Adult Psychopathology – PSYC353

A. Terms and definitions

a. Psychopathology: “pathology of the mind” wow
b. Study of the nature, causes, and treatment of psychological disorders
c. Medical diagnosis
i. All medical conditions are defined on various levels of abstraction
1. Ex:
a. Etiology
b. Structural pathology
c. Symptom presentation
d. Deviance from a physiological norm
ii. More complicated with mental disorders (key characteristics in the definition of
a mental disorder)
1. Personal distress
a. Problem: may not report, such as with drugs even though
unhealthy
2. Disability – does the condition have an impact on one’s ability to
function?
a. Interfering with any aspect of life
i. Social, example
3. Violation of social norms
a. Ex: talking to themselves in D.C.
b. Problematic: healthy people deviate from social norms
i. Esp. based on culture
1. Ex: artists have hella tattoos (ok for artist
culture, less so for ordinary people)
4. Dysfunction – is an ability of an individual impaired?
d. Harmful dysfunction
i. Jerome Wakefield has proposed that a disorder is a harmful dysfunction where
1. 1. Harmful is a value term, referring to conditions judged negative by
sociocultural standards and
2. Dysfunction is a scientific factual term, referring to failure of biologically
designed functioning. In modern science, “dysfunction” is ultimately
anchored in evolutionary biology and refers to failure of an internal
mechanism to perform one of its naturally selected functions
a. Biological processes become impaired
i. Ex: anxiety- fear always present
e. Actual definition
i. DSM-5 Definition of a mental disorder
1. A mental disorder is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotion regulation, or behavior
 that reflects a dysfunction in the psychological, biological, or
developmental process underlying mental function
2. Usually associated with significant distress or disability in social,
occupational, or other important activities
3. An expectable or culturally approved response to a common stressor or
loss is not a mental disorder
4. Socially deviant behavior (political, religious, or sexual) and conflicts
that are primarily between the individual and society are not mental
disorders unless the deviance or conflict results from a dysfunction in
the individual, as described above
ii. Stigma: mental disorders only affect those at the margin of society (“us”)
1. Prevalent in the general population
2. Mood disorder = 1 out 5
3. Substance use = 1 out of 6
4. Any disorder (lifetime) -46%
5. Projected lifetime risk for a mental disorder in US (55%), maybe
underestimate?
6. Ex: Depression
a. Girls – by the time 17, over 1/3 has experienced a major
depressive episode (14% males)
b. Only teens! :0
iii. Problems
1. Lost work
2. Reduced occupational achievement
a. Academic
3. Hospitalization
4. Mortality (suicide, drugs, medical complications)
5. #1 Top Ten sources of lost time to disability globally from all medical
causes (26%)
a. Not always seriously disabling
i. NCS-R severity of disorders
1. 40% mild
2. 37% moderate
3. 22% severe
ii. Ex: depression, most get better after a couple days and
return to normal
1. Sometimes not
a. Incredible variability
2. Severity of disability related to type of diagnosis
country, age, treatment, social support, other
resources
B. Freud
a. Paradigm
i. Goal: study abnormal behavior scientifically
 ii. Paradigm (Thomas Kuhn)
1. Perspective or conceptual framework from within a scientist operates
2. Subjective factors always interfere ;/
3. Nor one paradigm enough to completely explain pathology
b. Freud
i. And Breuer (1856-1939)
ii. Studies in Hysteria in 1895
iii. Freudian or Psychoanalytic theory
1. Human behavior determined by unconscious forces
2. Psychopathology results from conflicts among these unconscious forces
iv. Structure of the Mind
1. Id
a. Unconscious
b. Pleasure principle
i. Immediate gratification
2. Ego
a. Conscious
b. Reality principle
i. Attempt to satisfy Id’s demands within reality’s
constraints
3. Superego
a. Conscience
b. Develops as we incorporate parental and societal values
v. Healthy = balanced
1. Lack = psychopathology
vi. Defense Mechanisms
1. Always in conflict
2. Conflict generates anxiety
3. Ego generates strategies to protect itself from anxiety
a. Defense mechanism
vii. Psychoanalytic Therapy
1. Goals:
a. Understand early experiences, esp with parents
b. Understand patterns in current relationships
2. Techniques:
a. Free association – what comes to mind immediate (unconscious
leaking out?)
