ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

and makes every attempt to

Chapter 1: Abnormal Behavior in avoid interaction, even though
Historical Context they would like to have friends

Understanding Psychopathology
What is a psychological disorder? 3. Atypical or not culturally expected
What’s not?
- Deviations from “average”
How do we describe people with mental
- Violation of social norms
illness?
- “Harmful dysfunction”
Lazy, crazy, dumb?
- Lady Gaga’s eccentric personality
Weak in character? is not deviating from the norms
Dangerous? but did only to enhance her
Hopeless? popularity
Knowing where to draw the line
between normal and abnormal
dysfunction is often difficult.
What is a Psychological Disorder?
Psychological dysfunction
1. Breakdown in function
- Cognitive
- Behavioral
- Emotional
- EXAMPLE: Judy: Who fainted at
the sight of blood What is psychological abnormality?
- Having a dysfunction is not
“The four Ds”(Comer, 2013)
enough to meet the criteria for a
psychological disorder. 1. Deviance - different, extreme,
2. Personal distress or impairment unusual, perhaps even bizarre
2. Distressing - unpleasant and
- The criterion is satisfied if the upsetting to the person
individual is extremely upset 3. Dysfunction - interfering with the
- Individual versus others person’s ability to conduct daily
- Appropriateness to situation activities in a constructive way,
- Degree of impairment – being and
shy or lazy doesn’t mean the 4. Danger - putting others and self
person is abnormal. But if the at risk
person finds it impossible to date
or even interact with other people Dysfunction
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- it interferes with daily functioning. symptoms are close to the

- it so upsets, distracts, or prototype
confuses people that they cannot ● Dimensional estimates of the
care for themselves properly, severity of specific disorders e.g.
participate in ordinary social intensity and frequency of panic
interactions, or work productively. attack in anxiety (DSM IV and
- withdraw from the productive life DSM 5)
once led
Dangerous The Science of Psychopathology
- the ultimate in psychological
Psychopathology is the scientific study
dysfunctioning is behavior that psychological disorders
becomes dangerous to oneself or
others. Conducted by
- behavior is consistently careless, ● Clinical and counseling
hostile, or confused may be psychologists (PhD, PsyD)
placing themselves or those ● Psychiatrists (MD
around them at risk ● Psychiatric social workers (MSW
● Psychiatric nurses (MN, MSN,
PhD)
An accepted definition: ● Marriage and family therapists
DSM-5 (MA, MS, MFT)
- describes behavioral, ● Mental health counselors (MA,
psychological, or biological MS)
dysfunctions that are unexpected The Scientist-Practitioner
in their cultural context and Interaction of clinical work and science
associated with present distress
and impairment in functioning, or ● Consumer of science
increased risk of suffering, death, - Informs practice –
pain, or impairment scientific developments
● Evaluator of science
Diagnostic and Statistical Manual - Utilizes science – evaluate
● DSM-5 own assessment or
● Prototypes/typical profiles – treatment procedures to
that some patients may have only see if they work
some features or symptoms of ● Creator of science
the disorder (a minimum number) - Synthesizes both –
and still meet the criteria for the conduct research
disorder because his or her
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

benzodiazepine,
selective-serotonin reuptake
inhibitors (SSRIs) such as Prozac
and Paxil, Psychological
Interventions, combined
psychological and drug
treatments, etc.

Clinical Description
● Clinical Description –
represents the unique
combination of behaviors,
thoughts, and feelings that make
up a single disorder
● Prevalence – How many people ● Age of onset may shape
in the population have the presentation
disorder? - Developmental psychology
● Incidence - statistics on how - Developmental
many occur during a given psychopathology
period, such a year - Life-span developmental
● Course – individual patterns, e.g. psychopathology
chronic course, episodic course,
time limited course Historical Conceptions of Abnormal
● Onset – acute onset- they begin Behavior
suddenly, insidious onset- Major psychological disorders
develop gradually have existed across time and cultures
● Prognosis – anticipated course
Causes and treatment of
of a disorder, good vs. guarded
abnormal behavior varied widely,
● Causation (etiology) - study of
depending on context
origins, what causes the disorder
and includes biological, The Supernatural Tradition
psychological, and social Deviance = Battle of “Good” vs. “Evil”
dimension
Etiology—devil, witchcraft, sorcery
● Treatment and outcome – e.g.
medications such as
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

