during times of stress or danger by rapidly
activating the organs and glands under its control.
▪ Heart beats faster: Increasing the flow of blood to the muscles.
▪ Respiration increases: Allowing more oxygen to get into the blood
and brain.
▪ Adrenal glands are stimulated.
• 2 Parasympathetic Nervous System
o Takes over after the sympathetic nervous system has been active for a
while.
▪ Normalizing our arousal and facilitating the storage of energy by
helping the digestive process.
• Telomere
o Part of a chromosome that appears to moderate the effect of depression and cortisol.
▪ Shorter telomeres were associated with greater cortisol reactivity to stress.

4 NEUROTRANSMITTERS
Agonists Effectively increase the activity of a neurotransmitter by mimicking its effects.
Antagonists Decrease, or block, a neurotransmitter.
Inverse Agonists Produce effects opposite to those produced by the neurotransmitter.
Reuptake After a neurotransmitter is released, it is quickly broken down and brought back from the synaptic
cleft into the same neuron that released it.
*Drug therapies work by either increasing or decreasing the flow of specific neurotransmitters.
Two Types of Neurotransmitters
Monoamine Class Norepinephrine (noradrenaline), serotonin, and dopamine.
Amino-Acid Gamma-aminobutyric acid (GABA) and glutamate.
Neurotransmitters
A. Amino-Acid Neurotransmitters
Glutamate Excitatory transmitter that “turns on” many different neurons, leading to action.
• MSG (Monosodium Glutamate) can increase the amount of glutamate in the body.
o Headaches, ringing in the ears, or other physical symptoms.
Gamma-Aminobutyric Inhibit (or regulate) the transmission of information and action potentials.
Acid (GABA) • Best-known effect is to reduce anxiety.
• Benzodiazepines (Minor Tranquilizers)
o Makes it easier for GABA molecules to attach themselves to the receptors of
specialized neurons.
• Effects
o Reduce overall arousal somewhat and to temper our emotional responses.
o Reduce levels of anger, hostility, aggression, and perhaps even positive emotional
states such as eager anticipation and pleasure.
B. Monoamine Class
1 Serotonin Regulates our behavior, moods, and thought processes.
(5- • Extremely Low Activity Levels: Less
Hydroxytryptamine- inhibition and with instability, impulsivity, and
5ht) the tendency to overreact to situations.
• Low Serotonin Activity: Aggression, suicide,
impulsive overeating, and excessive sexual
behavior.
• Selective-Serotonin Reuptake Inhibitors
(SSRIs), (Prozac)
o Used to treat a number of psychological
disorders, particularly anxiety, mood,
and eating disorders.
2 Norepinephrine Regulate or modulate certain behavioral tendencies and is not directly involved in specific
(Noradrenaline) patterns of behavior or in psychological disorders.
• Stimulate at least two groups of receptors.
o Alpha-adrenergic and beta-adrenergic receptors.
• Beta-Blockers
o Class of drugs that block the beta-receptors so that their response to a surge of
norepinephrine is reduced, which keeps blood pressure and heart rate down.
3 Dopamine Implicated in the pathophysiology of schizophrenia, Parkinson’s disease, and disorders of
addiction.
• Depression and attention deficit hyperactivity disorder.
• Dopamine activity is associated with exploratory, outgoing, pleasure-seeking behaviors.
 5 PSYCHOSOCIAL INFLUENCES ON BRAIN STRUCTURE AND FUNCTION
• Lewis R. Baxter and his colleagues
o Exposure and Response Prevention
▪ Treated the patients with a cognitive-behavioral therapy known to be effective in OCD.
• Placebo Effects
o Sugar pills, or other “sham” (inactive) treatments to result in behavioral and emotional changes in patients.
▪ Both antidepressant medications and placebos changed brain function but in somewhat different parts of
the brain.

BEHAVIORAL AND COGNITIVE SCIENCE

Cognitive Science Concerned with how we acquire and process information and how we store and ultimately
retrieve it.

1 CONDITIONING AND COGNITIVE PROCESSES

1 Robert Rescorla’s experiment
• Contiguity: Pairing a neutral stimulus and an unconditioned stimulus—does not result in the same kind of
conditioning.
o Contiguity-only group experiences the usual conditioning procedure: Pairing a tone and meat causes the tone to
take on properties of the meat.
o Contiguity-and-random group: the meat appeared away from the tones, as well as with it, making the tone less
meaningful.

2 LEARNED HELPLESSNESS
1 Martin Seligman and his colleague Steven Maier
• Occurs when rats or other animals encounter conditions over which they have no control.
o People become depressed if they “decide” or “think” they can do little about the stress in their lives.
2 Learned Optimism
• If people faced with considerable stress and difficulty in their lives nevertheless display an optimistic, upbeat attitude,
they are likely to function better psychologically and physically.

3 SOCIAL LEARNING
1 Albert Bandura
• Modeling or Observational Learning: Learn by observing what happens to someone else in a given situation.

4 PREPARED LEARNING
• We have become highly prepared for learning about certain types of objects or situations over the course of evolution
because this knowledge contributes to the survival of the species.
o Eg., more likely to learn to fear snakes.

5 COGNITIVE SCIENCE AND THE UNCONSCIOUS

Implicit Memory When someone clearly acts on the basis of things that have happened in the past but can’t
remember the events.
Studying the 1 Black Box
Unconscious • Unobservable feelings and cognitions inferred from an individual’s self-report or
behaviors.
2 Stroop Paradigm
• Participants are shown a variety of words, each printed in a different color.
• Asked to name the colors in which they are printed while ignoring their meaning.

EMOTIONS

Flight or Fight Response • The alarm reaction that activates during potentially life-threatening emergencies.
o Purpose of the physical rush of adrenaline is to mobilize us to escape the danger
(flight) or to fend it off (fight).

1 EMOTIONAL PHENOMENA
Emotion
A subjective feeling of terror, a strong motivation for behavior.
Action Tendency A tendency to behave in a certain way elicited by an external event (a threat) and a feeling state
(terror) and accompanied by a possibly characteristic physiological response.
Mood More persistent period of affect or emotionality.
Affect The valence dimension of an emotion (pleasant or positive vs. unpleasant or negative).
Circumplex Model of Any emotional experience can be assigned as a point on this two-dimensional system.
Emotions
Affective Style Used to summarize commonalities among emotional states characteristic of an individual.
 2 THE COMPONENTS OF EMOTION

CULTURAL, SOCIAL, AND INTERPERSONAL FACTORS

1 VOODOO, THE EVIL EYE, AND OTHER FEARS

Fright Disorders Characterized by exaggerated startle responses, and other observable fear and anxiety reactions.
Susto In Latin American, describes various anxiety-based symptoms, including insomnia, irritability,
phobias, and the marked somatic symptoms of sweating and increased heart rate (tachycardia).
• Believes that he or she has become the object of black magic, or witchcraft, and is suddenly
badly frightened (evil eye).

2 GENDER
Gender Roles Cultural expectations of men and women.
• Man is more likely to hide or endure the fear until he gets over it (being bitten by insects).

3 SOCIAL EFFECTS ON HEALTH AND BEHAVIOR

• The greater the number and frequency of social relationships and contacts, the longer you are likely to live.
o Social and Interpersonal Influences on the Elderly
o Social Stigma

Life-Span Development
Equifinality Used in developmental psychopathology to indicate that we must consider a number of paths to a given
outcome.
ABNORMAL PSYCHOLOGY
BOOK: Abnormal Psychology: An Integrative Approach |Compiled/organized by: MARY-ANN SEVILLA
AUTHOR: David H. Barlow, V. Mark Durand, Stefan G. Hofmann | *Do not reproduce w/o consent esp. for monetary
CHAPTER: 3 – Clinical Assessment & Diagnosis gain/purposes :>

Chapter 3: Clinical Assessment & Diagnosis

ASSESSING PSYCHOLOGICAL DISORDERS

Clinical Assessment The systematic evaluation and measurement of psychological, biological, and social factors in an
individual presenting with a possible psychological disorder.
Diagnosis The process of determining whether the particular problem afflicting the individual meets all
criteria for a psychological disorder, as set forth in the DSM-5.

