14.1: How are psychological disorders conceptualized and classified?
Psychopathology: sickness or disorder of the mind. Thought to be due to demons. People removed to insane
asylum. Hippocrates classified mania, melancholia, and phrenitis, due to relative amount of “humors” (bodily
Psychopathology is different from everyday problems: ¼ Americans has mental disorder in given year,
½ have some form of mental disorder at some point. Only 7% severely affected, suffer from multiple
psychological problem considered disorder when it disrupts person’s life and causes significant distress
over long period
o Psychological disorders are maladaptive: does person act in way that deviates from cultural
norms for acceptable behavior? Is behavior maladaptive? Is behavior self-destructive? Does
behavior impair social relationships?
Psychological disorders are classified into categories: etiology: factors that contribute to the
development of a disorder. Kraepelin recognized not all patients suffer from same disorder, separated
mood from cognition disorders. APA published Diagnostic and Statistical Manual of Mental Disorders.
Current edition describes disorders in terms of observable symptoms; patient must meet specific criteria
to get diagnosed, classified through multiaxial system: calls for assessment along five axes that
describe important mental health factors (clinical disorders, mental retardation, general medical
conditions, psychosocial/enviro problems, global assessment of functioning). Problem is either/or
evaluation – categorical, fails to capture differences in severity. Alternate: dimensional approach:
consider mental disorders along continuum, separates disorders that usually go together
Psychological disorders must be assessed: assessment: examination of person’s mental state to diagnose
possible psychological disorders, which leads to prognosis. Mental status exam: snapshot of patient’s
psyc functioning (emergency room). Clinical interview: interviewer’s skills determine quantity and
value of info obtained, express empathy, build rapport, nonjudgmental.
o Structured versus unstructured interviews: very flexible, topics of discussion vary, never elicit
same info from same patient. In structured interview, standardized questions asked in same
order. Formula, Structural Clinical Interview for DSM.
o Observation and types of testing: most popular questionnaire for psyc assessment: Minnesota
multiphasic personality inventory, 567 true/false items with 1- clinical scales to generate profile,
much bias from respondents balanced with validity scales (faking good/bad). Criticized for being
inappropriate in other countries or minorities. Neuropsychological testing: patient copies
pictures, draws from memory, sorts cards, blocks, etc
o Evidence-based assessment: clinicians often choose tests based on their own
experience/judgment, instead of formal method such as structured interview. Evidence –based
assessment: approach to clinical evaluation in which research guides evaluation of mental
disorders, selection of appropriate tests, and making diagnosis, e.g. comorbidity: mental
disorders occur together
Psychological disorders have many causes: diathesis-stress model: diagnostic model that proposes that
a disorder may develop when an underlying vulnerability is coupled with a precipitating event.
Individual can have underlying vulnerability/predisposition (diathesis) to mental disorder, can be
bio/enviro, disorder triggered with addition of circumstances that exceed ability to cope
o Biological factors: fetus vulnerable, childhood/adolescent exposure to toxins/malnutrition cause
risk due to effect on CNS. PET and fMRI show brain regions may behave differently individuals
with mental disorders. Neurotransmitters also have role.
o Psychological factors: family systems model: considers symptoms within an individual as
indicating problems within the family. Sociocultural model: views psychopathology as result of
interaction between individuals and their cultures.
o Cognitive behavioral approach: views psychopathology as result of learned, maladaptive
thoughts and beliefs, due to classical and operant conditioning thouhts/beliefs are types of
behavior, can become disorted and produce maladaptive behaviors/emotions, belives thought
procfesses are available to conscious mind o Sex differences in mental disorders: alcoholism more likely in males, anorexia more likely in
females, schizophrenia/bipolar disorder equally likely. Internalizing disorders: negative
emotions, grouped into categories that reflect distress/fear. Externalizing disorders:
o Culture and mental disorders: disorder w/ strong bio component will be more similar across
cultures, a disorder influenced by enviro more likely to differ across cultures
14.2 Can anxiety be the root of seemingly different disorders? Anxiety disorder: excessive anxiety in absence of
true danger; normal to be anxious in certain situations, abnormal to feel strong chronic anxiety without cause
There are different types of anxiety disorders: high levels of autonomic arousal: tense, apprehensive,
depressed, irritable, trouble sleeping, attention span and concentration impaired, bodily symptoms,
pointless motor behaviors, atrophy in hippocampus
o Phobic disorder: fear of specific object/situation, exaggerated and out of proportion. Specific vs.