● Great Persian Empire (900 to 600 The moon and the stars
BC) ● Moon and stars
● 14th and 15th century Europe ● Paracelsus - Lunacy
● Salem witch trials in U.S. ● Modern examples - Astrology
Psychological disorders are seen
as the work of the Demons and witches
The Biological Tradition
Treatments—exorcism, torture, and
crude surgeries Hippocrates (460-377 BC)
● Father of modern Western
medicine
Stress and Melancholy ● Etiology = physical disease
Etiology—natural, curable phenomenon ● Precursor to somatoform
● Illness model – mental disorders
depression and anxiety were - Hysteria
recognized as illness Galen (129-198 AD)
● Still connected with sin ● Hippocratic foundation
Treatments for possession – people - Galenic-Hippocratic Tradition
were subjected to confinement, ● Humoral theory of mental illness
beatings, and other forms of torture, - Black, blue, yellow and phlegm
hanging people over a pit full of biles
poisonous snakes to scare the evil Etiology = brain chemical imbalances
spirits, dunking in ice-cold water
Treatments = environmental regulation
- Heat, dryness, moisture, cold
Mass hysteria - Bloodletting, induced vomiting
● St. Vitus’s dance
● Tarantism
19th Century
Syphilis and general paresis
● STD with psychosis-like
Modern Mass hysteria symptoms
● Emotion contagion – the - Delusion
experience of an emotion seems - Hallucinations
to spread to those around us Etiology = bacterial microorganism
● “Mob psychology” – shared - Louis Pasteur’s germ theory
response
Biological basis for madness
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

John Grey (1850s) The Psychological Tradition

- American proponent of the Plato, Aristotle, and Greece
biological tradition Etiology = social and environmental
Etiology = always physical factors
Treatments = as is physically ill Treatment
- Rest, Diet, Room temperature - Reeducation via discussion
Improved hospital conditions - Therapeutic environments
Similar practices in ancient Muslim
countries
The Development of Biological
Treatments
Mental Illness = Physical Illness Moral Therapy

The 1930s “Moral” = emotional or psychological

- Insulin shock therapy - Treating patients normally

- Brain surgery - Encouraging social interaction
- ECT - Focus on relationships
- Individual attention
Benjamin Franklin (1750s) – - Education
discovery: a mild and modest
electric shock to the head
produced a brief convulsion and Key figures in humanistic reform:
memory loss (amnesia) but did France
only little harm
● Philippe Pinel (1745 – 1826)
● Jean-Baptiste Pussin
Treatment for depression? England
Consequences of the Biological ● William Tuke (1732 – 1822)
Tradition
United States
1. Increased hospitalization
- “Untreatable” conditions ● Benjamin Rush (1745 – 1813)
2. Improved diagnosis and ● Horace Mann (1833)
classification
- Emil Kraepelin
Asylum Reform and the Decline of
3. Increased role of science in
Moral Therapy
psychopathology
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Declines in the Mid-19th Century

● Increased numbers of patients
- Immigrants
- Homeless
“Mental Hygiene
Movement”
→ Dorothea Dix
(1802-1887)
● Staffing problems
Outcome = decreased treatment
● Defense mechanisms
efficacy
- Ego fights to stay on top of the
Id and Superego
Psychoanalytic Theory - Loss = anxiety
- Coping strategies include:
Anton Mesmer (1734 – 1815) 1. Displacement - Transfers a
- “Mesmerism” and hypnosis feeling about, or a response to,
- Suggestibility an object that causes discomfort
onto another, usually
Jean Charcot (1825-1893)
less-threatening, object or person
- Hypnosis as treatment 2. Denial - Refuses to acknowledge
- Mentor to Freud some aspect of objective reality
Josef Breuer (1842-1925) or subjective experience that is
apparent to others
- Furthered hypnosis treatments
3. Projection - Falsely attributes
- Collaborator with Freud
own unacceptable feelings,
Conscious versus unconscious: impulses, or thoughts to another
● Id individual or object
- Pleasure principle 4. Rationalization - Conceals the
- Illogical, emotional, irrational true motivations for actions,
● Ego thoughts, or feelings through
- Reality principle elaborate reassuring or
- Logical and rational selfserving but incorrect
● Superego explanations
- Moral principles 5. Reaction formation - Substitutes
- Balances Id and Ego behavior, thoughts, or feelings
that are the direct opposite of
unacceptable ones
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

