Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition) - a summary
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Clinical psychology
Chapter 5
Mood disorders
Mood disorders involve disabling disturbances in emotion.
The DSM-5 recognizes two broad types of mood disorders:
Depressive disorders
The cardinal symptoms of depression include profound sadness and/or an inability to experience pleasure.
Physical symptoms of depression are also common
Social withdrawal is common.
Major depressive disorder
Major depressive disorder (MDD)
DSM-5 criteria
Persistent depressive disorder (Dysthymia)
People wit dysthymia are chronically depressed, more then half of the time for at least 2 years. They feel blue or derive little pleasures from usual activities and pastimes.
DSM-5 criteria for persistent depressive disorder (dysthymia)
DSM-5 criteria for premenstrual dysphoric disorder
DSM-5 criteria for disruptive mood dysregulation disorder
Epidemiology and consequences of depressive disorders
MMD is one of the most prevalent psychiatric disorders.
Persistent depressive disorder appears to be rarer than MDD.
The prevalence of depression varies across cultures.
Symptoms of depression also show some cross-cultural variation, probably resulting from differences in cultural standards regarding acceptable expressions of emotional distress.
These symptom differences do not appear to be major enough to explain the differing rates of depression across countries.
Differences between countries in rates of depression may be fairly complex.
In most countries, the prevalence of MDD increased steadily during the mid to late twentieth century.
At the same time, the age onset decreased. The median age of onset is now the late teens to early 20s.
Beyond the prevalence rates, the symptoms of depression vary somewhat across the life span.
Both MDD and persistent depressive disorder are often associated, or comorbid, with other psychological problems.
Depression has many serious consequences
Bipolar disorders
DSM-5 recognizes three forms of bipolar disorders:
Manic symptoms are the defining feature of each of these disorders.
The bipolar disorders are differentiated by how severe and long-lasting the manic symptoms are.
The disorders are labeled ‘bipolar’ because most people who experience mania will also experience depression during their lifetime.
An episode of depression is not required for a diagnoses of bipolar I, but it is required for a diagnoses of bipolar II disorder.
Mania: a state of intense elation or irritability, accompanied by other symptoms shown in the diagnostic criteria.
During manic episodes, people will act and think in ways that are highly unusual compared with their typical selves.
Flight of ideas.
Hypomania: less extreme than mania.
Mania involves significant impairment, hypomania does not.
Hypomania involves a change in functioning that dos not cause serious problems.
The person with hypomania may feel more social, flirtatious, energized, and productive.
DSM-5 criteria for manic and hypomanic episodes
Bipolar I disorder
A single episode of mania during the course of a person’s life.
A person who is diagnosed may or may not be experiencing curring symptoms of mania.
Even someone who experienced only 1 week of manic symptoms years ago is still diagnosed with bipolar I disorder.
Bipolar episodes tend to recur.
Bipolar II disorder
To be diagnosed with bipolar II disorder, a person must have experienced at least one major depressive episode and at least one episode of hypomania.
Cyclothymic disorder
Also called cyclothymia.
A chronic mood disorder.
The symptoms must be present for at least 2 years among adults.
In cyclothymic disorder, the person has frequent but mild symptoms of depression, alternating with mild symptoms of mania.
Although the symptoms do not reach the severity of full-blown hypomanic or depressive episodes, people with the disorder and those close to them typically notice the ups and downs.
During the lows, a person may be sad, feel inadequate, withdraw from people, and sleep for 10 hours a night.
During the highs, a person may be boisterous, overly confident, socially uninhibited and gregarious, and need little sleep.
DSM-5 criteria for Cyclothymic disorder
Epidemiology and consequences of bipolar disorder
Bipolar I disorder is much rarer than MDD.
Culture may shape tendencies to label behaviors as manic symptoms.
It is extremely hard to estimate the prevalence of milder forms of bipolar disorder, because some of the most commonly used diagnostic interviews are not reliable.
More than half of those with bipolar spectrum disorders report onset before age 25, but these conditions are being seen with increasing frequency among children and adolescents.
Bipolar occurs equally often in men and women, but women experience more episodes of depression than do men.
About two-third of people diagnosed with bipolar disorder meet diagnostic criteria for a cormorbid anxiety disorder, and more than a third report a history of substance use.
Bipolar I is among the most severe forms of mental illness.
Subtypes of depressive disorders and bipolar disorders
The mood disorders are highly heterogeneous. People who have been diagnosed with the same disorder may show very different symptoms.
The DSM-5 deals with this by providing criteria for dividing MDD and bipolar disorders into a number of specifiers (subtypes), based on either specific symptoms or the pattern of symptoms over time.
Rapid cycling and seasonal specifiers: the overall pattern of episodes over time, whereas other specifiers describe the current episode of major depression or mania.
Melancholic is used only for episodes of depression.
The seasonal specifier of major depressive disorder has achieved a fair amount of support, but many of the other specifiers have not been well validated.
No single cause can explain mood disorders.
A number of different factors combine to explain their onset.