b. Analysis of transference
c. Interpretation
viii. Problems
1. Developmental models based on adults (not kids)
2. Model of normal development based on clinical samples
a. Not healthy individuals
3. No experimental – interviews, case studies (bias)
 4. Difficult to test elements of model – can’t access unconscious aspects
ix. Continuing Influecnes
1. Legacy:
a. Childhood experiences helps shape adult personality
b. There are unconscious inlfueves on behavior (not Freudian
structures but still outside awareness)
c. Evolution of Contemporary thought: Rise of behaviorism
i. John Watson
1. Behaviorism
a. Focus on observable behavior
i. Emphasis on learning rather than thinking or innate
tendencies
2. Three types of learning
a. Classical conditioning
i. Pavlov, dogs and salivating at the bell
ii. Cues
iii. Conditioned response
iv. Time solidifies buuutt
1. Addiction relapse
a. Cues from drugs (mental)
2. How are fears acquired?
a. Acquisition of fear
i. White rate + loud noise (UCS) =
rat (CS)
v. Anxiety
1. UCS – trauma
2. UCR – Pain, fear
3. Are paired with environmental stimuli that may
all serve as future CS (sights, sounds, etc.)
4. Internal states may also become CS (heart rate)
5. These CS now elicit CR of fear (cognitions,
emotions)
6. Implications: exposure therapy
b. Operant conditioning
i. Thorndike
1. Learning through consequences
2. Law of effect
a. Behavior followed by satisfying
consequences will be repeated and vice
versa with negative
ii. Skinner
1. Principle of reinforcement
2. Reinforcement schedule
a. Ex: gambling
 3. Extinction burst – in reinforcement is not put in
place
iii. All behavior is learned
1. Humans are adaptive and behavior serves a
purpose
2. Look to environment
3. Must understand Antecedents of Behavior and
consequences (ABC)
c. Modeling
C. Cognitive
a. Behavior (revisited) - Limits
i. Behavior can be acquired without direct experiences
1. Ex: phobias – attacked by dog and fear of all dogs vs. phobia w/o
traumas
ii. Strictly behavior perspectives do not consider individual differences in how
experiences are perceived or interpreted
1. (thoughts or cognition)
b. Modeling
i. Learning by watching and imitating others’ behaviors
1. Can occur without reinforcement to observer
2. Classical conditioning can also occur
ii. Bandura & Menlove
1. Modeling reduced children’s fear of dogs
iii. Bandura- violence
1. Kids acquire aggressive behavior through watching an adult beat the
fuck out of a doll
iv. Modeling leads to fear?
v. Modeling and Vicarious learning: The acquisition of disgust/fear in children
1. With weird animal and different adult faces
2. Negative image = more disgust
c. Current Paradigms; Cognitive Behavioral
i. Roots in learning principles and cognitive science
ii. Behavior is reinforced by consequences
1. Attention
2. Escape or avoidance
3. Sensory stimulation access to desirable objects or events
iii. To alter behavior, modify consequences
iv. Systematic desensitization
1. Relaxation plus exposure
a. Imaginal or in vivo
b. Important treatment for anxiety disorders
v. Behaviorism = ignores thoughts and emotions
vi. Cognition
 a. Mental process that includes perceiving, recognizing, judging,
reasoning
vii. Role of attention in psychopathology
1. Anxious individuals more likely to attend to threat or danger
2. Dot-probe task: measuring attentional bias
a. Older: looking at positive faces more
b. Younger: no difference
c. Older: look more at positive events? More happy?