1 KEY CONCEPTS IN ASSESSMENT

Three basic concepts that help determine the value of our assessments:
1 Reliability The degree to which a measurement is consistent.
2 Validity Measures what it is designed to measure.
• Concurrent or Descriptive Validity: Comparing the results of an assessment measure
under consideration with the results of others that are better known allows you to begin to
determine the validity of the first measure.
• Predictive Validity: How well your assessment tells you what will happen in the future.
3 Standardization The process by which a certain set of standards or norms is determined for a technique to make
its use consistent across different measurements.
• Procedures of testing, scoring, and evaluating data

2 CLINICAL INTERVIEW
Gathers information on current and past behavior, attitudes, and emotions, as well as a detailed history of the individual’s
life in general and of the presenting problem.
A. Mental Status Exam (MSE)
Involves the systematic observation of an individual’s behavior.
Five Categories of MSE (TAMIS)
1 Appearance and Overt physical behaviors (leg twitching), individual’s dress, general appearance, posture, and
Behavior facial expression.
• Psychomotor Retardation: slow and effortful motor behavior.
2 Thought Processes Rate or flow of speech.
• Continuity of speech.
o Loose Association or Derailment: Disorganized speech pattern (schizophrenia).
• Content of speech.
o Delusions: Distorted views of reality.
o Delusions of Persecution: Someone thinks people are after him and out to get him all
the time.
o Delusions of Grandeur: Individual thinks she is all-powerful in some way.
o Ideas of Reference: Everything everyone else does somehow relates back to the
individual.
o Hallucinations: Things a person sees or hears when those things really aren’t there.
3 Mood and Affect • Mood: The predominant feeling state of the individual.
• Affect: The feeling state that accompanies what we say at a given point.
o Appropriate Affect: We laugh when we say something funny or look sad when we talk
about something sad.
o Blunted or Flat Affect: Talking about a range of happy and sad things with no affect.
4 Intellectual Reasonable vocabulary, talk in abstraction and metaphors, and person’s memory.
Functioning
5 Sensorium General awareness of our surroundings.
• What the date is, what time it is, where he or she is, who he or she is, and who you are?

B. Semi-structured Clinical Interviews

• Made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner
so that clinicians can be sure they have inquired about the most important aspects of particular disorders.
• Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5)
o Clinician first asks if the patient is bothered by thoughts, images, or impulses (obsessions) or feels driven to
experience some behavior or thought repeatedly (compulsions).
 ▪ Clinician then asks the patient to rate each obsession on two measures: persistence–distress (how often it
occurs and how much distress it causes) and resistance (types of attempts the patient makes to get rid of
the obsession).
▪ For compulsions, the patient provides a rating of their frequency.

3 PHYSICAL EXAMINATION
Aware of the medical conditions and drug use and abuse that may contribute to the kinds of problems described by the
patient.

4 BEHAVIORAL ASSESSMENT
• Using direct observation to formally assess an individual’s thoughts, feelings, and behavior in specific situations or
contexts.
o Appropriate to use individuals who are not old enough or skilled enough to report their problems and experience.
o Role-Play Simulations: See how people might behave in similar situations in their daily lives.
The ABCs of Observation
Antecedents What happened just before the behavior.
Behavior Observable action.
Consequences What happened afterward.
• Formal Observation: Involves identifying specific behaviors that are observable and
measurable (Operational Definition).
Self-Monitoring (Self-Observation)
Observe their own behavior to find patterns.
Checklists and Formal and structured way to observe behavior.
Behavior Rating Scales
Brief Psychiatric Rating Assesses 18 general areas of concern.
Scale • Each symptom is rated on a 7-point scale from 0 (not present) to 6 (extremely severe).
• The rating scale screens for moderate to severe psychotic disorders and includes such
items as somatic concern, guilt feelings, and grandiosity.
Reactivity A phenomenon that can distort any observational data.
• Your presence may cause them to change their behavior.

5 PSYCHOLOGICAL TESTING
A. Projective Testing
• Ambiguous stimuli (pictures, inkblots) are presented to people who are asked to describe what they see.
o People project their own personality and unconscious fears onto other people and things and, without realizing
it, reveal their unconscious thoughts to the therapist.
Rorschach Inkblot Test • Developed by Swiss psychiatrist Hermann Rorschach.
• A series of inkblots, initially to study perceptual processes and then to diagnose
psychological disorders.
o Includes 10 inkblot pictures then presents it he inkblots one by one to the person
being assessed, who responds by telling what he sees.
• Comprehensive System by John Exner
o A standardized version of the Rorschach inkblot test.
o Exner’s system of administering and scoring the Rorschach specifies how the cards
should be presented, what the examiner should say, and how the responses should
be recorded.
Thematic Apperception • Developed in 1935 by Christiana Morgan and Henry Murray at the Harvard Psychological
Test (TAT) Clinic.
• Consists of a series of 31 cards—30 with pictures on them and 1 blank card— although
only 20 cards are typically used during each administration.
o Ask the person to tell a dramatic story about the picture.
• Social Cognition and Object Relations Scale
o One of the formal scoring systems for TAT stories.
B. Personality Inventories
Self-report questionnaires that assess personal traits.
Minnesota Multiphasic • The individual being assessed reads statements and answers either “true” or “false.”
Personality Inventory • 550 items on the original version and now the 567 items on the MMPI-2.
(MMPI) • MMPI-A
o A version of the MMPI that is appropriate for adolescents.
• Subscales
o Lie Scale: Identify if the the person may be falsifying answers to look good.
o Infrequency Scale: Measures false claims about psychological problems or
determines whether the person is answering randomly.
o Subtle Defensiveness Scale: Assesses whether the person sees herself in
unrealistically positive ways.
C. Intelligent Testing
1 Alfred Binet and Commissioned by the French government to develop a test that would identify “slow learners”
Theodore Simon who would benefit from remedial help.
2 Lewis Terman of Stanford-Binet Test: Translated a revised version of this test for use in the United States.
Stanford University • The test provided a score known as an intelligence quotient, or IQ.
o Initially, IQ scores were calculated by using the child’s mental age.
▪ A child who passed all questions on the 7-year-old level and none of the
questions on the 8-year-old level received a mental age of 7.
o Mental age was then divided by the child’s chronological age and multiplied by 100
to get the IQ score.
 • Deviation IQ
o A person’s score is compared only with scores of others of the same age.
3 Wechsler Tests Developed by psychologist David Wechsler.
• Wechsler Adult Intelligence Scale, fourth edition, or WAIS-IV: for adults.
• Wechsler Intelligence Scale for Children, fifth edition, or WISC-V: for children.
• Wechsler Preschool and Primary Scale of Intelligence, fourth edition, or WPPSI-IV:
for young children.