Neurobiological factors in mood disorder
Genetic factors
Heritability of 37 percent for MDD.
About 37 percent of the variance in depression is explained in genes.
Bipolar is among the most heritable of disorders.
93 percent.
But, genetic models do not explain the timing of manic symptoms. Other factors likely serve as the immediate triggers of symptoms.
Genes may guide the way people regulate their emotions or respond to life stressors.
They may stet the stage for mood disorders to occur when other conditions are present.
Neurotransmitters
The absolute level of neurotransmitters is not important in mood disorders.
Functioning of the dopamine might be lowered in depression.
Dopamine plays a major role in the sensitivity of the reward system in the brain, which is believed to guide pleasure, motivation, and energy in the context of opportunities to obtain rewards.
Dopamine receptors may be overly sensitive in bipolar disorder.
Tryptophan: the major precursor of serotonin.
Lower serotonin levels causes temporary depressive symptoms among people with a history of depression or a family history of depression.
This effect is not observed among people with no personal or family history of depression.
People who are vulnerable to depression may have less sensitive serotonin receptors, causing them to respond more dramatically to lower levels of serotonin.
Bipolar disorder may be related to diminished sensitivity of the serotonin receptors.
Brain-imaging studies
Two different types of brain-imaging studies are commonly used in research on mood disorders.
Episodes of MDD are associated with changes in may of the brain systems that are involved in experiencing and regulating emotion.
Four primary brain structures that have been most studied in depression
The amygdala
The subgenual anterior cingulate, the hippocampus, and the dorsolateral prefrontal cortex
Theory
Many of the brain structures implicated in MDD also appear to be involved in bipolar disorder.
MDD and bipolar disorder might be differentiated by changes in the way that neurons throughout the brain function.
People with bipolar disorder often have deficits in the membranes of their neurons.
These deficits seem to operate across the brain, and they influence how readily neurons can be activated.
These cellular membrane deficits are not seen in people with MDD.
Protein kinase C activity appears to be abnormally high among people with mania.
The neuroendorcrine system: cortisol dysregulation
The HPA axis, the biological system that manages reactivity to stress, may be overly reactive among people with MDD, and the amygdala sends signals that activate the HPA axis.
The HPA axis triggers the release of cortisol, the main stress hormone
Cortisol is secreted at times of stress and increases activity of the immune system to help the body prepare for threats.
Various findings link depression to high cortisol levels.
The system does not seem to respond well to biological signals to decrease cortisol levels.
For those with MDD, dexamethasone does not suppress cortisol secretion, particularly among those with psychotic symptoms of depression.
Although cortisol helps mobilize beneficial short-term stress responses, prolonged high levels of cortisol can cause harm to body systems.
Like people with MDD, people with bipolar disorder fail to demonstrate the typical suppression of cortisol after the dex/CRH test.
This suggests that bipolar is also characterized by a poorly regulated cortisol system.
Like those with MDD, people with bipolar disorder who continue to show abnormal responses to cortisol challenge tests after their episode clears are at high risk for more episodes in the future.
Both bipolar disorder and MDD are characterized by problems in the regulation of cortisol levels.
Bysregulation in cortisol levels also predicts a worse course of illness for bipolar disorder and MDD.
Social factors in depression: life events and interpersonal difficulties
Neurobiological factors may be diatheses that increase risk for mood disorders in the context of other triggers or stressors.
The role of stressful life events in triggering episodes of depression is well established.
Life events typically happen before the depressive episode begins.
It remains possible that some life events are caused by early symptoms of depression that have not yet been developed into a full-blown disorder.
Stress can cause major depressive disorder
Common events
Diathesis-stress models: models that consider both preexisting vulnerabilities (diatheses) and stressors.
Diatheses could be biological, social, or psychological.
Expressed emotion (EE): a family’s member’s critical or hostile comments toward or emotional overinvolvement with the person with depression.
High EE strongly predicts relapse in depression.
Psychological factors in depression
Personality and cognitive theories describe different diatheses that might increase the risk of responding to negative life events with a depressive episode.
Neuroticism
Neuroticism: a personality trait that involves the tendency to react to events with greater-than-average negative affect.
Predicts the onset of depression.
Neuroticism explains at least part of the genetic vulnerability to depression.
Neuroticism is associated with anxiety as well as dysthymia.
Cognitive theories
In cognitive theories, negative thoughts and beliefs are seen as major causes of depression.
Beck’s theory
Depression is associated wit ha negative trait: negative views of the self, the world, and the future.
According to this model, in childhood, people with depression acquired negative schema through experiences such as loss of a parent, the social rejection of peers, or the depressive attitude of a parent.
Schemas: underlying set of beliefs that operate inside of a person’s awareness to shape the way a person makes sense of his or her experiences.
The negative schema is activated whenever a person encounters situations similar to those that originally caused the schema to form.
Once activated, negative schemas are believed to cause cognitive biases.
Hopelessness theory
The most important trigger of depression is hopelessness, which is defined as an expectation that
Rumination theory
A specific way of thinking called rumination may increase the risk of depression.