6. Repression - Blocks disturbing → Enduring personality traits

wishes, thoughts, or experiences (Introversion vs. extroversion)
from conscious awareness ● Alfred Adler (1870-1937)
7. Sublimation - Directs potentially - Birth order, Inferiority complex,
maladaptive feelings or impulses Striving for superiority,
into socially acceptable behavior Self-actualization
● Emphasis on life-span
development
● Stages of Psychosexual ● Influence of society and
Development culture on personality
- Patterns of gratifying basic Key figures:
needs - Karen Horney (1885-1952)
- Infancy to early childhood - Erich Fromm (1900-1980)
→ Oral - Erik Erickson (1902-1994)
→ Anal ● Psychoanalytic Psychotherapy
→ Phallic - Unearth intrapsychic conflicts
→ Latency - Long-term treatment model
→ Genital - Techniques: Free Association,
- Conflicts at each stage must be Dream Analysis
resolved
→ Oedipus complex in the phallic Transference/Counter-Transferen
stage ce
- Adult personality reflects Efficacy Data are Limited
childhood experience Emphasizes conflicts and
● Later developments in unconscious
psychoanalytic thought
● Self-Psychology - Trauma and active defense
- Anna Freud (1895-1982) mechanisms
- Ego defines behavior
● Object Relations Theory Focus on:
- Melanie Klein and Otto → Affect
Kernberg → Avoidance
- Children incorporation of → Patterns
“objects” → Past experience
→ Images, Memories, Values of → Interpersonal experience
significant others → Therapeutic relationship
● Freud’s students de-emphasize → Wishes, dreams, fantasies
sexuality
Criticisms
- Carl Jung (1875-1961)
→ Pejorative terms (neurosis)
→ Collective unconscious
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

→ Unscientific John B. Watson (1878–1958)

→ Untested - Scientific emphasis
Contributions - Objective
- Unconscious processes - “Little Albert” experiment
- Emotions triggered by cues
- “Therapeutic alliance”
- Defense mechanisms
Humanistic Theory
Theoretical constructs
- Intrinsic goodness
- Striving for self-actualization
- “Blocked” growth
The Behavioral Model and Behavior
Person-centered therapy
Therapy
- Carl Rogers (1902–1987)
Mary Cover Jones
Hierarchy of Needs
- Preexisting phobia extinguished
- Abraham Maslow (1908–1970) by exposure and modeling
Joseph Wolpe (1915–1997)
The Behavioral Model - Systematic desensitization
Classical conditioning - Relaxation

Ivan Pavlov (1849–1936)

- Ubiquitous form of learning The Behavioral Model - Operant
● Unconditioned stimulus Conditioning
(UCS) E.L. Thorndike (1874–1949)
● Unconditioned response
- Law of effect: consequences
(UCR)
shape behavior
● Conditioned stimulus (CS)
● Conditioned response B.F. Skinner (1904–1990)
(CR) - Behavior “operates” on
Classical conditioning – concepts environment
- Reinforcements
- Stimulus generalization
- Punishments
- Extinction
- Behavior “shaping”
- Introspection
Behaviorism
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

The Present: The Scientific Method ● Causes cannot be considered out

and an Integrative Approach of context
- Defining and studying What Caused Judy’s Phobia?
psychopathology Behavioral Influences
→ Requires a broad approach Ex. Judy’s reaction is an unconditioned
→ Multiple, interactive influences response that became associated with
(Biological, psychological, social situations similar to the scene in the
factors) movie
- Scientific emphasis Biological Influences- it is inherited, runs
→ Neuroscience in the family
→ Cognitive, behavioral sciences ● Genetics
● Physiology
Chapter 2: An Integrative Approach ● Neurobiology (vasovagal
to Psychopathology syncope-a common cause of
fainting, sinoaortic baroreflex
One-Dimensional vs arc-compensate for sudden
Multidimensional-Models increases in blood pressure by
lowering it)
Multidimensional Models
Emotional Influences - emotions can
● The Role of Genes
affect physiological responses such as
● Neuroscience
high blood pressure, heart rate, and
● Behavioral and Cognitive
respiration.
Sciences
● Emotions
● Cultural, Social, and Judy’s emotions may have triggered a
Interpersonal Factors stronger and more intense baroreflex.
● Life-Span Development
Emotions also changed the way she
One-Dimensional Models thought about situations involving blood
● Single cause, operating in and injury and motivated her to behave
isolation in ways she didn’t want to
● Linear causal model Social Influences - have direct
● Ignores critical information contributions to biology and behavior.
Multidimensional Models Ex Judy’s friends and family rushed to
● Systemic her aid when she fainted. Did their
● Several independent inputs that support help or hurt? Her principal
become interdependent rejected her and dismissed her problem.
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Rejection, particularly by authority - Polygenetic influences Rule, not