social (fear of being negatively evaluated by others; aka social anxiety disorder).
o Generalized anxiety disorder GAD: diffuse state of constant anxiety not associated with any
specific object/event, minor matters, not focused so can occur in response to anything
o Posttraumatic stress disorder PTSD: frequent nightmares, intrusive thoughts, and flashbacks
related to earlier trauma. Some individuals more at risk than others (genetic marker related to
serotonin functioning). PTSD involves inability to forget, attentional bias, emotional event is
“overconsolidated” (burned into memory)
o Panic disorder: sudden, overwhelming attacks of terror. Several minutes, sweat/tremble, racing
heart, chest pain, dizzy, numbness, feeling crazy, higher suicide attempt, likely to develop other
anxiety disorders. Agoraphobia: fear of being in situations where escape is difficult/impossible
o Obsessive compulsive disorder OCD: frequent intrusive thoughts and compulsive actions.
Obsessions: recurrent, intrusive, unwanted thoughts/ideas/mental images. Compulsion: acts that
person feels driven to perform repeatedly. Anticipate catastrophe and loss of control, checking
helps calm anxiety.
Anxiety disorders have cognitive, situational and biological components
o Cognitive components: anxious individuals assume ambiguous/neutral situations are threatening,
focus excessive attention on perceived threats, recall threatening events more easily than
nonthreatening, exaggerate perceived magnitude/frequency
o Situational components: observing other peoples’ fears might generalize
o Biological components: some aspects of childhood temperament observed in adult brain
(showing amygdala threat response to novel faces)
o Causes of obsessive compulsive disorder: OCD may result from conditioning, anxiety paired
with event, person engages in behavior that reduces anxiety. Etiology of OCD may be genetic;
OCD-related genes may control neurotransmitter glutamate (major excitatory transmitter, causes
increased neural firing). Caudate: brain structure involved in suppressing impulses, smaller and
abnormal in people w/ OCD, dysfunction causes leak of impulses into consciousness, and
prefrontal cortex becomes overactive to compensate. OCD may be triggered by enviro, e.g.
streptococcal infection overnight. Maybe autoimmune response damages caudate, producing
OCD symptoms. Most likely bio and cognitive-behavioral factors interact to produce OCD
symptoms- dysfunctional caudate allow impulses to enter consciousness, giving rise to
obsessions, prefrontal cortex becomes overactive to compensate, associates established between
obsessions and behaviors that reduce anxiety from obsessions.
14.3 are mood disorders extreme manifestations of normal moods?
There are categories of mood (affective) disorders, depressive (persistent and pervasive feelings of
sadness) and bipolar (radical fluctuations in mood)
o Depressive disorders: major depression: severe negative moods or lack of interest in normally
pleasurable activities, also appetite/weight changes, sleep issues, no energy, difficult concentration, guilt, thoughts of death. Dysthymia: mild to moderate severity, not severe enough
be diagnosed as major depression, symptoms less intense
o Roles of culture and gender in depressive disorders: “common cold of mental disorders,” leading
cause of disability, stigma esp. in developing countries, leading risk factor for suicide. Twice as
many women suffer, possible due to multiple roles, overwork, lack of support, men’s symptoms
more in line with male gender roles (externalize).
o Bipolar disorder: alternating periods of depression and mania. Manic episodes: elevated mood,
increased activity, less sleep, big ideas, racing thoughts, distractibility, results in excessive
involvement in nice but stupid activities. Hypomanic episodes: creative/productive
o Case study of bipolar disorder: K