Rumination: a tendency to repetitively dwell on sad experiences and thoughts, or to chew on material again and again.
Fitting together the etiological factors in depressive disorders
Some people seem ti inherit a propensity for a weaker serotonin system, which is then expressed as a greater likelihood to experience depression after a severe stressor.
Genetic vulnerability could set the stage for depressive disorder after major negative life events.
A polymorphism in the serotonin transporter gene has also been related to elevated activity of the amygdala.
Social and psychological factors in bipolar disorder
Most people who experience a manic episode during their life will also experience a major depressive episode, but not everyone will.
Depression is bipolar disorder
The triggers of depressive episodes in bipolar disorder appear similar to the triggers of major depressive episodes.
Predictors of mania
Two types of factors have been found to predict increases in manic symptoms over time
Just as sleep depriviations can trigger manic symptoms, protecting sleep can help reduce symptoms of bipolar disorder.
Psychological treatment of depression
Interpersonal psychotherapy
Interpersonal psychotherapy (IPT)
Build in the idea that depression is closely tied to interpersonal problems.
The core of therapy is to examine major interpersonal problems, such as role transitions, interpersonal conflicts, bereavement, and interpersonal isolation.
Typically, the therapist and the patient focus on one or two such issues, with the goal of helping the person identify his or her feelings about these issues, make important decisions, and make changes to resolve problems related to these issues.
IPT is typically brief
Techniques include discussing interpersonal problems, exploring negative feelings and encouraging their expression, improving both verbal and nonverbal communications, problem solving, and suggesting new and more satisfying modes of behavior.
IPT is effective in relieving MDD and it prevents relapse when continued after recovery.
IPT has also been found to be effective in the treatment of dysthymia.
Cognitive therapy
Cognitive therapy (CT)
Aimed at altering maladaptive thought patterns.
The therapist tries to help the person with depression to change his or her opinions about the self.
The therapist also teaches the person to monitor self-talk and the identify thought patterns that contribute to depression.
The therapist then teaches the person to challenge negative beliefs and to learn strategies that promote making realistic and positive assumptions.
Often, the client is asked to monitor their thoughts each day and to practice challenging overly negative thoughts.
Behavioral activation (BA)
People are encouraged to engage in pleasant activities that might bolster positive thoughts about one’s self and life.
Cognitive therapy is effective for relieving the symptoms of MDD.
With modifications, CT is promising in the treatment of dysthemia.
The strategies that clients learn in CT help diminish the risk of relapse even after therapy ends.
Computer-administered versions of CT have developed.
Typically, these interventions include at least brief contact with a therapist to guide the initial assessment, to answer questions, and to provide support and encouragement with the homework.
Computer-based programs have varied in effectiveness. It is important to ensure that consumers gain access to well-tested versions of computerized CT.
Mindfulnes-based cognitive therapy (MBCT)
Focuses on relapse prevention after successful treatment or recurrent episodes of major depression.
MBCT is based on the assumption that a person becomes vulnerable to relapse because of repeated associations between sad mood and patterns of self-devaluative, hopeless thinking during major depressive episodes. As a result, when people who have recovered from depression become sad, they begin to think as negatively as they had when they were severely depressed. These reactivated patterns of thinking turn intensify the sadness.
In people with a history of major depression, sadness is more likely to escalate, which may contribute to the onset of new episodes of depression.
The goal of MBCT is to teach people to recognize when they start to become depressed and to try adopting what can be called a ‘decentered’ perspective, viewing their thoughts merely as ‘mental events’ rather than as core aspects of the self or as accurate reflectations of reality.
MBCT is more effective than ‘treatment as usual’ in reducing the risk of relapse among people with three or more previous major depressive episodes.
MBCT does not appear to protect against relapse among people with only one or two previous major depressive episodes.
Behavioral activation (BA) therapy
The goal of BA is to increase participation in positively reinforcing activities so as to disrupt the spiral of depression, withdrawal, and avoidance.
Findings suggest that the BA component of CT performs as well as the full package does in relieving MDD and preventing relapse over a 2-year follow-up period.
Group versions of behavioral therapy also appear to be effective.
Behavioral couples therapy
Depression is often tied to relationship problems.
Researchers work with both members of a couple to improve communication and relationship satisfaction.
When a person with depression is also experiencing marital distress, behavioral couples therapy is as effective in relieving depression as individual CT or antidepressant medication.
Marital therapy has the advantage of relieving relationship distress.
Psychological treatment of bipolar disorder
Medication is a necessary part of treatment for bipolar disorder, but psychological treatments can supplement medications to help address many of its associated social and psychological problems.
These psychotherapies can also help reduce depressive symptoms in bipolar disorder.
Psychoeducational approaches: typically help people learn about the symptoms of the disorder, the expected time course of symptoms, the biological and psychological triggers for symptoms, and treatment strategies.
Careful education about bipolar disorder can help people adhere to treatment with medications.
Beyond helping people be more consistent about their medications, psychoeducational programs help people avoid hospitalization.
