Abnormal Psychology Midterm Reviewers PDF

ABNORMAL PSYCHOLOGY: MIDTERM REVIEWERS example, substance use disorders are defined in part Chapter 1: Introduction and History of by the social or occupational disability (e.g., serious Mental Disorder...

ABNORMAL PSYCHOLOGY: MIDTERM REVIEWERS example, substance use disorders are defined in part Chapter 1: Introduction and History of by the social or occupational disability (e.g., serious Mental Disorder arguments with one's spouse or poor work Overview performance) created by substance abuse. ▪ Definition of Mental Disorder However, not all disability is considered mental ▪ History of Psychopathology disorder (e.g. blindness), and not all disorder cause ▪ Evolution of Contemporary Thought disability (e.g. bulimia). DEFINITION OF MENTAL DISORDER Mental Disorder 3. Violation of Social Norms - behavior that violates Abnormal Psychology is about understanding the social norms might be classified as disordered since nature, causes, and treatment of mental disorders. social norms are used to evaluate the behavior as good There is no universal agreement about the definition of or bad, acceptable or not. For example, the abnormality. No one behavior makes someone abnormal. conversations with imaginary voices that some people But there are indicators used to consider if a behavior is with schizophrenia engage in. abnormal. Yet this way of defining mental disorders is "A mental disorder is defined as a syndrome that both too broad and too narrow. For example, it is too is present in an individual and that involves a clinically broad in that criminals violate social norms but are not significant disturbance in behavior, emotion regulation, or usually studied within the domain of psychopathology; cognitive functioning. These disturbances reflect it is too narrow in that highly anxious people typically do dysfunction in biological, psychological, or developmental not violate social norms. processes that are necessary for mental functioning." A mental disorder is one that contains several Lastly, social norms vary a great deal across characteristics. The definition of mental disorder presented cultures and ethnic groups. in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), provides a number of 4. Dysfunction - according to Wakefield (1992), mental characteristics essential to the concept of mental disorder disorders could be defined as harmful (Stein et al., 2010), including the following: dysfunction, which can be assessed through value  The disorder occurs within the individual. judgment and objective process.  It involves clinically significant difficulties in thinking, 4.1. Value Judgment - it is based on social feeling, or behaving. norms and values (Harmful).  It involves dysfunction in processes that support mental functioning. 4.2. Objective Process - occurs when an  It is not a culturally specific reaction to an event (e.g., internal mechanism is unable to perform its the death of a loved one). natural function, or the function it evolved to  It is not primarily a result of social deviance or conflict perform (Dysfunction). with society. PROBLEM: Internal mechanisms involved in mental In summary, these are the four characteristics disorders are largely unknown; thus, it cannot be said that a comprehensive definition ought to have: exactly what may or may not be functioning properly. 1. Personal Distress - a person's behavior may be WAKEFILED's SOLUTION: refer to plausible classified as disordered if it causes great distress. dysfunctions rather than proven ones. It is commonly observed to meet disorders, but There are instances wherein behavior or a set not all of them cause distress (e.g., an individual with of behaviors are judged as harmful and then decided the antisocial type of personality disorder may treat that the behavior represents a mental disorder because others coldheartedly and violate the law without it is believed to be caused by a dysfunction of an experiencing any guilt), unknown internal mechanism. and not all distressing behavior is disordered For example, hallucinations (hearing voices) (e.g., the distress of hunger due to religious fasting or could be construed as a failure of the mind to "turn off" the pain of childbirth). unwanted sounds. 