6 NEUROPSYCHOLOGICAL TESTING
Assesses brain dysfunction by observing the effects of the dysfunction on the person’s ability to perform certain tasks.
Bender Visual–Motor Gestalt Test
A child is given a series of cards on which are drawn various lines and shapes then the child will copy what is drawn on the
card.
• Disadvantage: The nature or location of the problem cannot be determined with this test.
Luria-Nebraska Neuropsychological Battery and the Halstead-Reitan Neuropsychological Battery
Two of the most popular advanced tests of organic (brain) damage that allow more precise determinations of the location of
the problem.
1 Halstead-Reitan Neuropsychological Battery
• Rhythm Test: Asks the person to compare rhythmic beats, thus testing sound recognition, attention, and
concentration.
• Strength of Grip Test: Compares the grips of the right and left hands.
• Tactile Performance Test: Requires the test taker to place wooden blocks in a form board while blindfolded, thus
testing learning and memory skills.
• Disadvantages
o False Positive: Test shows a problem when none exists.
o False Negative: No problem is found even though some difficulty is present.

7 NEUROIMAGING
Divided into two categories:
• Procedures that examine the structure of the brain.
• Procedures that examine the actual functioning of the brain by mapping blood flow and other metabolic activity.
A. Images of Brain Structure
1 Computerized Axial • First neuroimaging technique, developed in the early 1970s.
Tomography (CAT) • Uses multiple X-ray exposures of the brain from different angles.
Scan or (CT Scan) o A computer then reconstructs pictures of various slices of the brain.
• Advantages
o Useful in identifying and locating abnormalities in the structure or shape of the brain.
o Particularly useful in locating brain tumors, injuries, and other structural and
anatomical abnormalities.
2 Magnetic • The patient’s head is placed in a high-strength magnetic field through which radio frequency
Resonance Imaging signals are transmitted.
(MRI) o Where there are lesions or damage, the signal is lighter or darker.
B. Images of Brain Functioning
1 Positron Emission • Injected with a tracer substance attached to radioactive isotopes, or groups of atoms that
Tomography (PET) react distinctively. This substance interacts with blood, oxygen, or glucose.
Scan o Learn what parts of the brain are working and what parts are not.
• Advantages:
o Useful in supplementing MRI and CT scans when localizing the sites of trauma
resulting from head injury or stroke, as well as when localizing brain tumors.
o Used increasingly to look at varying patterns of metabolism that might be associated
with different disorders.
2 Single Photon • It works much like PET, although a different tracer substance is used.
Emission Computed • Somewhat less accurate and less expensive.
Tomography (SPECT)
3 Functional MRI • Take pictures of the brain at work, recording its changes from one second to the next.
(fMRI) o See the immediate response of the brain to a brief event.
• BOLD-fMRI (Blood-Oxygen-Level-Dependent fMRI)
o Most common fMRI technique used to study psychological disorders.

8 Psychophysiological Assessment
• Psychophysiology
o Measurable changes in the nervous system that reflect emotional or psychological events.
o Electroencephalogram (EEG)
▪ Measuring electrical activity in the head related to the firing of a specific group of neurons reveals brain wave
activity.
 ▪ Electrodes are placed directly on various places on the scalp to record the different low-voltage currents.
o Event-Related Potential (ERP) Or Evoked Potential
▪ Event-related voltage changes in the ongoing EEG activity that are time-locked to sensory, motor, and
cognitive events.
o Alpha Waves
▪ Waking activities are characterized by a regular pattern of changes healthy adults.
▪ Associated with relaxation and calmness.

DIAGNOSING PSYCHOLOGICAL DISORDERS

Idiographic vs Nomothetic Strategy

Idiographic Strategy Determine what is unique about an individual’s personality, cultural background, or circumstances.
Nomothetic Strategy Determine a general class of problems to which the presenting problem belongs.
Classification
Any effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared
attributes or relations.
Taxonomy The classification is in a scientific context.
Nosology If you apply a taxonomic system to psychological or medical phenomena or other clinical areas.
Nomenclature Describes the names or labels of the disorders that make up the nosology.

1 CLASSIFICATION ISSUES
Classical (Pure) Originates in the work of Emil Kraepelin (1856–1926)
Categorical Approach • There is still only one set of causative factors per disorder, which does not overlap with those of
other disorders.
• Very diagnosis has a clear underlying pathophysiological cause and that each disorder is unique’.
Dimensional Continuum of severity.
Approach • Note the variety of cognitions, moods, and behaviors with which the patient presents and
quantify them on a scale.
Prototypical There are combinations of characteristics (prototypes of behavior disorders) that tend to occur together
Approach regularly.
• Many possible features or properties of the disorder are listed, and any candidate must meet
enough of them to fall into that category.

2 DIAGNOSIS BEFORE 1980

Dementia Praecox • Kraepelin first identified the disorder of schizophrenia.
• Deterioration of the brain that sometimes occurs with advancing age (dementia) and develops
earlier than it is supposed to, or “prematurely” (praecox).
o Also described bipolar disorder, then called manic depressive psychosis.
1948 World Health • Added a section classifying mental disorders to the sixth edition of the International
Organization (WHO) Classification of Diseases and Related Health Problems (ICD).
Published in 1952 • First Diagnostic and Statistical Manual (DSM-I).
1968 • The American Psychiatric Association published a second edition of its Diagnostic and Statistical
Manual (DSM-II).

3 DSM-III and DSM-III-R

• Third Edition of the Diagnostic and Statistical Manual (DSM-III)
o Under the leadership of Robert Spitzer, DSM-III departed radically from its predecessors.
▪ 1 Attempted to take an atheoretical approach to diagnosis.
• Relying on precise descriptions of the disorders as they presented to clinicians rather than on psychoanalytic
or biological theories of etiology.
▪ 2 The specificity and detail with which the criteria for identifying a disorder were listed made it possible to study
their reliability and validity.

4 DSM-IV and DSM-IV-TR

1992 The 10th edition of the International Classification of Diseases was published.
1994 1 Fourth Edition of the DSM (DSM-IV)
• Distinction between organically based disorders and psychologically based disorders that was present in
previous editions was eliminated.
2 DSM-IV-TR (2000)
• A committee updated the text that describes the research literature accompanying the DSM-IV diagnostic
category and made minor changes to some of the criteria themselves to improve consistency.

5 DSM-5 (2013)
• 1 Some new disorders are introduced, and other disorders have been reclassified.
• 2 Organizational and structural changes.
o The manual is divided into three main sections.
▪ The manual and describes how best to use it.
▪ Presents the disorders themselves.
▪ Descriptions of disorders or conditions that need further research before they can qualify as official diagnoses.
• 3 The use of dimensional axes for rating severity, intensity, frequency, or duration of specific disorders in a relatively uniform
manner across all disorders.
• Caution about Labeling and Stigma
o Moron (least severe), imbecile, and idiot (most severe).
o In DSM-5, the term “mental retardation” has been dropped in favor of the more accurate term “intellectual disability,”
which is further described as mild, moderate, severe, or profound.
▪ !! Terms in psychopathology do not describe people but identify patterns of behavior that may or may not occur in
certain circumstances.
ABNORMAL PSYCHOLOGY
BOOK: Abnormal Psychology: An Integrative Approach |Compiled/organized by: MARY-ANN SEVILLA
AUTHOR: David H. Barlow, V. Mark Durand, Stefan G. Hofmann | *Do not reproduce w/o consent esp. for monetary
CHAPTER: 4 – Research Methods gain/purposes :>

Chapter 4: Research Methods

EXAMINING ABNORMAL BEHAVIOR

1 BASIC COMPONENTS OF RESEARCH

Hypothesis
• An educated guess.
o Testability: The ability to support the hypothesis
Research Design
• The aspects you want to measure in the people you are studying (the dependent variable) and the influences on these
characteristics or behaviors (the independent variable).
1 Dependent Variable What is measured, and it may be influenced directly by the study.
2 Independent Factors thought to affect the dependent variables and may be directly manipulated by the
Variable researchers.
Two Forms of Validity in Research Studies
Internal Validity The extent to which you can be confident that the independent variable is causing the dependent
variable to change.
• Confounding Variable: Any factor occurring in a study that makes the results uninterpretable
because a variable other than the independent variable may also affect the dependent variable.
• Strategies to Ensure Internal Validity
o Control Group: People are similar to the experimental group in every way except that
members of the experimental group are exposed to the independent variable and those in
the control group are not.
o Randomization: The process of assigning people to different research groups in such a way
that each person has an equal chance of being placed in any group.
o Analogue Models: Create in the controlled conditions of the laboratory aspects that are
comparable (analogous) to the phenomenon under study.
External Validity How well the results relate to things outside your study.
• Generalizability: The extent that the results can be applied to people other than the
participants of the study and in other settings.