Several other types of therapy are designed to help build skills and reduce symptoms for those with bipolar disorder.
Biological treatments of mood disorders
Electroconvulsive therapy for depression
Electroconvulsive therapy (ECT)
ECT is only used to treat MDD that has not responded to medication.
ECT entails deliberately inducing a momentary seizure and unconsciousness by passing 70- to 130- volt current trough the patients brain.
Unilateral ECT, in which the current passes only through the nondominant cerebral hemisphere is often used.
The patient is given a muscle relaxant before the current is applied.
The patients awakes a few minutes later remembering nothing about the treatment.
Typically, patients receive between 6 and 12 treatments, spaced several days apart.
ECT is more powerful than anitdepressant medications for the treatment of depression, particularly when psychotic features are present, even though we don’t know why it works.
People undergoing ECT face some risks for short-term confusion and memory loss.
It is fairly common for patients to have no memory of the period during which they received ECT and sometimes for the weeks surrounding the procedure.
Unilateral ECT produces fewer cognitive side effects than bilateral ECT does.
unilateral is associated with deficits in cognitive functioning 6 months after treatment.
Medications for depressive disorders
Drugs are most commonly used for depressive disorders.
Three major categories of antidepressant drugs
Antidepressants are effective for those with severe depression, but not for those with mild depression.
Although the various antidepressants hasten recovery form an episode of depression, relapse is common after the drugs are withdrawn.
Research comparing treatments for major depressive disorder
Combining psychotherapy and antidepressant medication bolsters the odds of recovery by more than 10 to 20 percent above either psychotherapy or medications alone for most people with depression.
Each treatment offers unique advantages.
CT is as effective as antidepressant medication for severe depression, and both treatments are more effective as an placebo.
CT has two advantages
Medications for bipolar disorder
Medications that reduce manic symptoms are called mood-stabilizing medications.
Two classes of medications other than lithium
Unfortunately, all these medications have serious side effects.
The mood-stabilizing medications used to treat mania also help relieve depression.
But many people continue to experience depression even after taking mood-stabilizing medication like lithium. For these people, antidepressant medication is often added to the regimen.
Depression and primary care
About half of all antidepressants are written by primary care physicians.
A final note on treatment
Antidepressant medication and ECT both stimulate growth of neurons in the hippocampus in rats.
Suicide ideation: thoughts about killing oneself
Suicide attempts: behavior intended to kill oneself
Suicide: death from deliberate self-injury
Nonsuicidal self-injury: behaviors intended to injure oneself without intend to kill oneself.
Epidemiology of suicide and suicide attempts
Suicide rates may be grossly underestimated because some deaths are ambiguous.
Models of suicide
Psychological disorders
Many persons with mood disorders have suicidal thoughts and some engage in suicidal behaviors.
More than half of those who try to kill themselves are depressed at time of the act.
As many as 90 percent of people who attempt to suicide are suffering from a mental illness.
Suicides are most likely when a person is experiencing comorbid depression.
Most people with mental illnesses do not die from suicide.
Neurobiological models
Heritability is about 48 percent for suicide attempts.
There is a connection between serotonin and suicide.
Serotonin dysfunction may increase the risk of violent suicide.
Social factors
Economic ans social events have been shown to influence suicide rates.
Social factors that are more directly relevant to the individual are also powerful predictors of suicidality.
Psychological models
Suicide may have many different meanings
The psychological variables involved in suicide vary across people.
Positive qualities may motivate a person to live and help a clinician build a case for choosing life.
People with more reasons to live tend to be less suicidal.
Preventing suicide
Giving a person permission to talk about suicide may relive a sense of isolation.
Most people are ambivalent about their suicidal thoughts, and they will communicate their intentions in some way.
Treating the associated psychological disorder
One approach to suicide prevention builds on our knowledge that most people who kill themselves are suffering from a psychological disorder.
Treating suicidality directly
Cognitive behavioral approaches appear to be the most promising therapies for reducing suicidality.
They also reduce suicidal ideation.
Cognitive behavioral treatments include a set of strategies to prevent suicide
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Clinical psychology
Chapter 1
Introduction and historical overview
Introduction
Psychopathology: the field concerned with the nature, development, and treatment of mental disorders.
Continually developing and adding new findings.
Sigma: the destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner, such as people with mental illness.
Stigma has four characteristics:
The treatment of individuals with mental disorders throughout recorded history has not generally been good, and this has contributed to their stigmatization.
Mental illness remains one of the most stigmatized of conditions in the twenty-first century.
Mental disorder is one disorder that contains several characteristics.
Four key characteristics that any comprehensive mental disorder definition ought to have:
No single characteristic can fully define the concept.
Mental disorder is usually determined based on the presence of several characteristics at one time.
Personal distress
A person’s behavior may be classified as disordered if it causes him or her great distress.
But not all mental disorders cause distress.
And not all behavior that causes distress is disordered.
Disability
Impairment in some important area of life.
Disability alone cannot be used to define mental disorder. Not all disorders involve disability.
Other characteristics that might, in some circumstances, be considered disabilities, do not fall within the domain of psychopathology.