figures can make psychological the exception
disorders worse. Genetic Contributions to
Developmental Influences- as we Psychopathology
enter a developmental critical period Evidence of the complexity and the
when we are more or less reactive to a contextual nature of genetics:
given situation or influence than at other
times. - Quantitative genetics accounts
for the small, individual effects of
→ All of these interact interdependently several genes
- Gene expression and
gene-environment interactions
New Developments in the Study of
Genes and Behavior
Behavioral genetics
● Role of genes and psychological
disorders
First, specific genes or small
group of genes are ultimately be found
to be associated with certain
psychological disorders. Current
The Nature of Genes evidences suggest that contributions to
The nature of genes psychological disorders came from
many genes, each having a relatively
What are genes?
small effect (Flint, 2009; Rutter, 2006).
- Long molecules of DNA
Second, it has become
- Double Helix structure
increasingly clear that genetic
- Located on chromosomes
contributions cannot be studied in the
● 46 chromosomes in 23
absence of interactions with events in
pairs
the environment that trigger genetic
● Pairs 1 – 22 = body and
vulnerability or “turn on” specific genes
brain development
(Kendler et al., 2011; Rutter 2010).
● Pair 23 = gender
- Determine physical
characteristics (e.g., weight) The Interaction of Genes and the
- Importance of contextual factors Environment
- Dominant vs. recessive genes
- Single-gene determinants
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Eric Kandel—learning affects genetic

structure of cells
- Activation of dormant genes
- Continued development in the
brain → Plasticity - subject to
continual change vs. Hardwired
→ With this new finding in mind,
we can now explore
gene-environment interactions as
they relate to psychopathology ● Gene-environment correlation
model
● Genes shape how we create our
The Diathesis-Stress Model
environments
Individuals inherit tendencies to express ● Inherited predispositions or traits
certain traits and behaviors, which may that increase one ’s likelihood to
then be activated under conditioned of engage in activities or seek out
stress. Each inherited tendency is a situations
diathesis, (or vulnerability) which Example: divorce- If you and your
means literally making someone spouse each have an identical twin, and
susceptible to developing a disorder. both identical twins have been divorced,
Diathesis is genetically based and the the chance that you will also divorce
stress is environmental but that must increases greatly.
interact to produce a disorder.

The Interaction of Genes and the

Environment
Diathesis:
- Inherited tendency to express
traits/behaviors
- Genetic
Stress:
- Life events or contextual
variables Epigenetics and the Nongenomic
- Environmental “Inheritance” of Behavior

Combining both yields activation ● Overemphasis on the role of

under the right conditions genes?
● Environment and early learning
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Cross fostering studies of

development
- Critical vs. sensitive periods
- Robert Sapolsky concluded
“genetic influences are often a lot
less powerful than is commonly
believed. The environment, even
working subtly, can still mold and
hold its own in the biological
interactions that shape who we
are”

Neuroscience and its Contributions

to Psychopathology
● The field of neuroscience
- The role of the nervous system
in disease and behavior
● The central nervous system
- CNS Brain and spinal cord
- PNS Somatic and autonomic
branches
The Central Nervous System

The neuron-basic building block

- Soma
- Dendrites
- Axon
- Axon terminals
- Synaptic cleft - electrical
- Communication: chemical The Structure of the Brain
→ Neurotransmitters Two main parts:
1. Brain stem - Basic functions
2. Forebrain Higher cognition

Hindbrain
- Medulla: Heart rate, blood pressure,
respiration
- Pons: Regulates sleep stages
- Cerebellum: Physical coordination
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Midbrain
- Coordinates movement with sensory
input
- Contains parts of the reticular
activating system (RAS)

Forebrain (cerebral cortex)

- Most sensory, emotional, and cognitive
Thalamus and hypothalamus
processing
- Relays between brain stem and
- Two specialized hemispheres
forebrain
→ Left: Verbal, math, logic
- Behavioral and emotional regulation
→ Right: Perceptual
Limbic system
- Emotions, basic drives, impulse control
- Associated structures and
psychopathology

Basal ganglia
- Caudate nucleus
- Motor activity

Lobes of the cerebral cortex

● Frontal: Thinking and reasoning
abilities, memory
● Temporal: Sight and sound
recognition, long-term memory
storage
● Parietal: Touch recognition
● Occipital: Integrates visual input

The Peripheral Nervous System

 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Somatic system
- Voluntary muscles and movement
Autonomic system
- Sympathetic (activating)
- Parasympathetic (normalizing)
- Both divisions regulate:
Cardiovascular system/body
temperature Endocrine
system/digestion

Neurotransmitters
Production – estimates-more than 100
different neurotransmitters, each with
multiple receptors, are functioning in
various parts of the nervous system
Reuptake - after a neuro transmitter is
released, it is quickly drawn back from
the synaptic cleft of the same neuron