3. Eye tracking
a. Anxious individuals showed increased vigilant for threat during
free viewing and visual search, showed more difficulty
disengaging from threat in visual search task
viii. Cognition Therapy
1. Emphasize how people think about themselves and their experiences
can be a major determinant of psysp
2. Focus on understanding maladaptive thoughts
3. Change cognitions to change feelings and behaviors
ix. CBT
1. Attends to thoughts, perceptions, judgements, self-statements, and
unconscious assumptions
2. Cognitive restructuring
a. Change a pattern of thinking
b. Changes in thinking can change feelings, behaviors, and
symptoms
x. Beck’s CT
1. Initially developed for depression
2. Depression caused by distorted thoughts
a. Nothing ever goes right for me
3. Info-processing bias
a. Attention, interpretation, and recall of negative and positive
info biased in depression
4. Helps patients recognize and change maladaptive thought patterns
xi. Evaluating Cognitive Behavioral Paradigm
1. Focus on current determinants
a. Less childhood
2. Are distorted thoughts the cause or results of psysp
a. Causal status sometimes unclear
D. Genetics
a. Summary
i. Heredity plays a role in most behavior
ii. Genes
1. Carriers of genetic information (DNA)
2. Impacted by environmental influences
a. Stress, relationship, culture
 iii. Relationship between genes and environment is bidirectional
1. Nature via nurture
2. Both influence each other
b. Behavior genetics
i. Study of the degreeto which genes nd envrioemtnal factors influence behavior
ii. Genotype:
1. Unobservable
2. Genetic material inhereited by an individual
iii. Phenotype
1. Expressed genetic material
2. Observable behavior and characteristics
3. Depends on interaction of genotype and environment
iv. Terms
1. Gene expression
a. Proteins influence whether the action of a specific gene will
occur
2. Heritability
a. Extent to which variability in behavior is due to genetic factors
b. 0-1
c. Group, rather than individual behavior
i. Not for individual
c. Correlational Research: Genetics
i. Family – does the disorder run in families, share genes but also environment
1. Informative but doesn’t rule out environmental factors
ii. Twin – same genetics
iii. Adoption studies – study of adoptees who have biological parents with pysp
1. Different environment, same genes
iv. Cross fostering – study of adoptees who have adoptive parents with pysp
1. Raised with people who have a disorder
d. Environmental Effects
i. Shred environment – events that family have in common
ii. Nonshared environment – unique to each family member
E. Gene Complications
a. Polygenetic transmission
i. Old model was a single gene
1. Gene x -> disorder
ii. No evidence for that
iii. Multiple genes influence a trait or phenotype
1. Multiple genes each of small effect in combo give rise to phenotype
b. Pleiotropy
i. One gene can affect multiple traits
ii. Gene x -> trait 1,2,3
c. Spontaneous Mutations
i. Father’s are older than other
 ii. Increasing paternal age – de novo mutations, increased risk for schizophrenia
d. Gene environment interaction
i. One’s response to a specific environment is influenced by how genes interact
with the environment
ii. Same genes may result in different behavioral expressing in different
environments
1. Ex: two long alleles have the same percentage (low) for being
susceptible to depression
e. Epigenetics
i. The study of changes in organism caused by modification of gene expression
rather than alteration of the genetic code itself
ii. Environmental information is inherited in that environmental influenced genetic
expression is passed on to offspring
iii. Simple: environment is triggering certain genes to express themselves and that
can be inherited through offspring
f. Reciprocal gene environment interaction
i. Genes predispose individuals to seek out situations that increase the likelihood
of developing a behavior
ii. Girls who are genetically vulnerable for depression are more likely to experience
events that can trigger depression
iii. Evocative effects: genetically influenced behavior may evoke responses from
others, creating an environmental influence
g. Turkheimer
i. first law: all human behavioral traits are heritable
ii. second: the effect of being raised in the same family (shared environment) is
smaller than the effect of genes
iii. third: a substantial portion of the variation in complex human behavioral traits
is not accounted for by the effects or families (nonshared environment)
1. unique events large factor
F. Neuroscinece
a. What
i. Examines the contribution of brian structure and function to psyp
ii. Mental disorders are linked to structure or function of brain
b. Components
i. Neurons and neurotransmitters
ii. Structure and function of the brain
iii. Neuroendocrine system
c. Neuron: Basic Unit of the Nervous System