Violation of social norms
In the realm of behaviors, social norms are widely held standards that people use consciously or intuitively to make judgments about where behaviors are situated on such scales as good-bad, right-wrong, justified-unjustified, and acceptable-unacceptable.
Behavior that violates social norms might be classified as disordered.
This is not enough for defining mental disorder. It is too broad and too narrow.
And social norms vary across cultures and ethnic groups.
Dysfunction
Harmful dysfunction. Has a value judgment and a objective component (dysfunction).
A judgment
Clinical psychology
Chapter 2
Current paradigms in psychopathology
Introduction
Science is a human enterprise that is bound by scientists’ human limitations.
Paradigm: a conceptual framework or approach within a scientist works.
A paradigm as profound implications for how scientist operate at any given time.
Three paradigms that guide the study and treatment of psychopathology
Factors that cut across all the paradigms:
Almost all behavior is heritable to some degree.
Despite this, genes do not operate in isolation from the environment. Through the life span, the environment shapes how our genes are expressed, and our genes also shape the environment.
Nature via nurture.
Without the environment, genes could not express themselves and thus contribute to behavior.
Genes: the carriers of genetic information.
The number of genes is not important. The sequencing, or ordering, of these genes as well as their expression is what makes us unique.
What genes do matters more than the number of genes we have. Genes make proteins that in turn make the body and the brain work.
Gene expression: some proteins switch, or turn, on and off other genes.
Polygenic: several genes turning themselves on and off as they interact with a person’s environment is the essence of genetic vulnerability.
We do not inherit mental illness from our genes. We develop mental illness trough the interaction of our genes with our environment.
Heritability: the extent to which variability in a particular behavior in a population can be accounted for by genetic factors.
Shared environment factors: those things that members of a family have in common, such as parents’ marital status.
Nonshared environment (or unique environment) factors: those things believed to be important in understanding why two siblings from the same family can be so different.
Nonshared environmental experiences have much more to do with the development of mental illness than the shared experiences.
Behavior genetics
Behavior genetics: the study of the degree to which genes and environmental factors influence behavior.
Genotype: the total genetic makeup of an individual, consisting of inherited genes. The genotype cannot be observed outwardly.
Phenotype: the totality of observable behavioral characteristics.
The genotype should not be viewed as a static entity. Genetic programs are quite flexible.
The phenotype changes
Clinical psychology
Chapter 3
Diagnosis and assessment
Introduction
Diagnosis can be the first major step in good clinical care.
Having a correct diagnosis will allow the clinician to describe base rates, causes, and treatment.
Hearing a diagnosis can help a person understand why certain symptoms are occurring.
Two concepts that play a key role in diagnosis and assessment:
Reliability
Reliability: consistency of measurement.
Validity
Validity: whether a measure measures what it is supposed to measure.
Unreliable measures will not have good validity.
Reliability does not guarantee validity.
The diagnostic system of the American psychiatric association: DSM-5
Diagnostic and Statistical Manual of Mental Disorders (DSM).
Multiaxial classification system forces the diagnostician to consider a broad range of information.
Axis:
Removal oaf the multiaxial system
The multiaxinal system developed for DSM-IV-TR is removed in DSM-5.
In place of the first three axes clinicians are simply to note psychiatric and medical diagnoses.
Organizing diagnoses by causes
DSM-5 defines diagnoses entirely on the basis of symptoms.
In the DSM-5, the chapters are reorganized to reflect patterns of comorbidity and shared etiology.
Enhanced sensitivity to the developmental nature of psychopathology
Childhood diagnoses
.....read moreClinical psychology
Chapter 4
Research methods in psychopathology
Introduction
Theory: a set of propositions meant to explain a class observations.
Hypotheses: expectations about what should occur if a theory is true.
The case study
Case study: recording detailed information about one person at a time.
The case study can be used:
The correlational method
Variables are measured as they exist in nature.
Psycho-pathologist will rely on correlational methods when there are ethical reasons not to manipulate a variable.
Comparison of people with and without diagnoses can be correlational as well.
Measuring correlation
Statistical and clinical significance
A statistical correlation is unlikely to have occurred by chance.
A non-significant correlation may have occurred by chance, so it does not provide evidence for an important relationship.
A statistical finding is usually considered significant if the probability that it is a chance finding is 5 less in 100. p<0.05.
In general, as the absolute size of the correlation coefficient increases, the result is more likely to be statistically significant.
The significance is also influenced by the number of participants in the study.
Clinical significance: whether a relationship between variables is large enough to matter.
Problems of causality
Correlational method does not allow determination of cause-effect relationship.
Epidemiology: the study of the distribution of disorders in a population.
Focuses on three features of a disorder
Epidemiological studies are designed to be representative of
.....read moreClinical psychology
Chapter 5
Mood disorders
Mood disorders involve disabling disturbances in emotion.
The DSM-5 recognizes two broad types of mood disorders:
Depressive disorders
The cardinal symptoms of depression include profound sadness and/or an inability to experience pleasure.
