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A. DIFFERENT TYPES OF PSYCHOLOGICALPRACTITIONERS.
MD Psychologist – 4 years of medical school, licensed to medication
PsyD – doctorate
PhD – focused on research
Psychoanalyst – needs either a MD or PhD or PsyD
B. THE MEANING OF "ABNORMALITY" IN PSYCHOPATHOLOGY.
1. Distress or Psychological Suffering.
− Psychopathology: The study of the nature causes of treatment of mental disorders. The pattern of thought, emotion, and
behavior that result in personal distress, or a significant impairment in a persons social or occupational functioning.
2. Dysfunctional or Impaired Functioning.
3. Deviant, Irrational and Unpredictable Behavior.
− Social norms: cultural rules that tell us how we should behave and not behave in various situations especially in relation to
other people, can also be defined as being eccentric.
C. THE "DIAGNOSTICAND STATISTICALMANUAL OF MENTAL DISORDERS" (DSM).
1. The Disadvantages of Classifying Mental Disorders.
(a) Social Stigma.
− It won’t get out of some people’s heads because they were diagnosed with some disorder, and identify themselves with that
particular disorder. This doesn’t mean they have it for the rest of their lives. Current or previous employers can see, causing
− Other’s can stereotype the patient with everyone else, when there are different cases for everyone.
− Others or the patient’s can identify themselves with that disorder, identifying themselves.
D. CULTURE SPECIFIC DISORDERS.
E. RESEARCH AND PSYCHOPATHOLOGY.
F. SOURCES OF RESEARCH INFORMATION.
1. Case Studies.
2. Self-Reporting Inventories.
− You can say anything about yourself whether true or false. It can be very inaccurate; can be skewed. People can take
advantage to make themselves look better. Page 2 of23
3. Observational Approaches.
G. OVERVIEW OF PSYCHOTHERAPY MODELS.
1. Stressful Life Experiences.
2. The TherapeuticAlliance.
− Court mandated, gain more insight into themselves, stuck at a point with themselves, marital and family counseling
H. COGNITIVE-BEHAVIORAL PSYCHOTHERAPY.
− The patient is made aware of the connection between his or her patterns of distorted thinking and the patient’s emotional
responses. Then after your patient learns how to challenge the validity of those erroneous automatic thoughts.
− Client learns how to refrain from doing any of the following things:
1. Selectively perceiving the world around them as harmful while ignoring evidence to the contrary
2. Overgeneralizing on the basis of limited examples such as viewing themselves as totally worthless because they received a
3. Magnifying the significance of undesirable events.
4. Engaging in absolutist thinking, such as viewing oneself as a worthless student as opposed to a worthy student.
I. PSYCHODYNAMIC PSYCHOTHERAPY.
− Focuses on self-understanding with an emphasis on the role of the past in shaping the present and the belief that secrets of the
past are locked in the patient’s subconscious.
ID – pleasure, EGO – reality, SUPEREGO – control of ID’s desires (sexual instincts)
− Amental process by which words, memories, or images spontaneously bring other words or images or memories to ones
− Repression: unconsciously not thinking about or dealing with those conflicting thoughts
− Suppression: making an attempt, deliberately trying to conceal or resist or deny those conflicting feelings
2. Analysis of Dreams.
− Patient relating the events of the dream to the analyst and freely associating about those events.
Ex. Male patient is distraught because he had a dream he was sexually intimate with another male, he is convinced that he is
3. Analysis of Resistance.
− Your patient is holding back within the therapy.
− Ex. Always late, missing a session
− Resistance: an individuals unwillingness or inability to talk about certain thoughts, motives or experiences Page 3 of23
4. Analysis of Transference.
− Transference: an unconscious process in which a patient projects on to the therapist a variety of attitudes and feelings that the
patient has experienced in their relationships with another significant person from the patients past.