i. Basic cells of the nervous systems
ii. 4 major parts
1. Cell body
2. Dendrites
3. Axons
4. Terminal buttons
 iii. Nerve impulse
1. Dendrites or cell body stimulated
2. Travels down axon to terminal
iv. Synapse
1. Gaps between neurons
d. Neurotransmitters
i. Chemical that allows neurons to send a signal across the synapse to another
neuron
ii. Receptor sites on postsynaptic neuron absorb neurotransmitter
1. Excitatory
2. Inhibitory
iii. Reuptake
1. Reabsorption of leftover neurotransmitter by presynaptic neuron
e. Neurotransmitters and psychopathology
i. Serotonin and dopamine
1. Depression, mania, schizo
ii. Norepinephrine
1. Anxiety and stress related disorders
iii. Gamma-Aminobutyric Acid (GABA)
1. Inhibits nerve impulses
2. Anxiety
iv. Possible Mechanisms
1. Excessive or inadequate levels
2. Insufficient reuptake
3. Excessive number or sensitivity of postsynaptic receptors
4. Second messengers help neurons adjust receptor sensitivity after
periods
v. Agonists drugs stimulate neurotransmitter receptor sites
vi. Antagonist drugs dampen neurotransmitter receptor sites
f. Etiology of Mood Disorder: Neurobiological Disorders
i. Neurotransmitters: dopamine, serotonin, norepinephrine
1. MDD
a. Low depending
2. Mania
a. High depending
ii. Brain imaging
1. Structural studies
a. Focus on number or of connections among cells
2. Activation studies
a. Look at levels
g. Human Connectome Project
i. Detailed map of human brain – MRI tech
h. Neuroscience Approaches to Treatment
i. Alter neurotransmitter activity
 1. Antidepressants
2. Antipsychotics
3. Benzodiazepines
ii. Does not preclude psychological interventions
i. Neuro Paradigm
i. Sometimes reductionism – can’t understand everything from just the brain
ii. Voodoo correlations – many voxels, many correlations
j. Factors across paradigms
i. Sociocultural factors
1. Gender, race, culture, ethnicity, economic status
2. May increase vulnerability to pysp
a. Men = substance abuse
b. Women = depression
k. Diathesis-stress: current paradigm
i. All factors are important
1. Underlying predisposition
a. Bio or psychological
2. Stressor
a. Environmental event
i. Triggers
3. No one factor!
G. Ted talk
a. Thomas Insel
i. Medical – getting better (leukemia, AIDS)
b. Mental Disorders
i. Suicide
1. 95% related to mental factors
ii. 1 in 5 people will get a disorder
1. 1 in 20 disabling
iii. Early onset
H. Diagnosis and DSM
a. The classification of disorders by symptoms and signs
b. Advantages
i. Advances for causes and treatment
ii. Facilitates comm between professionals
iii. Cornerstone of clinical care
c. Needs to be reliable
i. Consistency of measurement – agreement
1. Inter-rater: observer agreement
ii. Test-retest
1. Sim. Scores, repeated test
iii. Alternate forms
1. Not identical
iv. Internal consistency
 1. Extent to which test items are related to each other
d. Validity
i. Content validity
1. Adequately samples the domain of interest, all symptoms of disorder
ii. Criterion validity
1. Extent to which a measure is associated with another measure
a. Concurrent – two measurements, same point
b. Predictive- one measure predicts another variable measured in
the future
iii. Construct validity
1. Involves correlating multiple indirect measures of the attribute
a. Self-reported anxiety correlate with HR, breathing
e. DSM5
i. Categorical vs dimensional
1. Cat: yes/no
2. Dim: 1-10
3. Ex: depression rating scale
ii. Ethical and cultural considerations
1. Revised criteria to better apply cultures
2. Ex: Japanese “offending others”
3. Focus on influence of culture
iii. Criticisms:
1. Too many? 354 current
2. Comorbidity
a. Presence of second diagnosis
b. 45% will have second disorder
i. Share of common symptoms
3. Poor interrater reliability
a. Extent to which clinicians agree on diagnosis
4. Construct validity
a. Useful information in diagnosis?
f. Classification Criticisms
i. Stigma against mental illness
ii. Does not capture the uniqueness of individual
iii. May over emphasize trivial similarities
I. Psychological Assessment
a. Clinical Interviews – less structured
i. Lower reliability
b. Clinical interviews – structured
i. Preferred
ii. SCID baseline script
c. Assessment of stress
i. Experience of distress in response to environmental problems
ii. LEDS
 1. Semi structured interview
2. Evaluates stressors within context of each individual’s circumstance
iii. Self-reported stress checklists
1. Faster way to assess stress
2. Test retest reliability low
d. Personality tests
i. Self report personality inventories
1. MMPI
a. Detects lying ish
b. Yields profile of psychological functioning
ii. Projective tests
1. Inkblot
a. Reliable and valid concerns, still kinda popular in some settings
2. Projective hypothesis
3. Response to ambiguous stimuli reflect unconscious.
e. Standardization
i. Collecting statistical norms