2 STATISTICAL VERSUS CLINICAL SIGNIFICANCE

Statistical The probability of obtaining the observed effect by chance is small.
Significance • A mathematical calculation about the difference between groups.
Clinical Significance Whether or not the difference was meaningful for those affected.
*Social Validity This technique involves obtaining input from the person being treated, as well as from significant
(Montrose Wolf, 1978) others, about the importance of the changes that have occurred.

3 THE “AVERAGE” CLIENT

Patient Uniformity Tendency to see all participants as one homogeneous group.
Myth • Leads researchers to make inaccurate generalizations about disorders and their
treatments.

TYPES OF RESEARCH METHODS

1 INDIVIDUAL CASE STUDIES

• Investigating intensively one or more individuals who display the behavioral and physical patterns.
o Best way to begin exploring a relatively unknown disorder.
o Disadvantage: Sometimes coincidences occur that are irrelevant to the condition under study.

2 CORRELATIONAL RESEARCH
• Correlation: A statistical relationship between two variables.
o Correlation does not imply causation: two things occurring together does not necessarily mean that one caused
the other.
o 1 Positive Correlation
▪ Great strength or quantity in one variable is associated with great strength or quantity in the other variable.
▪ The lower strength or quantity in one variable is associated with lower strength or quantity in the other.
o 2 Negative Correlation
▪ One increases, the other decreases.
o Correlation Coefficient
▪ +1.00: Positive relationship and perfect relationship.
▪ 0.00: No relationship exists.
▪ !!The higher the number, the stronger the relationship.
o Problem of Directionality
▪ A correlation allows us to see whether a relationship exists between two variables but not to draw
conclusions about whether either variable causes the effects.
▪ Do not know whether A causes B, B causes A, or a third variable, C, causes A and B.
 3 EPIDEMIOLOGICAL RESEARCH
Epidemiology The study of the incidence, distribution, and consequences of a particular problem or set of problems
in one or more populations.
Prevalence The number of people with a disorder at any one time.
Incidence The estimated number of new cases during a specific period.

4 EXPERIMENTAL RESEARCH
Experiment • Involves the manipulation of an independent variable and the observation of its effects.
o Manipulate the independent variable to answer the question of causality.
A. Group Experimental Designs
• Manipulating Variable: Introducing or withdrawing a variable in a way that would not have occurred naturally.
• Clinical Trial: An experiment used to determine the effectiveness and safety of a treatment or treatments.
o Randomized Clinical Trials: Employ randomization of participants into each experimental group.
o Controlled Clinical Trials: Used to describe experiments that rely on control conditions to be used for
comparison purposes.
o Randomized controlled trial: uses both randomization and one or more control conditions.
B. Control Groups
• People who are similar to the experimental group in every way except they are not exposed to the independent variable.
o Nearly identical to the treatment group in such factors as age, gender, socioeconomic backgrounds, and the
problems they are reporting.
• 1 Placebo Effect
o Latin word: “I shall please”.
o In treatment group, when behavior changes as a result of a person’s expectation of change rather than as a result
of any manipulation by an experimenter.
o Placebo Control Groups: Inactive medications (sugar pills).
▪ The placebo is given to members of the control group to make them believe they are getting treatment.
o Double-Blind Control: Not only are the participants in the study “blind,” or unaware of what group they are in or
what treatment they are given, but so are the researchers or therapists providing treatment.
• 2 Frustro Effect
o In control group, participants may be disappointed that they are not receiving treatment.
C. Comparative Treatment Research
The researcher gives different treatments to two or more comparable groups of people with a particular disorder and can
then assess how or whether each treatment helped the people who received it.
Process Research Focuses on the mechanisms responsible for behavior change.
(why does it work?)
Outcome Research Focuses on the positive, negative, or both results of the treatment.
(does it work?) • Treatment Process: Finding out why or how your treatment works.
• Treatment Outcome: Finding out what changes occur after treatment.

5 SINGLE-CASE EXPERIMENTAL DESIGNS

Systematic study of individuals under a variety of experimental conditions.
Repeated Measurements
• A behavior is measured several times instead of only once before you change the independent variable and once
afterward.
o It helps identify how a person is doing before and after intervention and whether the treatment accounted for any
changes.
Withdrawal Designs
• A researcher tries to determine whether the independent variable is responsible for changes in behavior.
o 1 A person’s condition is evaluated before treatment, to establish a baseline.
o 2 Then comes the change in the independent variable.
o 3 Treatment is withdrawn (“return to baseline”).
• Drug Holidays
o Periods when the medication is withdrawn so that clinicians can determine whether it is responsible for the
treatment effects.
Multiple Baseline
• The researcher starts treatment at different times across settings (home versus school), behaviors (yelling at
spouse/partner or boss), or people.

GENETICS AND BEHAVIOR ACROSS TIME AND CULTURES

1 STUDYING GENETICS
Phenotypes The observable characteristics or behavior of the individual.
Genotypes The unique genetic makeup of individual people.
Endophenotypes Genetic mechanisms that ultimately contribute to the underlying problems causing the
symptoms and difficulties experienced by people with psychological disorders.
• Human Genome Project: Completed a rough draft of the mapping of the approximately
25,000 human genes.
o Identified hundreds of genes that contribute to inherited diseases.
o Genome: All the genes of an organism.
Four Categories of Research Strategies Used to Study the Interaction of Environment and Genetics
Basic Genetic Starts by finding whether a disorder has a genetic component.
Epidemiology
Advanced Genetic Researchers explore the nature of the genetic influences by seeing how genetics affect
Epidemiology aspects of the disorder.
Linkage And Association Scientists use sophisticated statistical methods.
Studies
Gene Finding Find out just where the gene or genes are located in the genome.
Molecular Genetics Examining what these genes do and how they interact with the environment to create the symptoms
associated with psychological disorders.
A. Family Studies
• Scientists simply examine a behavioral pattern or emotional trait in the context of the family.
o Proband: The family member with the trait singled out for study.
B. Adoption Studies
• Determine how we can separate environmental from genetic influences in families.
o Suppose a young man has a disorder and scientists discover his brother was adopted as a baby and brought up in a
different home.
C. Twin Studies
Identical (Monozygotic) Twins Have identical genes.
Fraternal (Dizygotic) Twins Come from different eggs and have only about 50% of their genes in common.
D. Genetic Linkage Analysis and Association Studies
Genetic Linkage Analysis When a family disorder is studied, other inherited characteristics are assessed at the same
time.
• These other characteristics—called genetic markers.
• If a match or link is discovered between the inheritance of the disorder and the
inheritance of a genetic marker, the genes for the disorder and the genetic marker are
probably close together on the same chromosome.
Association Studies Also used genetic markers, compare such people to people without the disorder.