− Negative transference: Hate
− Positive transference: Love
K. COUNTERTRANSFERENCE AND THE PSYCHOTHERAPIST.
L. PSYCHODYNAMIC PSYCHOTHERAPYAND PSYCHOANALYTIC-ORIENTED PSYCHOTHERAPY.
A. CAUSES AND RISK FACTORS FOR PSYCHOPATHOLOGY:
1. The Diathesis-Stress Model ofAbnormal Behavior.
− Biopsychosocial model, it is the most comprehensive and influential approach in the explanation of psychopathology.
− Describes the relationship between potential causes of psychological disorders and the degree to which people may be
vulnerable to react to those causes.
− For a person that has strong diathesis, they are more vulnerable. Arelatively mild stressor may be sufficient to trigger a
subsequent psychological disorder. Conversely, a person who has weaker diathesis, less vulnerability, they may not show
signs of psychological distress until the stress becomes extreme or prolonged in their life.
2. TheAdditive Model ofAbnormal Behavior. (NOT ON MIDTERM)
− An individual who has a high level of diathesis, high vulnerability may need only a small amount of stress
3. Protective Factors.
− Influences in your life that help you lower your level of vulnerability to certain type of stressors (coping).
Many times, protective factors lead to "resilience."
"Resilience is the ability to adapt successfully to very difficult circumstances (such as severe environmental risk factors).
B. THE BIOLOGICALVIEWPOINT OFABNORMALBEHAVIOR:
− Mental disorders of the neurological systems that are either inherited or caused by some pathological process.
− Abnormality in the brain can lead to neuro pychopathology.
The nervous system consists of neurons and glial cells that form the structures in which neurons reside.
1. Neurotransmitter and Hormonal Abnormalities in the Brain:
A"neurotransmitter" is a chemical that assists in the transfer of signals from one neuron to another neuron.
There are 4 basic types of functional neuron cells as follows: Page 4 of23
1. Sensory Neurons: Sensory neurons are the most specialized of all neurons because they have unique mechanisms for responding to
a specific type of energy or detecting a specific substance.
2. Motor Neurons (and other Output Neurons).
3. Communication Neurons.
4. Computation Neurons.
Neurons have two kinds of branches which are:
Neurons use electricity to communicate what is happening in different parts of the neuron.
When an action potential reaches the end of an axon, a neurotransmitter is released into the synapse.
Neurotransmitters travel to post-synaptic cells and attach to proteins (that are called "neural receptors") to stimulate the post-synaptic
cells to open up and thus allow chemical ions to flow-in-and-out of the post-synaptic cells.
The flow of these ions in-and-out of the postsynaptic cell produces a change in its membrane potential that is called a "post-synaptic
The post-synaptic potential spreads along the membrane of the post-synaptic cell. In so doing, the post-synaptic potential begins to
fade along its way.
These 5 neurotransmitters have been studied most frequently: ON THE MIDTERM!
5. GABA(gamma aminobutyric acid).
A"hormone" is chemical messenger that is secreted by a set of endocrine glands in our body.
E. GENETIC VULNERABILITIES:
Chromosomal abnormalities have been associated with psychopathology.
Mental disorders and personality traits can be "influenced" by genetic abnormalities on the chromosomes and/or by polymorphisms.
Mental disorders or personality traits can also be influenced by naturally occurring variations of genes, which are known as
If a mental disorder is influenced by multiple genes that means it is polygenic.
F. TEMPERAMENT: Page 5 of 23
"Temperament" an individual’s basic reactivity and characteristic ways of self-regulation.
Beginning about 2-3 months of age, there are 5 different dimensions of temperament.
These 5 different dimensions of temperament:
2. Irritability and frustration.
3. Positive affect.
4. Activity level.
5. Attentional persistence and effortful control.
All of these early dimensions of temperament in a "child" seem to be related to the following 3 different dimensions of "adult
1. Negative emotionality or neuroticism.
2. Positive emotionality of extraversion.
G. BRAIN DYSFUNCTIONAND NEURALPLASTICITY.
"Neural plasticity" is the flexibility of the brain in making changes in organization and/or function in response to pre-natal and post-
Plasticity occurs throughout the central nervous system.