Functions
● Agonists - effectively increase
endocrine system the activity of a neurotransmitter
- Hormones by mimicking its effect
hypothalamic - pituitary - ● Antagonists - decrease or block
adrenalcortical axis (HPA axis) a neurotransmitter
- Integration of endocrine and nervous
system Glutamate and GABA (the ‘chemical
brothers’, determine whether the neuron
is activated (or fires) or not)
● Glutamate - An Excitatory
transmitter that ‘turns on’ many
different neurons, leading to
action.
● GABA - An Inhibitory
neurotransmitter whose job is to
inhibit (or regulate) transmission
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

of information and action - Not directly involved in specific

potentials. patterns of behavior or in psychological
→ Fast acting disorders.
→ Complex subsystems
→ Implicated in anxiety
(Benzodiazepines)
● Serotonin (5HT)
- Monamine class
- Widespread, complex circuits
- Regulates behavior, moods,
thought processes
- Low levels and vulnerabilities-
associated with instability,
impulsivity, and tendency to
overreact to situations Dopamine – a major neurotransmitter
- Implicated in several - Play a significant role in depression
psychopathologies and attention deficit hyperactivity
disorder
- “Switch” function in brain circuits
- Interacts with other neurotransmitters
- Implicated in schizophrenia (Dopamine
circuit is too active)
- Associated in Parkinson’s disease-
marked deterioration in motor behavior

Norepinephrine
- Stimulation of alpha- and
beta-adrenergic receptors Implications for Psychopathology
- Respiration, reactions, alarm response The brain and abnormal behavior
- Implicated in panic Studying images
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Obsessive-compulsive disorder environment run to a corner and

- Patients with OCD have increased displayed severe anxiety and panic
activity in the part of the prefrontal lobe unlike the first group who have control
of the cerebral cortex called the orbital and behave differently.
surface
- Increased activity is also present in the - The structure of neurons themselves,
cingulate gyrus and, to a lesser extent in including the number of receptors on a
the caudate nucleus. If one area is cell, can be changed by learning and
active, the other areas are also. experience during development

Psychosocial Influences on Brain Greenough et al (1990) discovered that

Structure and Function the nervous sytems of rats raised in a
Psychosocial influences on the brain rich environment requiring a lot of
- Functional normalization in OCD learning and motor behavior developed
- Placebo differently from the nervous sytems of
- Psychotherapy rats that were couch potatoes. The
- Stress and early development active rats has many more connections
Interactions of psychosocial factors between nerve cells in the cerebellum
with brain structure and function and grew many more dendrites. This
- Developmental disorders findings suggest enormous plasticity in
- Environment and brain structures the brain structure as a result of
- Some research indicates that experience. Also, less stress is
psychosocial factors directly experienced later in life.
affect levels of neurotransmitters
- An experiement with 2 groups of Behavioral and Cognitive Sciences
rhesus monkeys who were raised Conditioning and cognitive
identically except for their ability processes
to control things in their cages. - Respondent and operant learning
The first group had free access to - Environmental relationships
toys and food, but the second - A variety of judgements and cognitive
group got these toys and food processes are combined to determine
only when the first group did. the final outcome of learning even in
lower animals such as rats
Result: The monkeys in the first group - Complex cognitive processing of
grew up with a sense of control over information, as well as emotional
things in their lives and those in the processing, is involved when
second group did not. When conditioning occurs, even in aminals.
administered benzodiazepine later in
lives, monkeys with little control in the
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Emotional response is terror,

motivation for action
- Richard Lazarus - the type of
appraisal you make determines the
emotions you experience. He suggest
that thinking and feeling cannot be
separated.

The Components of Emotion

Emotion has three important and
Learned helplessness - (Martin overlapping components:
Seligman) people become depressed if behavior, cognition, and physiology
they ‘decide’ or ‘think’ they can do little
about the stress in their lives even if it
seem to others that there is something
they could do
- Perceptions of control
- Implicated in depression Negative
attributions
- “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.

Social learning
- Albert Bandura
- Modeling Anger and Your Heart
- Observational learning - Hostility and anger are risk factors for
- Interactive and contingent on heart disease
perceptions of similarity → Cardiovascular efficiency
- Interactions with genetic risks
Emotions
The nature of emotion Emotion and Psychopathology
- Fight or flight response ● Timing of emotional responses
- Fear response ● Degree of response
- Cardiovascular ● Environmental and social
- Cortical interactions
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Voodoo, the evil eye, and other fears ● Disorders are common across
Cultural factors cultures accounting for 13% of
- Influence form and expression of the global burden of disease
behavior ● Rates and expression varies
- Culturally-bound “fright disorders” ● Prevalence and incidence
- Influence on objects of fear influenced by:
- Interaction with physiology - Poverty
- Political unrest
Gender - Technological disparities
- Gender effects and roles ● Treatment depends on views and
- Related to cultural imperatives provider availability
- Influence across several
dimensions → Type and Life-Span Developmental
prevalence of fears Change over time
→ Fear behaviors Responses - Biological maturation
→ Coping strategies - Psychological development
- Social complexity
Social Effects on Health and - Roles and demands
Behavior - Expression of disorders
● Frequency and quality are critical - Treatment response
● Low social contacts “The end of history” illusion
- Higher mortality
- Higher psychopathology The principle of equifinality
- Lower life expectancy - Chicchetti, 1991
● Mediated by meaning and - Several paths to a given outcome
perception - Paths vary by developmental
● “Drift” stage Example: Delirium
● Social and interpersonal - Interaction with other dimensions
influences on the elderly → Social support
● Stigma of psychopathology
- Influences the expression
of distress
- Limits help-seeking Chapter 5: Anxiety Disorders,
behaviors Trauma- and Stressor-Related, and
- Helps maintain the cycle of Obsessive-Compulsive and Related
pathology Disorders