2 STUDYING BEHAVIOR OVER TIME

A. Prevention Research
• Design interventions and services to prevent these problems.
Four Broad Categories of Prevention Research
Health Promotion or Efforts to blanket entire populations of people—even those who may not be at risk—to prevent later
Positive Development problems and promote protective behaviors.
Strategies
Universal Prevention Focus on entire populations and target certain specific risk factors without focusing on specific
Strategies individuals.
• Eg., behavior problems in inner-city classrooms.
Selective Prevention Specifically targets whole groups at risk and designs specific interventions aimed at helping them
avoid future problems.
• Eg., Children who have parents who have died.
Indicated Prevention A strategy for those individuals who are beginning to show signs of problems but do not yet have a
psychological disorder.
• Eg., depressive symptoms.
Research Designs
Cross-Sectional Designs Compare different people at different ages.
• Cohorts: The participants in each age group.
• Cohort Effect: The confounding of age and experience, is a limitation of the cross-sectional
design.
Longitudinal Designs Follow one group over time and assess change in its members directly.
• Cross-generational Effect: Involves trying to generalize the findings to groups whose
experiences are different from those of the study participants.
Sequential Design Combine longitudinal and cross-sectional designs.
• Involves repeated study of different cohorts over time.

3 RESEARCH ETHICS
• Informed Consent: A research participant’s formal agreement to cooperate in a study following full disclosure of the nature
of the research and the participant’s role in it.
o Revelations that the Nazis had forced prisoners into so-called medical experiments helped establish the informed
consent guidelines that are still used today.
• Research participants must be capable of consenting to participation in the research.
• Must volunteer or not be coerced into participating.
• Must have all the information they need to make the decision.
• Must understand what their participation will involve.
• People in research experiments must be protected from both physical and psychological harm.
• Researchers must hold in confidence all information obtained from participants, who have the right to concealment of their
identity on all data, either written or informal.
• If deception or concealment is used, participants must be debriefed.
ABNORMAL PSYCHOLOGY
BOOK: Abnormal Psychology: An Integrative Approach |Compiled/organized by: MARY-ANN SEVILLA
AUTHOR: David H. Barlow, V. Mark Durand, Stefan G. Hofmann | *Do not reproduce w/o consent esp. for monetary
CHAPTER: 5 - Anxiety, Trauma- and Stressor-Related, and gain/purposes :>
Obsessive-Compulsive and Related Disorders

CHAPTER 5: ANXIETY, TRAUMA- AND STRESSOR-RELATED, AND OBSESSIVE-COMPULSIVE AND

RELATED DISORDERS

THE COMPLEXITY OF ANXIETY DISORDERS

1 ANXIETY, FEAR, AND PANIC

Anxiety
• A negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future.
• Howard and Liddell (1949)
o ‘Shadow of intelligence’
o The human ability to plan in some detail for the future was connected to that gnawing feeling that things could go
wrong and we had better be prepared for them.
Fear
• Immediate alarm reaction to danger.
o Characterized by strong escapist action tendencies and, often, a surge in the sympathetic branch of the
autonomic nervous system.
• Flight or Fight Response
o It protects us by activating a massive response from the autonomic nervous system which, along with our
subjective sense of terror, motivates us to escape (flee) or, possibly, to attack (fight).
Panic
• Greek god Pan who terrified travelers with bloodcurdling screams.
• Panic Attack
o An abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually
include heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.
o Two Basic Types of Panic Attacks
▪ Expected (Cued) Panic Attack
• More common in specific phobias or social anxiety disorder.
▪ Unexpected (Uncued) Panic Attacks: You don’t have a clue when or where the next attack will occur.
• Important in panic disorder.

2 CAUSES OF ANXIETY AND RELATED DISORDERS

Biological Contributions
• Inherit a tendency to be tense, uptight, anxious, and to panic.
o Run in families and probably has a genetic component.
• Specific Brain Circuits and Neurotransmitter Systems
o 1 Increased Anxiety
▪ Depleted levels of gamma-aminobutyric acid (GABA)
▪ Noradrenergic system
▪ Serotonergic neurotransmitter system
o 2 Corticotropin-Releasing Factor (CRF)
▪ Central to the expression of anxiety (and depression).
▪ Activates the hypothalamic–pituitary–adrenocortical (HPA) axis.
o 3 Limbic System
▪ The area of the brain most often associated with anxiety.
o 4 Behavioral Inhibition System (BIS): Jeffrey Gray
▪ Activated by signals from the brain stem of unexpected events, such as major changes in body functioning
that might signal danger.
▪ When the BIS is activated by signals that arise from the brain stem or descend from the cortex, our tendency
is to freeze, experience anxiety, and apprehensively evaluate the situation to confirm that danger is present.
o 5 Fight/Flight System (FFS)
▪ This circuit originates in the brain stem and travels through several midbrain structures.
▪ Activated partly by deficiencies in serotonin.
▪ *When stimulated in animals, this circuit produces an immediate alarm-and-escape response that looks
very much like panic in humans.
 o 6 People w/ Anxiety
▪ Abnormal Bottom-Up Processing: The limbic system, including the amygdala, is overly responsive to
stimulation or new information.
▪ Abnormal Top-Down Processing: Controlling functions of the cortex that would down-regulate the
hyperexcitable amygdala are deficient.
Psychological Contributions
1 Sense of Uncontrollability
• Develop early as a function of upbringing and other disruptive or traumatic environmental factors.
• The actions of parents in early childhood.
o Parents who interact in a positive and predictable way with their children by responding to their needs.
▪ Develop healthy sense of control.
o Parents who are overprotective and overintrusive and who “clear the way” for their children.
▪ Unable to handle adversity.
• Anxiety Sensitivity: Tendency to respond fearfully. to anxiety symptoms.
2 Fear Response & Panic Attack
• Classical Conditioning
o External Cues: Places or situations similar to the one where the initial panic attack occurred.
o Internal Cues: Increase in heart rate or respiration that were associated with the initial panic attack.
Social Contributions
• Stressful life events trigger our biological and psychological vulnerabilities to anxiety.
Integrated Model: Triple Vulnerability Theory
1 Generalized Biological Vulnerability
• Tendency to be uptight or high-strung might be
inherited.
2 Generalized Psychological Vulnerability
• Grow up believing the world is dangerous and out of
control and you might not be able to cope when things
go wrong based on your early experiences.
3 Specific Psychological Vulnerability
• You learn from early experience, such as being taught
by your parents, that some situations or objects are
fraught with danger.
• *Anxiety increases the likelihood of panic.

3 COMORBIDITY OF ANXIETY AND RELATED DISORDERS

• Comorbidity: Co-occurrence of two or more disorders in a single individual.
o Major Depression
▪ The most common additional diagnosis for all anxiety disorders.
• Generalized anxiety disorder and social anxiety disorder who engaged in deliberate self-harm were especially more
likely to engage in this behavior multiple times.
o Additional Diagnoses of Depression or Alcohol or Drug Abuse
▪ Less likely that you will recover from an anxiety disorder and more likely that you will relapse if you do
recover.

4 COMORBIDITY WITH PHYSICAL DISORDERS

• Anxiety disorder was associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine
headaches, and allergic conditions.
• Anxiety disorder most often begins before the physical disorder.
o Having an anxiety disorder might cause, or contribute to the cause of, the physical disorder.
• Panic attacks often co-occur with certain medical conditions, particularly cardio, respiratory, gastrointestinal, and
vestibular (inner ear) disorders.

5 SUICIDE
• 20% of patients with panic disorder had attempted suicide.
o Having any anxiety or related disorder increases the chances of having thoughts about suicide (suicidal ideation)
or making suicidal.
o The relationship is strongest with panic disorder and posttraumatic stress disorder.