Physical symptoms of depression are also common
Social withdrawal is common.
Major depressive disorder
Major depressive disorder (MDD)
DSM-5 criteria
Persistent depressive disorder (Dysthymia)
People wit dysthymia are chronically depressed, more then half of the time for at least 2 years. They feel blue or derive little pleasures from usual activities and pastimes.
DSM-5 criteria for persistent depressive disorder (dysthymia)
Clinical psychology
Chapter 6
Anxiety disorders
Introduction
Anxiety: apprehension over an anticipated problem (future)
Fear: a reaction to immediate danger
Both anxiety and fear can involve arousal, or sympathetic nervous system activity.
Anxiety and fear are both adaptive.
In some anxiety disorders, the fear system seems to misfire. A person experiences fear at a time when there is no danger in the environment.
Anxiety creates a U-shape curve with performance.
Anxiety disorders as a group are the most common type of psychiatric diagnosis.
Phobias are particularly common
For each anxiety disorder, several criteria must be met for a DSM-5 diagnoses to be made:
Each disorder, though, is defined by a different set of symptoms related to anxiety or fear.
Anxiety disorders:
Specific phobias
A specific phobia: a disproportionate fear caused by a specific object or situation.
The person recognizes that the fear is excessive, but still goes to great lengths to avoid the feared object or situation.
Specific phobias tend to cluster around a small number of feared objects and situations.
The DSM categorizes specific phobias according to these sources of fear.
A person with one type of specific phobia is very likely to have another type of specific phobia as well. There is high comorbidity of specific phobias.
DSM-5 criteria:
Social anxiety disorder
Social anxiety disorder: a persistent, unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people.
The problems caused by it tend to be much more pervasive and to interfere much more with normal activities than the problems caused by other phobias.
Social anxiety disorder generally begins during adolescence. For some, though, the symptoms first emerge during childhood.
Without
Clinical psychology
Chapter 7
Obsessive-compulsive-related and trauma-related disorders
OCD is defined by repetitive thoughts and urges (obsessions) as well as an irresistible need to engage in repetitive behaviors or mental acts (compulsions)
Body dysmorphic disorder and hoarding disorder have symptoms or repetitive thoughts and behaviors.
For all three conditions, the repetitive thoughts and behaviors are distressing, feel uncontrollable, and require a considerable amount of time.
For the person with these conditions, the thoughts and behaviors feel unstoppable.
These syndromes often co-occur.
Clinical descriptions and epidemiology of the obsessive-compulsive and related disorders
Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) is characterized by obsessions or compulsions.
Obsessions: intrusive and recurring thoughts, images, or impulses that are persistent and uncontrollable and often appear irrational to the person experiencing them.
For people with OCD, obsessions have such force and frequency that they interfere with normal activities.
People with obsessions may also be prone to extreme doubts, procrastination, and indecision.
Compulsions: repetitive, clearly excessive behaviors or mental acts that the person feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent some calamity from occurring.
Even though rationally understanding that there is no need for this behavior, the person feels as something dire will happen if the act is not performed.
The sheer frequency with which compulsions are repeated may be staggering.
Commonly reported compulsions:
OCD tends to begin either before age 10 or else in late adolescence/early adulthood.
Slightly more common among women than men.
The pattern of symptoms appears to be similar across cultures.
High comorbidity.
DSM-5 criteria for Obsessive-compulsive disorder
Clinical psychology
Chapter 8
Dissociative disorders and somatic symptom- related disorders
Introduction
Both types of disorders are hypothesized to be associated with stressful experiences, yet symptoms do not involve direct expressions of anxiety.
Dissociative and somatic symptom-related disorders tend to be comorbid.
The DSM-5 includes three major dissociative disorders:
The dissociative disorders are all presumed to be caused by a common mechanism, dissociation. Which results in some aspect of cognition or experience being inaccessible consciously.
Dissociation and memory
Psychodynamic theory suggests that in dissociative disorder traumatic events are repressed.
In this model, memories are forgotten because they are so aversive.
Memory for emotional relevant stimuli is enhanced by stress, while memory for neutral stimuli is impaired.
Dissociative disorders involve unusual ways of responding to stress.
Extremely high levels of stress hormones could interfere with memory formation.
In the face of severe trauma, memories may be stored in such a way that they are not accessible to awareness later when the person has returned to a more normal state.
Dissociative disorders are considered an extreme outcome of this process.
Dissociative amnesia
The person with dissociative amnesia is unable to recall important personal information, usually information about some traumatic experience.
The holes in memory are too extensive to be explained by ordinary forgetfulness.
The information is not permanently lost, but it cannot be retrieved during the episode of amnesia, which may last for as short a period as several hours, or as long as several years.
The amnesia usually disappears as suddenly as it began, with complete recovery and only a small change of recurrence.
Most of the memory loss involves information about some part of a traumatic experience.
More rarely the amnesia is for entire events during a circumscribed period of distress.
During the period of amnesia, the person’s behavior is otherwise unremarkable, except that the memory loss may cause some disorientation.