Global Incidence of Psychological

Disorders The Complexity of Anxiety Disorders
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

● Fear
- Immediate, present-oriented
- Sympathetic nervous system
activation

● Anxiety
- Apprehensive, future-oriented
- Somatic symptoms = tension
- Both: Negative affect

Anxiety, Fear, and Panic: Some

Definitions
● Panic Attacks
- abrupt experience of intense fear
- Symptoms: palpitations, chest
pain, dizziness

TWO TYPES:
- Expected
- Unexpected

Biological Contributions
● Increased physiological
vulnerability
- Polygenetic influences – “turn
on” these genes
- Corticotropin releasing factor
(CRF)

● Brain circuits and

neurotransmitters
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

GABA – depleted levels ● Biological vulnerabilities

Noradrenergic – implicated in triggered by stressful life
anxiety events
Serotonergic systems – - Family – death of a loved one,
directly related to GABA broken family
- Interpersonal – love life problem
● Limbic System - Occupational – difficulties in
- Behavioral inhibition system (BIS) work
- Brain stem - Educational – pressures to excel
- Septal-hippocampal system in school
- Amygdala boost the BIS
An Integrated Model
● Fight/flight (FFS) system
- Panic circuit ● Triple vulnerability
- Alarm and escape response
❖ Generalized biological
● Brain circuits are shaped by vulnerability
environment - Diathesis
- Example: teenage cigarette ❖ Generalized psychological
smoking vulnerability
- Interactive relationship with - Beliefs/perceptions
somatic symptoms ❖ Specific psychological
vulnerability
Psychological Contributions - Learning/modeling

● FREUD
- Anxiety = psychic reaction to
danger
- Reactivation of infantile fear
situation

● BEHAVIORIST
- Classical and operant
conditioning Comorbidity of Anxiety and Related
- Modeling Disorders

Social Contributions ● High Rates of Comorbidity

- 55% to 76%
● Commonalities
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Features
- Vulnerabilities
● Links with Physical Disorders
● Physical Disorders

Suicide

● Suicide Attempt Rates

- similar to major depression
- 20%
● Increases for all anxiety
disorders
● Comorbidity with depression?

The Anxiety Disorders

● Statistics
● Types of Anxiety Disorders - 3.1% (year)
- Generalized Anxiety Disorder - ▪ 5.7% (lifetime)
- Panic Disorder and Agoraphobia - Similar rates worldwide
- Specific Phobias - Insidious onset
- Social Anxiety Disorder - Early adulthood
- Separation Anxiety Disorder - Chronic course
- Selective Mutism
● GAD in the Elderly
Generalized Anxiety Disorder (GAD) - Worry about failing health, loss
- Up to 10% prevalence
● Clinical Depression - Use of minor tranquilizers:
- Shift from possible crisis to crisis 17-50%
- Worry about minor, everyday - Medical problems?
concerns - Sleep problems?
- Job, family, chores, appointments - Falls
- Problems sleeping - Cognitive impairments

● GAD in Children Causes

- Need only one physical symptom
- Worry = academic, social, athletic - Inherited tendency to become
performance anxious- inherited vulnability to
stress
- “Neuroticism”
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Less responsiveness- on most - Antidepressants

physiological
- measures such as heart rate, ● Psychological
blood pressure - Cognitive-behavioral treatments
- People with GAD are - Exposure to worry process
called “Autonomic - Confronting
restrictors” anxiety-provoking images
- Threat sensitivity - Coping strategies
- Frontal lobe activation – - Acceptance
intense cognitive processing in - Meditation
the frontal lobes particularly in the - Similar benefits
right hemisphere this finding - Better long-term results
would suggest frantic, intense
thought process or worry without Panic Disorder and Agoraphobia
accompanying images