ANXIETY DISORDERS

1 GENERALIZED ANXIETY DISORDER (GAD)

A. Clinical Description
• At least 6 months of excessive anxiety and worry (apprehensive expectation).
o People with GAD mostly worry about minor, everyday life events.
o Characterized by muscle tension, mental agitation, susceptibility to fatigue, some irritability, and difficulty
sleeping.
o Children: only one physical symptom is required.
B. Statistics
• GAD one of the most common anxiety disorders.
• About twice as many individuals with GAD are female than male in epidemiological studies (differs per country).
• Some people with GAD report onset in early adulthood, usually in response to a life stressor.
• The median age of onset based on interviews is 31.
• Follows a chronic course.
• GAD is prevalent among older adults.
o Most common in the group over 45 years of age and least common in the youngest group, ages 15 to 24.
 C. Causes
1 Generalized Biological Vulnerability
• Anxiety Sensitivity
o Tendency to become distressed in response to arousal related sensations, arising from beliefs that these anxiety-
related sensations have harmful consequences.
2 Autonomic Restrictors
• Show less responsiveness on most physiological measures than do individuals with other anxiety disorders.
• Low cardiac vagal tone (the vagus nerve is the largest parasympathetic nerve innervating the heart and decreasing its
activity), leading to autonomic inflexibility, because the heart is less responsive to certain tasks.
• The Peripheral Autonomic Arousal of Individuals with GAD is Restricted.
o Intense cognitive processing in the frontal lobes as indicated by EEG activity, particularly in the left hemisphere.
o Intense thought processes or worry without accompanying images.
o Thinking so hard about upcoming problems that they don’t have the attentional capacity left for the all-important
process of creating images of the potential threat.
o Avoid images associated with the threat.
3 Generalized Psychological Vulnerability
• Highly sensitive to threat in general.
• Allocate their attention more readily to sources of threat.
o Due to early stressful experiences where they learned that the world is dangerous and out of control, and they
might not be able to cope.
D. Treatment
1 Benzodiazepines
• Most often prescribed for generalized anxiety.
• No more than a week or two.
• Side Effects
o Impair both cognitive and motor functioning.
o Associated with falls, resulting in hip fractures in older adults.
o Produce both psychological and physical dependence.
2 Antidepressants
• Paroxetine (Paxil) And Venlafaxine (Effexor)
o Better choice than benzodiazepines.
3 Psychological Treatments
• More effective in the long term.
• Help process the threatening information on an emotional level, using images, so that they will experience (rather than
avoid feeling) the emotion associated with the images.
• Cognitive-Behavioral Treatment (CBT)
o Patients evoke the worry process during therapy sessions and confront threatening images and thoughts head-
on.
• Meditational and Mindfulness-Based Approaches
o Teach the patient to be more tolerant of these feelings.
• Train patients in increasing their tolerance to uncertainty about the future and changing their beliefs about worrying.
o *Metacognitions
▪ Cognitions [beliefs] about cognitions [worrying].

2 PANIC DISORDER
• Individuals experience severe, unexpected panic attacks.
o They may think they’re dying or otherwise losing control.
A. Clinical Description
• Criteria for Panic Disorder
o Experience an unexpected panic attack.
o Develop substantial anxiety over the possibility of having another attack.
*Nocturnal • Occur during delta wave or slow wave sleep.
Panic o Typically occurs several hours after we fall asleep and is the deepest stage of sleep.
o Begin to panic when they start sinking into delta sleep, and then they awaken amid an attack.
• Cause
o Change in stages of sleep to slow wave sleep produces physical sensations of “letting go”
that are frightening to an individual with panic disorder.
 • *Isolated Sleep Paralysis
o Occurs during the transitional state between sleep and waking.
o Unable to move and experiences a surge of terror that resembles a panic attack.
• *People are not dreaming when they have nocturnal panics.
• *Panic attacks occur more often between 1:30 a.m. and 3:30 a.m. than any other time.
B. Statistics
• Onset of Panic Disorder
o Early adult life— from midteens through about 40 years of age.
• Median Age of Onset
o Between 20 and 24.
• Most initial unexpected panic attacks begin at or after puberty.
• Health and vitality are the primary focus of anxiety in the elderly population.
• Prevalence of PD or comorbid panic disorder and agoraphobia decreases among the elderly.
C. Cultural Differences
• Asian and African countries usually showing the lowest rates.
Susto Fright disorder in Latin America.
Characterized by sweating, increased heart rate, and insomnia but not by reports of anxiety or fear,
even though a severe fright is the cause.
Ataques De Symptoms similar to panic attack but also involves shouting uncontrollably or bursting into tears.
Nervios
Kyol Goeu Panic disorder among khmer (Cambodian).
(Wind Overload) Too much wind or gas in the body, which may cause blood vessels to burst becomes the focus of
catastrophic thinking during panic attacks.
• Experience Orthostatic Dizziness: Dizziness from standing up quickly.
D. Causes
1 Panic Attack and Panic Disorder
• Related most strongly to biological and psychological factors and their interaction.
2 Generalized Biological Vulnerability
• Tendency to be generally neurobiologically overreactive to the events of daily life.
• More likely than others to have an emergency alarm reaction when confronted with stress-producing events.
3 Learned Alarms
• Particular situations quickly become associated in an individual’s mind with external and internal cues that were
present during the panic attack.
4 Specific Psychological Vulnerability
• Tendency to believe that unexpected bodily sensations are dangerous.
5 David Clark
• Emphasizes the specific psychological vulnerability of people with this disorder to interpret normal physical
sensations in a catastrophic way.
o Interpret the response as dangerous and feel a surge of anxiety.
o This anxiety, in turn, produces more physical sensations because of the action of the sympathetic nervous
system.
o Additional sensations as even more dangerous, and a vicious cycle begins that results in a panic attack.
6 Panic Disorder and Agoraphobia
• Early object loss and/or separation anxiety might predispose someone to develop the condition as an adult.
• *Agoraphobia
o Dependent personality tendencies often characterize a person with agoraphobia.
o Possible reaction to early separation.
E. Treatment
1 Medication
• SSRI: Indicated drug for panic disorder.
o Side Effect: sexual dysfunction.
• High-Potency Benzodiazepines
o Alprazolam (Xanax)
o Commonly used for panic disorder, work quickly but are hard to stop.
o Not recommended as strongly as the SSRIs.
o Side Effect: Psychological and physical dependence and addiction, affect cognitive and motor functions.
2 Psychological Intervention
• Exposure-Based Treatment
o Arrange conditions in which the patient can gradually face the feared situations and learn there is nothing to fear.
• Panic Control Treatment (PCT)
o Exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of
their panic attacks.
o Create “mini” panic attacks in the office by having the patients exercise to elevate their heart rates or perhaps by
spinning them in a chair to make them dizzy.
o Cognitive Therapy
▪ Basic attitudes and perceptions concerning the dangerousness of the feared but objectively harmless
situations are identified and modified.
o Relaxation or Breathing Retraining
▪ Help them reduce anxiety and excess arousal.
• Calm Tools for Living
o Clinician and patient sit side-by-side as they both view the program on screen.
o The program prompts clinicians to engage in specific therapeutic tasks.
▪ Helping patients to establish a fear hierarchy, demonstrating breathing skills, or designing exposure
assignments.
o Goal of the Computerized Program
 ▪ Enhance the integrity of cognitive behavioral therapy in the hands of novice and relatively untrained
clinicians.
3 Combined Psychological and Drug Treatments
• No advantage to combining drugs and CBT initially for panic disorder and agoraphobia.
• Psychological treatments seemed to perform better in the long run.
• “Stepped Care” Approach
o Clinician begins with one treatment and then adds another if needed may be superior to combining treatments
from the beginning.