H. THE PSYCHOLOGICALVIEWPOINT OFABNORMALBEHAVIOR:
Focuses on the early developmental experiences.
The 3 major psychosocial orientations concerning abnormal behavior are:
1. Psychodynamic Psychology;
2. Behavioral Psychology – Skinner most well known
3. Cognitive-Behavioral Psychology (CBT). – Aaron Beck founder of CBT
There are 2 other psychosocial orientations concerning abnormal behavior, which are:
1. Humanistic Psychology, and
2. Existential Psychology.
I. PSYCHODYNAMIC THERAPY:
Freud's classical psychoanalysis and other closely-related therapies are often collectively referred to as: "psychodynamic therapy."
Psychodynamic therapy emphasizes the importance of unconscious motives or thoughts, which are considered to be products of the
Psychoanalysis seeks to bring the unconscious material to the awareness of the individual so that it can be integrated into the
conscious part of the individual's mind. Page 6 of23
Otherwise, the unconscious material may lead to irrational and maladaptive behavior.
J. PSYCHOANALYTIC PSYCHOTHERAPY:
In psychoanalytic theory, an individual's behavior occurs as a result of the interactions of the id, and the ego, and the superego.
1. The Id: Pleasure principles
The id is the source of 2 instinctual drives that are called the "life instincts" and the "death instincts."
2. The Ego:
The ego operates on the "reality principle."
The ego mediates between the demands of the id and the realities of the external world.
3. The Superego:
The superego is often referred to as our "human conscience." What’s right and what’s wrong.
The superego mediates between the uninhibited desires of the id, and the demands of reality, and the moral constraints of the superego.
As a result, the superego is often referred to as: the executive branch of the personality.
K. ANXIETY, UNCONSCIOUS,AND DEFENSE MECHANISMS:
"Anxiety" is defined as a generalized feeling of fear and apprehension.
The ego-defense mechanisms help an individual to push painful ideas out of the individual's consciousness (as opposed to dealing
directly with an actual issue or problem).
Although there are many ego-defense mechanisms, the most common ego-defense mechanisms include:
1. Displacement – putting emotions onto another person
2. Fixation – refers to a persistent focus of the ID’s pleasure seeking energies, on an earlier stage of psychosexual development.
3. Projection – Ex. if you have a strong dislike for someone, you might instead believe that he or she does not like you, so then you
might begin to project
4. Rationalization – Ex. Freud asked me on a date, and I said no thank you, then Freud could be disappointed and feeling rejected.
Then I would begin to rationalize and feeling really sorry, but I would say I didn’t like him anyway. Freud could rationalize and say
it’s her loss.
5. Reaction Formation – reduces anxiety by taking up the opposite feeling, impulse or behavior.
Ex. Saying someone is so great, amazing, smart, etc. but when you walk away you say she’s worthless, she’s nothing; you’re two
6. Regression – when you’re confronted by stressful events, people sometimes abandons their coping skills and reverts to patterns of
behavior used earlier in development
7. Repression – acts to keep information out of conscious awareness
8. Sublimation – defense mechanism that allows us to act out unacceptable impulses, by converting these behaviors into a more
Ex. For a surgeon, you have a bad day and you have sublimation by cutting into someone for surgery the next day.
9. Denial – outright refusal to admit or recognize that something has occurred or is currently occurring Page 7 of 23
10. Intellectualization – works to reduce anxiety by thinking about events in a clinical way
Ex. You have a terminal illness and you are so sad so you go on the Internet and try to learn everything about it, then you feel better
because you’re intellectualizing yourself.
Abnormal behavior is the product of distorted thoughts and distorted information processing based on the different guides.