In a more severe sub-type of amnesia, fugue, the memory loss is more extensive.
The person not only becomes totally amnesic but suddenly leaves home and work.
Recovery is usually complete, although it takes various amounts of time.
After recovery, people are fully able to remember the details of their life and experiences,
Clinical psychology
Chapter 9
Schizophrenia
Schizophrenia: a disorder characterized by disturbances in thought, emotion and behavior.
>1% prevalence
Slightly more men than women.
Sometimes develops in childhood, but usually appears in late adolescence or early adulthood
people with schizophrenia typically have a number of episodes of their symptoms and less severe but still debilitating symptoms between episodes.
The range of symptoms in the diagnosis of schizophrenia is extensive, although people with schizophrenia typically have only some of these problems at any given time.
No single essential symptom must be present for a diagnosis of schizophrenia.
Researchers divided symptoms in three
DSM-5 criteria of schizophrenia
Positive symptoms
Positive symptoms comprise excesses and distortions, such as hallucinations and delusions.
For the most part, acute episodes of schizophrenia are characterized by positive symptoms.
Delusions
Delusions: beliefs contrary to reality and firmly held in spite of disconfirming evidence.
Common symptoms in schizophrenia.
Delusions take several forms including:
Delusions are also found in other diagnoses,
Hallucinations and other disturbances of perception
Hallucinations: sensory experiences in the absence of any relevant information for the environment.
More often auditory than visual.
Negative symptoms
The negative symptoms of schizophrenia consists of behavioral deficits.
Include:
Negative symptoms tend to endure beyond an acute episode and have profound
.....read moreClinical psychology
Chapter 10
Substance use disorders
Prevalence adolescents: 9,3 to 10 percent.
Addiction: a more severe substance use disorder that is characterized by having more symptoms, tolerance, and withdrawal, by using more of the substance than intended, by trying unsuccessfully to stop, by having physical or psychological problems made worse by the drug, and by experiencing problems at work or with friends.
Tolerance: indicated by either:
Withdrawal: the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount.
DSM-5 criteria for substance use disorder
Alcohol use disorder
Delirium tremens (DTs): when the level of alcohol in the blood drops suddenly.
Liver enzymes that metabolize alcohol can account to a small extent for tolerance. The central nervous system is responsible as well.
Tolerance results from changes in the number or sensitivity of GABA or glutamate receptors. Withdrawal may result because some neural pathways increase their activation to compensate for alcohol’s inhibitory effects in the brain.
Alcohol use disorder is often part of polydurg abuse.
Polydrug abuse: abusing ore than one drug at a time.
Alcohol and nicotine are cross-tolerant; nicotine can induce tolerance for the rewarding effects of alcohol and vice versa.
Consumption of both drugs may be increased to maintain their rewarding effects.
Prevalence and cost of alcohol abuse and dependence
No yet prevalence estimates.
Especially frequent among college-age adults.
Binge drinking: having five drinks in a short period of time
Heavy-use drinking: having five drinks on the same occasion five or mire times in a 30-day period.
Among college students, binge drinking and heavy-use prevalence rates are 43,5 and 16 percent.
Binge drinking can have serious consequences
More men than women have problems with alcohol, though
.....read moreClinical psychology
Chapter 11
Eating disorders
Anorexia nervousa
DSM-5 criteria for anorexia nervousa
Amenorrhea: loss of menstrual period
Two types of anorexia nervosa:
Typically begins in the early to middle teenage years, often after an episode of dieting and the occurrence of life stress.
Lifetime prevalence: less than one percent
10 time more frequent in women than in men.
Suicide rates are quite high for people with anorexia
Physical consequences of anorexia nervosa
Self-starvation and use of laxatives produce numerous undesirable biological consequences in people with anorexia nervosa.
Prognosis
Between 50 and 70 percent of people with anorexia eventually recover.
Recovery often takes 6 to 7 years, and relapses are common before a stable pattern of eating and weight maintenance is achieved.
Anorexia nervosa is a life-threatening illness.
Bulimia nervosa
DSM-5 criteria for bulimia nervosa
Involves episodes of rapid consumption of a large amount of food, followed by compensatory behavior, such as vomiting, fasting, or excessive exercise, to prevent weight gain.
Binge has two characteristics:
Bulimia nervosa is not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss.
The diagnoses in such a case is anorexia nervosa, binge-eating/purgning type.
The key difference between anorexia and bulimia is weight loss.
People with bulimia do not lose a
Clinical psychology
Chapter 12
Sexual disorders
Sexual dysfunctions are defined by persistent disruptions in the ability to experience sexual arousal, desire, orgasm, or by pain associated with intercourse.
Paraphilias are defined by persistent and troubling attractions to unusual sexual activities or objects.
Definitions of what is normal or desirable in human sexual behavior vary with time and place.
Culture influences attitudes and beliefs about sexuality.
Gender and sexuality
Women tend to be more ashamed of any flaws in their appearance than do men, and this shame can interfere with sexual satisfaction.