3 AGORAPHOBIA
• Characterized either by avoiding or by enduring them with intense fear and anxiety in which a person feels unsafe or
unable to escape to get home or to a hospital in the event of a developing panic, panic-like symptoms, or other physical
symptoms.
A. Clinical Description
Agoraphobia Coined in 1871 by Karl Westphal (German Physician).
Greek: fear of the marketplace.
• Agoraphobic Behavior can become relatively independent of panic attacks.
o An individual who has not had a panic attack for years may still have strong
agoraphobic avoidance.
Interoceptive Avoidance of internal physical sensations.
Avoidance Also occurs in panic disorder.
B. Statistics
• Most (75% or more) of those who suffer from agoraphobia are women.
o More accepted for women to report fear and to avoid numerous situations.
o Large proportion of males with unexpected panic attacks cope in a culturally acceptable way.
▪ Consume large amounts of alcohol.
C. Causes
• Agoraphobia often develops after a person has unexpected panic attacks (or panic-like sensations).
• Whether agoraphobia develops and how severe it becomes seem to be socially and culturally determined.
D. Treatment
• Gradual exposure exercises, combined with anxiety-reducing coping mechanisms (relaxation or breathing
retraining).
o Proved effective in helping patients overcome agoraphobic behavior whether associated with panic disorder or
not

4 SPECIFIC PHOBIA
Definition • An irrational fear of a specific object or situation.
o Earlier versions of DSM: ‘simple phobia’.
• Jack D. Maser: Compiled a list of phobias.
• Four Major Subtypes
o 1 Blood–injection–injury type
o 2 Situational Type
o 3 Natural Environment Type
o 4 Animal Type
o *Other: Phobias that do not fit any of the four major subtypes.
4.1 Blood-Injection- • Marked drop in heart rate and blood pressure and fainted.
Injury Phobia • Inherit a strong vasovagal response to blood, injury, or the possibility of an injection.
o Runs in families more strongly than any phobic disorder.
o Cause a drop in blood pressure and a tendency to faint.
• Average Age of Onset
o Approximately 9 years.
4.2 Situational Phobia • Characterized by fear of public transportation or enclosed places.
o Tends to emerge from midteens to mid-20s.
o Run in families.
• Claustrophobia
o A fear of small enclosed places.
• Main Difference Between Situational Phobia and Panic Disorder
 o Situational Phobia: Never experience panic attacks outside the context of their
phobic object or situation.
o Panic Disorder: Experience unexpected, uncued panic attacks at any time.
4.3 Natural Environment • fears of situations or events occurring in nature.
Phobia o Heights, storms, and water.
• Peak Age of Onset: About 7 years.
o *Not phobias if they are only passing fears.
o *Persistent (at least 6 months) and to interfere substantially with the person’s
functioning.
▪ Avoidance of boat trips or summer vacations in the mountains.
4.4 Animal Phobia • Fears of animals and insects.
o Severe interference with functioning occurs.
▪ Eg. unable to read magazine.
• Age of Onset: Peaks around 7 years.
A. Statistics
• Fears of snakes and heights rank near the top.
• Sex ratio among common fears is overwhelmingly female with a couple of
exceptions.
o Fear of heights: sex ratio is approximately equal.
• Sex ratio for specific phobias is overwhelmingly female.
• Median Age of Onset for Specific Phobia
o 7 years of age.
• Tends to last a lifetime (chronic course).
• Normal fears and anxieties experienced throughout childhood:
o Infants
▪ Marked fear of loud noises and strangers.
o 1 to 2 years of age
▪ Anxious about separating from parents, and fears of animals and
the dark also develop and may persist into the fourth or fifth year of
life.
o Age 3
▪ Fear of various monsters and other imaginary creatures.
o Age 10
▪ Fear evaluation by others and feel anxiety over their physical
appearance.
• *Pa-leng
o Fear of the cold.
▪ Ruminate over loss of body heat and may wear several layers of clothing even on a hot day.
o Phobia in Chinese culture.
o Concepts of Yin and Yang
▪ A balance of yin and yang forces in the body for health to be maintained.
▪ Yin: The cold, dark, windy, energy-sapping aspects of life.
▪ Yang: The warm, bright, energy-producing aspects of life.
B. Causes
• 1 Acquired by Direct Experience
o Real danger or pain results in an alarm response.
• 2 Experiencing a False Alarm (Panic Attack) in a Specific
Situation.
• 3 Vicarious Experience
o Observing someone else experiencing severe fear.
• 4 Information Transmission
o Being told or warned repeatedly about a potential
danger.
• Several things to occur for a person to develop a phobia:
o 1 A traumatic conditioning experience.
o 2 Carry an inherited tendency to fear situations that have
always been dangerous to the human race.
o 3 Susceptible to developing anxiety about the possibility that the event will happen again.
• Social and cultural factors are strong determinants of who develops and reports a specific phobia.
o Unacceptable for males to express fears and phobias.
C. Treatment
• Exposure-Based Exercises
o Expose gradually to the phobic object or situation.
• For Separation Anxiety
o Parents are often included to help structure the exercises and also to address
parental reaction to childhood anxiety.
• Blood– Injection–Injury Phobia
o Individuals must tense various muscle groups during exposure exercises to keep
their blood pressure sufficiently high to complete the practice and to prevent
fainting.
o Change brain functioning.
▪ Modifying neural circuitry in such areas as the amygdala, insula, and
cingulate cortex.
▪ Responsiveness is diminished in this fear-sensitive network but increased
in prefrontal cortical areas.
 5 SEPARATION ANXIETY DISORDER
• Children’s unrealistic and persistent worry that something will happen to their parents or other important people in
their life or that something will happen to the children themselves that will separate them from their parents
• School Phobia
o Fear is clearly focused on something specific to the school situation.
• *Occurs in approximately 6.6% of the adult population over the course of a lifetime.
• *In some cases, the onset is in adulthood rather than carrying over from childhood.
• Treatment
o Parents are often included to help structure the exercises and also to address parental reaction to childhood
anxiety.
o Real-Time Coaching of Parents
▪ Using a small microphone in parents’ ear to allow therapists to actively instruct parents in how to best
respond when their child resists separation.

5.1 SELECTIVE MUTISM

• A rare childhood disorder.
• Lack of speech in one or more settings in which speaking is socially expected.
o Commonly occurs in some settings, such as home, but not others.
o Occur for more than one month and cannot be limited to the first month of school.
o girls more affected than boys.
• Cause
o Well-meaning parents enable this behavior by being more readily able to intervene and “do their talking for them”.
• Treatment
o Same cognitive behavioral principles used successfully to treat social anxiety in children but with a greater
emphasis on speech.

6 SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)

• An irrational and extreme fear of social or performance situations.
• Performance Anxiety
o Subtype of SAD
o No difficulty with social interaction, but when they must do something specific in front of people, anxiety takes
over.
• Anxiety-Provoking Physical Reactions
o Blushing
o Trembling
o Sweating
o Paruresis (‘bashful bladder’): Occurs in males, urinating in a public restroom.
A. Statistics
• Second only to specific phobia as the most prevalent anxiety disorder.
• The sex ratio for SAD is nearly 50:50.
• Usually begins during adolescence.
• Peak age of onset around 13 years.
• More prevalent in people who are young (18–29 years), undereducated, single, and of low
socioeconomic class.
• Shinkeishitsu
o Presentation of anxiety disorders in Japan.
o Taijin Kyofusho
▪ Most common subcategories of Shinkeishitsu.
▪ Strongly fear that some aspect of their personal presentation (blushing,
stuttering, body odor) will appear reprehensible, causing other people to feel
embarrassed.
▪ Olfactory Reference Syndrome
• Preoccupation with a belief that one is embarrassing oneself and
offending others with a foul body odor.
▪ *Japanese males with this disorder outnumber females by a 3:2 ratio.
B. Causes
• Prepared to fear angry, critical, or rejecting people.
o React to angry faces with greater activation of the amygdala and less
cortical control or regulation than “normals”.
• Jerome Kagan
o Discovered that shyness is evident as early as 4 months of age and is
probably inherited.