As individuals, we rely on a variety of schemas as our "guides" about the world, as well as on personal schemas about ourselves
A"schema" is an underlying representation of knowledge that guides the current processing of information.
A"self-schema" is defined as:
Our views on who we are, and what we might become, and what are the things that are important to us.
O. COGNITIVE THERAPY (AARON BECK):
Focuses on the contribution of the individual’s automatic thoughts to maladaptive emotions and behavior.
According to cognitive therapy, the manner in which an individual interprets experiences and events will determine the manner in
which the individual reacts or does not react to the different experiences and events.
According to Aaron Beck, many psychological disorders include the existence of "automatic thoughts."
Q. THE PSYCHOLOGICAL CAUSAL FACTORS OFABNORMAL BEHAVIOR:
When an individual is exposed to multiple uncontrollable and unpredictable frightening experiences and events, the individual may be
more vulnerable to the development of psychopathology.
Some sources of vulnerabilities include:
Early trauma or deprivation – death of a parent, lack of necessities
Inadequate parenting styles – parental abuse
Parental psychopathology – schizophrenia in family history, substance abuse
Marital conflicts – divorce (can be negative or may help a child feel healthier because child is better off in a home with no stress or
Maladaptive peer relationships – shunned, ostracized in middle school, bullied
1. Early Deprivation or Early Trauma.
2. Neglect andAbuse in the Home.
3. Parental Psychopathology.
4. Marital Discord and Divorce.
5. Maladaptive Peer Relationships.
Lecture 3 Page 8 of 23
A. CLINICALASSESSMENTAND DIAGNOSIS.
B. THE BASIC ELEMENTS INACLINICALASSESSMENT. NOT ON MIDTERM
1. The Components of a Patient History.
2. The Components of a Culturally-SensitiveAssessment.
3. The Components of Communication and Confidentiality Between the Clinician
4. The Components of a MedicalAssessment.
(a) General Physical Examination.
(b) Neurological Examination.
(c) Neuropsychological Examination.
C. THE PSYCHOSOCIALASSESSMENT.
1. Structured and Unstructured Interviews.
2. Direct Observation of the Patient's Behavior.
− Rule out any underlying reasons
− Observe, use all your senses to see what’s going on with the patient
3. Rating Scales.
4. Psychological Testing.
(a) Intelligence Tests.
(b) Projective Personality Tests.
(c) Objective Personality Tests.
D. THE INTEGRATION OF CLINICALASSESSMENT INFORMATION.
− Ethical Issues: You have an ethical duty; you have a higher standard of care for your patient.
You exercise the appropriate ways, such as confidentiality.
E. THE CLASSIFICATION OF PSYCHOPATHOLOGY.
1. Reliability and Validity.
− Validity presupposes reliability
− If a classification system is not valid, or if it is unreliable, it will probably be a useless classification system.
2. Formal Classification of Mental Disorders.
− In the behavioral sciences, such as medicine, we use two major classification systems. DSM-V for psychology and
psychiatry. ICD for medicine. Page 9 of 23
3. The DSM Classification System.
(a)Axis I through Axis V.
A. STRESS DISORDERSAND PATIENT HEALTH.
− Stress reactions are a result of psychological behavioral responses that occur in the face of stressors.
− Coping strategies are ways to bring down or eliminate particular stressors in your life.
o Problem focused coping skills – skills that an individual uses to reduce stress like changing whatever it is that is
causing the stress.
Ex. Good time management
o Emotional focused coping skills – you try to improve your feelings about whatever it is that is causing you stress.
Ex. I know I’m going to do well on the final exam because I’ve been studying.
1. Some Factors that Might Predispose an Individual to Stress.
− Acute stress disorder and PTSD; PTSD is now included under illness anxiety disorder.
2. Characteristics of Stressors.
(a) Identify Certain Factors.