● Clinical description
- Avoidance can be persistent
- Use and abuse of drugs and
alcohol – coping with panic attack
- Interoceptive avoidance or
avoidance of internal physical
sensations
Treatments

● Pharmacological
- Benzodiazepines
- Risks versus benefits
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

● Statistics
- 2.7% (year)
- 4.7% (life)
- Female: male = 2:1
- Acute onset, ages 20-24

● Special Populations
- Children
- Hyperventilation
- Cognitive development
- Elderly
- Health focus
- Changes in prevalence

● Social/gender roles
- 75% of those with agoraphobia
are female

● Similar prevalence rates

● Variable symptom expression
- Somatic symptoms
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

● Generalized biological
Cultural Influences vulnerability
- Alarm reaction to stress
● Culture-bound Syndromes ● Cues get associated with
- Susto situations
- Ataque de nervios - Conditioning occurs
- Kyol goeu ● Generalized psychological
vulnerability
Nocturnal Panic - Anxiety about future attacks
- Hypervigilance
● 60% with panic disorder - Increase interoceptive awareness
experience nocturnal attacks
- non-REM sleep
- Delta wave

● Caused by deep relaxation,

- Sensations of “letting go”
● Sleep terrors
● Isolated sleep paralysis

Treatment

● Medications
- Multiple systems
- serotonergic
- noradrenergic
- benzodiazepine GABA
- SSRIs (e.g., Prozac and Paxil)
- High relapse rates
● Psychological intervention
- Exposure- based
- Reality testing
Causes - Relaxation
- Breathing
● Panic control treatment (PCT)
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Exposure to interoceptive cues

- Cognitive therapy
- Relaxation/breathing
● High degree of efficacy
● Combined psychological and
drug treatments
- No better than individual
- CBT = better long term

Specific Phobias

● Clinical Description
- Extreme and irrational fear of a
specific object or situation that
markedly interferes with an
individual’s ability to function.
- Significant impairment
- Recognizes fears as
unreasonable
- Avoidance

● Blood-injection-injury phobia
- Decreased heart rate and blood
pressure ▪ Fainting
- Inherited vasovagal response
- Onset = ~ 9
● Situational phobia
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Fear of specific situations

- Transportation, small
places
- No uncued panic attacks
▪ Onset = early to mid 20s
● Natural Environment Phobia
- Heights, storms, water
- May cluster together
- Associated with real dangers
- Onset = ~7
● Animal Phobia
- Dogs, snakes, mice, insects
- May be associated with real Causes
dangers -Direct experience - danger is real and
- Onset = ~7 results in an alarm response
- Vicarious experience - seeing
● Statistics someone else have a traumatic
- 12.5% (life); 8.7% (year) experience or endure intense fear
- Female : Male = 4:1 - Information transmission - being
- Chronic course warned repeatedly about a potential
- Onset = ~ 7 danger
- “Prepared” - we seem to have carry
an inherited tendencies to fear situations

Treatment
- Cognitive-behavior therapies
- Exposure
- Graduated
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

- Structured
- Relaxation

Separation Anxiety Disorder

Clinical Description
▪ Characterized by 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 (for example, they will be
lost, kidnapped, killed, or hurt in an
accident)
▪ 4.1% meet criteria for children, 6.6%
for adults

Separation Anxiety Disorder (Social

Phobia)
Clinical description
▪ Extreme and irrational fear/shyness
▪ Social/performance situations
▪ Significant impairment
▪ Avoidance or distressed endurance
▪ Generalized subtype

Statistics
●12.1% (life); 6.8% (year)
●Female : Male = 1:1
●Onset = adolescence Japan—taijin kyofusho
•Peak age of 13 ●Fear of offending others
●Young (18–29 years), undereducated, ●Symptoms
single, and of low socioeconomic class, ●Female : Male = 2:3
13.6%
●Over 60, 6.6% Causes
•Generalized psychological
vulnerability – belief that events,
particularly stressful events, are
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

potentially uncontrollable and would Psychological

increase an individual’s vulnerability ●Cognitive-behavioral treatment
•Exposure
•Generalized- biological vulnerability •Rehearsal
– e.g. we inherit a tendency for fear •Role-play
●Highly effective one study 84%
improvement

Selective Mutism (SM)

Clinical description
●Rare childhood disorder characterized
by a lack of speech
●Must occur for more than one month
and cannot be limited to the first month
of school
●Comorbidity with SAD
●Treatment
• Cognitive-Behavioral like the treatment
for social anxiety best