1 Generalized Biological Vulnerability

• Biological tendency to be socially inhibited.
2 Generalized Psychological Vulnerability
• Belief that events, particularly stressful events, are potentially
uncontrollable—would increase an individual’s vulnerability.
o 1 A person could have anxiety and self-focused attention increase to the
point of disrupting performance, even in the absence of a false alarm (panic attack).
o 2 Someone might have an unexpected panic attack in a social situation that would become associated
(conditioned) to social cues.
o 3 Someone might experience a real social trauma resulting in a true alarm.
3 Specific Psychological Vulnerability
• learned growing up that social evaluation in particular can be dangerous.
 C. Treatment
1 Cognitive Therapy Program
• Emphasized real-life experiences during therapy to disprove automatic perceptions of danger.
o Clearly superior to a second very credible treatment, interpersonal psychotherapy (IPT).
2 Family-Based Treatment
• Appears to outperform individual treatment when the child’s parents also have an anxiety disorder.
3 Medication: SSRIs Paxil, Zoloft, and Effexor.
4 Adding The Drug D-Cycloserine (DCS) To Cognitive-Behavioral Treatments
• Enhance exposure therapy.
• DCS: Works in the amygdala.
o Known to facilitate extinction of anxiety by modifying neurotransmitter flow in the glutamate system.

TRAUMA AND STRESSOR-RELATED DISORDER

• Develop after a relatively stressful life event, often an extremely stressful or traumatic life event.
o 1 Posttraumatic stress disorder (PTSD)
o 2 Acute Stress Disorder
o 3 Attachment Disorders
o 4 Adjustment Disorders

1 POSTTRAUMATIC STRESS DISORDER (PTSD)

• Setting Events For PTSD
o 1 Exposure to a traumatic event during which an individual experiences or witnesses death or threatened death,
actual or threatened serious injury, or actual or threatened sexual violation.
o 2 Learning that the traumatic event occurred to a close family member or friend.
o 3 Enduring repeated exposure to details of a traumatic event.
• At least one month after the occurrence of the traumatic event.
o With Delayed Onset
▪ Few or no symptoms immediately or for months after a trauma, but at least 6 months later.
Flashback Reliving the event accompanied by strong emotion.
Dissociative Subtype Less arousal than normal along with feelings of unreality.
A. Statistics
• The highest rates are associated with experiences of rape; being held captive, tortured, or kidnapped; or being badly
assaulted.
B. Causes
• Develop due to precipitating event.
o Intensity of exposure to assaultive violence.
1 Generalized Biological • A family history of anxiety.
Vulnerability • Low Intelligence.
2 Generalized • Family instability
Psychological o The world is an uncontrollable, potentially dangerous place.
Vulnerability
3 Social Factors • Strong and supportive group of people around you, it is much less likely you will
develop PTSD after a trauma.
o Reduces cortisol secretion and hypothalamic– pituitary–adrenocortical (HPA)
axis activity.
4 Damaged Hippocampus • Elevated or restricted corticotropin-releasing factor (CRF).
• Heightened activity in the HPA axis.
• Persistent and chronic arousal as well as some disruptions in learning and memory.
C. Treatment
• Face the original trauma, process the intense emotions, and develop effective coping procedures.
Catharsis Reliving emotional trauma to relieve emotional suffering.
Imaginal Exposure Work with the victim to develop a narrative of the traumatic experience.
• Expose the patients for an extended period of time to the image (prolonged exposure
therapy).
• Effects of the exposure practices may be strengthened by strategically timing the exposure
treatment with sleep.
o Extinction learning appears to take place during slow wave sleep.
o Sleep quality reduces anxiety.
Cognitive Therapy Correct negative assumptions about the trauma.

2 ACUTE STRESS DISORDER

• Similar to PTSD but occurring within the first month after the trauma.

3 ADJUSTMENT DISORDERS
•
 2 ACUTE STRESS DISORDER
• Similar to PTSD but occurring within the first month after the trauma.

3 ADJUSTMENT DISORDERS
• Anxious or depressive reactions to life stress.
o Milder than one would see in acute stress disorder or PTSD.
o Stressful events is not considered traumatic, but unable to cope with the demands of the situation.
o Chronic
▪ Symptoms persist for more than six months after the removal of the stress or its consequences.

4 ATTACHMENT DISORDERS
• The child is unable or unwilling to form normal attachment relationships with caregiving adults.
o Emerging before five years of age.
o Due to inadequate or abusive child-rearing practices.
4.1 Reactive Attachment Disorder
• Seldom seek out a caregiver for protection, support, and nurturance.
o Seldom respond to offers from caregivers to provide this kind of care.
o Lack of responsiveness, limited positive affect, and additional heightened emotionality (fearfulness and intense
sadness).
4.2 Disinhibited Social Engagement Disorder
• No inhibitions whatsoever to approaching adults.
o May be due to early persistent harsh punishment.

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

DSM IV • Anxiety Disorder > Obsessive-Compulsive Disorder (OCD)

• Hoarding disorder and body dysmorphic disorder > somatoform disorders
• Trichotillomania > impulse control disorders

1 OBSESSIVE-COMPULSIVE DISORDER (OCD)

The dangerous event is a thought, image, or impulse.
Obsessions Intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or
eliminate.
Compulsions Thoughts or actions used to suppress the obsessions and provide relief.
Four Major Types of • Symmetry (26.7%)
Obsessions • Forbidden thoughts or actions (21%)
• Cleaning and contamination (15.9%)
• Hoarding (15.4%)
• *May present with compulsions, but few or no identifiable obsessions.
• Tic and OCD
o Tic: Characterized by involuntary movement.
▪ Commonly co-occur with OCD.
▪ The obsessions in tic-related OCD are almost always related to symmetry.
o Tourette’s disorder: More complex tics with involuntary vocalizations.
• Pediatric Autoimmune Disorder Associated with Streptococcal Infection (PANDAS)
o OCD and tics occurred after a bout of strep throat.
▪ *More likely to be male.
A. Statistics
• Sex Ratio: female to male that is nearly 1:1.
• In Children, more males than females. (Boys tend to develop OCD earlier.)
• Age of Onset: from childhood through the 30s.
• Median Age of Onset: 19.
• Age of onset peaks earlier in males (13 to 15) than in females (20 to 24). Chronic course.
B. Causes
• Generalized Biological and Psychological Vulnerabilities must be present for this disorder to develop.
• Specific Psychological Vulnerability
o Thoughts are unacceptable and therefore must be suppressed.
▪ Early experiences taught them that some thoughts are dangerous and unacceptable because the terrible
things they are thinking might happen and they would be responsible.
o Thought-Action Fusion
▪ Equate thoughts with the specific actions or activity represented by the thoughts.
▪ Caused by attitudes of excessive responsibility and resulting guilt developed during childhood.
C. Treatment
1 Medication Clomipramine or the SSRIs
• specifically inhibit the reuptake of serotonin.
2 Exposure And Ritual The rituals are actively prevented and the patient is systematically and gradually exposed to the
Prevention (ERP) feared thoughts or situations.
3 Cognitive Treatments Focus on the overestimation of threat, the importance and control of intrusive thoughts, the
sense of inflated responsibility.
4 Psychosurgery Neurosurgery for a psychological disorder.
Surgical lesion to the cingulate bundle.
5 Deep Brain Electrodes are placed through small holes drilled in the skull and are connected to a
Stimulation pacemaker-like device in the brain.