For women, sexuality appears to be more closely tied to relationship, status, and social norms than for men.
Among women with sexual symptoms, more than half believe their symptoms are caused by relationship problems. Men are more likely to think about their sexuality in terms of power than are women.
There are many parallels in men’s and women’s sexuality.
The sexual response cycle
Four phases in the human sexual response cycle
Sexual dysfunctions
Sexuality usually occurs in the context of an intimate personal relationship.
Our sexuality shapes at least part of our self-concept.
When sexual problems emerge, they can wreak havoc on our self-esteem and relationships.
Clinical descriptions of sexual dysfunctions
The DSM-5 divides sexual dysfunctions into three categories:
Separate diagnoses are provided for men and women.
The diagnostic criteria for all sexual dysfunction specify that dysfunction should be persistent and recurrent and should cause clinically significant distress or problems with functioning.
A diagnoses of sexual dysfunction is not made it the problem is believed to be due entirely to a medical illness or another psychological disorder.
Many people with problems in one phase of the sexual cycle will often report problems in another phase. Some of this may just be a vicious circle.
Sexual problems in one person may lead to sexual problems in the partner.
Disorders involving sexual interest, desire, and arousal
DSM-5 criteria for Male hypoactive sexual desire disorder
DSM-5 criteria for Erectile disorder
DSM-5 criteria for Female sexual interest/arousal disorder
Clinical psychology
Chapter 13
Disorders of childhood
Most theories of childhood disorder, consider childhood experience and development critically important to adult mental health.
Before making a diagnosis of a particular disorder in children, clinicians must first consider what is typical for a particular age.
Some childhood disorders are unique to children.
The more prevalent childhood disorders are often divided into two broad domains,
Children and adolescents may exhibit symptoms form both domains.
Across cultures, externalizing behaviors are consistently found more often among boys and internalizing behaviors more often among girls, at least in adolescence.
Childhood disorders involve an interaction of genetic, neurobiological, and psychological factors.
Clinical descriptions, prevalence, and prognosis of ADHD
DSM-5 criteria for attention-deficit/hyperactivity disorder
Although children with ADHD are usually friendly and talkative, they often miss subtle social cues.
Children with ADHD can know what the socially correct action is in hypothetical situations but be unable to translate this knowledge into appropriate behavior in real-life social interactions.
DSM-5 includes three specifiers to indicate which symptoms predominate
The combined specifier comprises the majority of children with ADHD.
A difficult differential diagnosis is between ADHD and conduct
.....read moreClinical psychology
Chapter 14
Late life and neurocognitive disorders
As we age, physiological changes are inevitable, and there may be emotional and mental changes as well.
Many of these influence social interactions.
The problems experienced in late life
Mental health is tied to the physical and social problems in a person’s life.
No other have more of these problems than the elderly.
As people age, the quality of depth of sleep declines.
Sleep apnea: a disorder in which a person stops breathing for seconds to minutes during the night. Increase with old age.
Several problems are evident in the medical treatment available during late life.
Research methods in the study of aging
Three kinds of effects:
Two major research designs
The DSM criteria are the same for older and younger adults.
The process of diagnoses must be considered with care. DSM criteria specify that a psychological disorder should not be diagnosed if the symptoms can be accounted for by a medical condition or medication side effects.
Clinicians must be extremely careful to consider the interactions between physical and psychological health.
Estimating the prevalence of psychological disorders in late life
Persons over age 65 have the lowest overall prevalence of mental disorders of all age groups.
Mot people with psychological disorders in late life are experiencing a continuation of symptoms that began earlier.
Why so low?
Methodological issues in estimating the prevalence of psychopathology
Clinical psychology
Chapter 15
Personality disorders
The personality disorders are a heterogeneous group of disorders defined by problems in forming a stably positive sense of self and with sustaining close and constructive relationships.
People with personality disorders experience difficulties with their identity and their relationship in multiple domains of life, and these problems are sustained for years.
Their personality problems are evident in cognition, emotion, relationships, and impulsive control. The symptoms of personality disorders are pervasive and persistent.
The DSM-5 approach to classification
In the DSM-5, the 10 different personality disorders are classified in three clusters, reflecting the idea that these disorders are characterized by:
Many people with psychological disorder will also experience a personality disorder.
Comorbid personality disorder are associated with more severe symptoms, poorer social functioning, and worse treatment outcomes for may conditions.
Diagnostic reliability
Using structured interviews and multiple informants can improve reliability.
Comorbidity
Personality disorders tend to be comorbid with each other.
Alternative DSM-5 model for personality disorders
Reducing the number of personality disorders, incorporating personality trait dimensions, and diagnosing personality disorders on the basis of extreme scores on personality trait dimensions.
Two types of dimensional scores
Key strengths:
Alternative DSM-5 criteria for Personality disorder
Odd/eccentric cluster includes:
Paranoid personality disorder
DSM-5 criteria for Paranoid personality disorder
In this magazine, you can find the information you need for the first year course introduction to clinical psychology in the study psychology at the uva.
This is a magazine about clinical psychology
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