Treatment Trauma and Stressor-Related

Medications Disorders
●Beta blockers Attachment disorders
●SSRI (Paxil, Zoloft, and Effexor) Posttraumatic stress disorder
●D-cycloserine
Post Traumatic Stress Disorder
(PTSD)
Clinical description
●Trauma exposure
●Extreme fear, helplessness, or horror
●Continued re-experiencing
•(e.g., memories, nightmares,
flashbacks)
●Avoidance
●Emotional numbing
●Reckless or self-destructive behavior
●Interpersonal problems
●Dysfunction
●One month
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Generalized psychological
vulnerability
●Uncontrollability and unpredictability
Social support

Statistics
●6.8% (life); 3.5% (year)
●Prevalence varies
•Type of trauma
•Proximity

Most common traumas

●Sexual assault 2.4 to 3.5 increase
●Accidents
●Combat

Causes
Trauma intensity
Generalized biological vulnerability
●Twin studies
●Reciprocal gene-environment
interactions
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Neurobiological model Adjustment Disorders

●Threatening cues activate CRF system Anxious or depressive reactions to life
●CRF system activates fear and anxiety stress that are generally milder than one
areas would see in acute stress disorder or
•Amygdala (central nucleus) PTSD but are nevertheless impairing in
●Increased HPA axis activation terms of interfering with work or school
•Cortisol performance, interpersonal
relationships, or other areas of living

Attachment Disorders
Disturbed and developmentally
inappropriate behaviors in children,
emerging before five years of age, in
which the child is unable or unwilling to
form normal attachment relationships
with caregiving adults

Reactive Attachment Disorder

The child will very seldom seek out a
caregiver for protection, support, and
nurturance and will seldom respond to
offers from caregivers to provide this
kind of care

Disinhibited Social Engagement

Treatment Disorder
Cognitive-behavioral treatment A pattern of behavior in which the child
•Exposure shows no inhibitions whatsoever to
•Imaginal approaching adults
•Graduated or massed
●Increase positive coping skills Obsessive-Compulsive Disorder
●Increase social support (OCD)
●Highly effective Clinical description
●Obsessions
Psychoanalytic therapy, catharsis •Intrusive and nonsensical
•Thoughts, images, or urges
Medications •Attempts to resist or eliminate
●SSRIs ●Compulsions
•Thoughts or actions
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

•Suppress obsessions Causes

•Provide relief

Compulsions
Four major categories
●Checking
●Ordering
●Arranging
●Washing/cleaning

Association with obsessions

Obsessions
Tic Disorder
60% have multiple obsessions
Tic disorder is characterized by
●Need for symmetry
involuntary movement (sudden jerking
●Forbidden thoughts or actions
of limbs, for example), to co-occur in
●Cleaning and contamination
patients with OCD
●Hoarding
Obsessive-Compulsive Disorder
(OCD)
Statistics
●1.6% to 2.3%(life); 1% (year)
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

●Female = Male Cognitive-behavioral therapy

●Chronic ●Exposure and ritual prevention (ERP)
●Onset = childhood to 30s medial 19 ●Highly effective
•86% benefit
Causes ●No added benefit from combined
Similar generalized biological treatment with drugs
vulnerability
Body Dysmorphic Disorder (BDD)
Specific psychological vulnerability A preoccupation with some imagined
●Early life experiences and learning defect in appearance by someone who
●Thoughts are dangerous/unacceptable actually looks reasonably normal
●Thought-action fusion ●Comorbid with OCD 10%
●Course lifelong
•Distraction temporarily reduces ●Onset – early adolescence through
anxiety 20s
●Increases frequency of thought ●Reaction to a horrible or grotesque
feature
●Two treatments
•SSRIs
•Exposure and response prevention

Causes

Treatment
Medications
●SSRIs
•60% benefit
•High relapse when discontinued
●Psychosurgery (cingulotomy)
•30% benefit
 ABNORMAL PSYCHOLOGY CHAPTER 1-2-5

Trichotillomania (Hair Pulling

Disorder) and Excoriation (Skin
Picking Disorder)
The urge to pull out one’s own hair from
anywhere on the body, including the
scalp, eyebrows, and arms, is referred
to as trichotillomania

•Excoriation (skin picking disorder) is

characterized by repetitive and
compulsive picking of the skin, leading
to tissue damage
●1- 5%
●Habit reversal training, show best
results

Plastic Surgery and Other Medical

Treatments
• Fully 76.4% had sought this type of
treatment and 66% were receiving it

• 8% to 25% of all patients who request

plastic surgery may have BDD

Hoarding Disorder
Estimates of prevalence range between
2% and 5% of the population, which is
twice as high as the prevalence of OCD
●Men = women
●Individuals usually begin acquiring
things during their teenage years and
often experience great pleasure, even
euphoria, from shopping or otherwise
collecting various items
●OCD tends to wax and wane, whereas
hoarding behavior can begin early in life
and get worse with each passing
decade