− How long has the stress been existing? When did it start? Who is it affecting? Why
Who what when where why
3. Crises in Life.
− Stressful situation exceeds your adaptive capabilities
4. Life Changes.
− Death of a family member, marriage, divorce, moving, illness, unemployment, pregnancy
B. THE STRESS RESPONSE.
Responses to stress can be physical or psychological.
1. Physical Stress and the Sympathetic-Adreno-Medullary (SAM) Response to Stress.
− Physical stress responses include SAM responses.
o That type of activation increases your heart rate, respiration, and many other physical processes. It also activates
HPA(hypothalamic pituitary activation) system, which releases cortical steroids.
o SAM – fight or flight response
(a) GeneralAdaptation Syndrome. Page 10 of23
− Helps people resist stress.
2. The Hypothalamic-Pituitary-Adrenocortical (HPA) Response to Stress. NOT ON MIDTERM
− When a threat is detected by your amygdala, it releases different types of chemicals and stimulates the synthesis of stress
hormones including cortisol
3. The Biological Effects of Stress.
− The biological cost of adapting to stress. Allostatic level low when you’re relaxed and not experiencing stress, but when
you’re experiencing stress, allostatic load is higher.
4. The Mind-and-Body Connection Model of Stress.
− Psychoneuroimmunology: The study of the connections among the stress (psycho), nervous system functioning (neuro), and
the immune system (immunology).
− Astressful event can initiate a stressful reaction in the body in respect of psychoneuroimmunology
C. STRESS AND PHYSICAL HEALTH.
1. Temperament and Stress.
− When a person is experiencing stress, the body is more susceptible to illness, viruses
− An individual who has an optimistic temperament is less vulnerable to the physical illness
− Aperson who is easily stressed out, frustrated, irritable, impatient, feel pressured, is more likely to have an increase in health
problems (e.g. cardiac problems)
D. CARDIOVASCULAR DISEASE AND STRESS.
1. Hypertension and Stress.
− Hypertension: high blood pressure
− Apatient with high blood pressure already has a biological tendency toward high cardiovascular reactivity to stress.
2. Coronary Heart Disease (CHD) and Stress.
− If you’re stressed out and have higher levels of stress, you are more susceptible to CHD.
3. Chronic andAcute Stress in Coronary Heart Disease.
− Persistent work related stress can lead to potential CHD.
4. Personality and Coronary Heart Disease. Page 11 of 23
(a) Type ABehavior Pattern.
− Excessive competitive drive, extreme commitment to work, hard driving, impatient, easily irritated.
(b) Type B Behavior Pattern.
− Relaxed and laid back, less pressured by time, less susceptible to CHD because they are more relaxed and laid back.
(c) Type D Behavior Personality.
− Distressed personality, experience negative emotions while inhibiting emotional expressions. They would be someone who
bottles things up inside.
5. Depression and Coronary Heart Disease.
− Aperson who is depressed is more likely to be vulnerable to CHD.
− Aheart attack victim is more susceptible to developing depression after their heart attack, and doctors do not pay attention to
this, so they are not getting treated for this, which leads to another heart attack.
6. Anxiety and Coronary Heart Disease.
− Higher levels of anxiety leads to an increased risk of CHD, and can lead to phobic disorders such as arachnophobia.
7. Social Isolation or the Lack of a Social Support Network and Coronary Heart Disease.
− Increased risk that can lead to CHD.
F. PSYCHOLOGICAL REACTIONS TO STRESS.
Difficulties in thinking when you’re stressed out
− Thinking that the absolute worst will occur.
2. Ruminative Thinking.
3. Disruptions in Thinking Clearly.
4. Difficulties inAccurate Recollections.
5. Problem-Solving Difficulties.
G. BEHAVIORALREACTIONS TO STRESS.
− Irritability, absenteeism, aggression, suicidal reactions
H. ADJUSTMENT DISORDER.
− Least stigmatizing or mildest condition a clinician can diagnose a patient.
− Adjustment Disorder: Apsychological stressor, a response to a common stressor, such as a loss of your best friend,