2. Disability - impairment in some area of life. For  The DSM definition provides a broader In the midst of the supernatural... The concept of dysfunction, which is supported by our Greek physician Hippocrates held a current body of evidence. biological view of mental illness, considering mental disorders to be The DSM definition of dysfunction refers to the diseases of the brain. fact that behavioral, psychological, and biological dysfunctions are all interrelated. That is, the brain In the 15th century BC, Hippocrates, impacts behavior, and behavior impacts the brain; thus, the father of modern medicine, separated medicine from dysfunction in these is interrelated. religion, magic, and superstition. For him, the brain is the organ of consciousness, intellectual life, and Remember! emotion. Thus, he thought disordered thinking and The characteristics of the definition of mental behavior were indications of brain pathology, which disorder constitute a useful partial definition, but they should be treated like other, common maladies. are not equally and invariably applicable to every He's often considered one of the earliest diagnosis. proponents of the notion that something wrong HISTORY OF MENTAL DISORDER with the brain disturbs thought and action. It is important to consider how concepts and Specifically, he believed that normal brain approaches have changed (or not) over time, because functioning depended on a balance among four we can learn not to make the same mistakes made in humors, the fluids of the body: blood, black bile, the past and because we can see that our current yellow bile, and phlegm, in which imbalance of such concepts and approaches are likely to change in the causes disorders. future. IMBALANCE OF HUMOR CAUSE DISORDER: At different periods in history, explanations for mental disorders have been supernatural, biological, 1. Preponderance of Phlegm (brain) = dull and and psychological. sluggish 2. Preponderance of Black bile (spleen) = melancholia SUPERNATURAL 3. Preponderance of Yellow bile (liver) = anxiousness Before the age of and irritability scientific inquiry, all good 4. Preponderance of Blood (heart) = changeable and bad manifestations of temperament power (e.g. eclipses, Through his teachings, the phenomena storms, seasons) and associated with mental disorders became more clearly behavior beyond human the province of physicians rather than priests. The control were regarded as supernatural. Thus, treatments Hippocrates suggested were quite different philosophers, theologians, and physicians regarded from exorcism. mental illness as a reflection of the displeasure of the gods or possession by demons. For melancholia, for example, he prescribed tranquility, sobriety, care in choosing food and drink, Demonology - the doctrine that an evil being, and abstinence from sexual activity. or spirit can dwell within a person and control the mind Although Hippocrates' ideas did not withstand and body. In other words, odd behavior was attributed later scientific scrutiny, his basic premise that human to the possession of the person by bad spirits, after God behavior is markedly affected by bodily substances in his wrath had withdrawn protection. foreshadowed aspects of contemporary thought. It led to treating it by exorcism, the ritualistic casting out of evil spirits: prayer, noisemaking, and drinking terrible-tasting brew; it also includes flogging and starvation to render the body uninhabitable.’  unrepentant were to be handed over to the law for THE DARK AGES execution. Modern investigators, however, believed that Galen was a Greek physician many accused of being witches were mentally ill who followed Hippocrates’ ideas (Zilboorg & Henry, 1941) because the confessions of and is regarded as the last the accused were interpreted by the investigators as great physician of the classical delusional beliefs or hallucinations. era. In contrast, more detailed investigations of the historical period indicate that many of the accused were not mentally ill, but rather were healthy Galen (A.D. 130-200), a Greek physician who individuals. followed Hippocrates’ ideas, is regarded as the last The basis for this was that confessions were great physician of the classical era. His death was the typically obtained during brutal torture, having been turning point of the Dark Ages in Western European suggested to the accused witches both by their medicine and in the treatment and investigation of accusers and by the prevailing beliefs of the times. mental disorders. Similarly, Schoeneman (1977) reported that in At this time, Christian monasteries England, where torture was not allowed, confessions replaced physicians as healers of mental disorders. did not usually contain resumptions resembling Monks cared for people with mental disorders by delusions or hallucinations. praying over them, touching them with relics, and In the thirteenth century, there were lunacy providing them with concocted potions to drink in the trials that determined a person's mental health in waning phase of the moon. England. However, many people with mental illness The trials are based on the dependent's roamed, destitute, and progressively becoming worse. orientation, memory, intellect, daily life, and habits. Therefore, there was a return to a belief in However, a notable approach was that strange supernatural causes. behavior was attributable to physical illness, injury, or emotional shock. The trials were conducted to protect Persecution of Witches the people with mental illness, and a judgment of insanity allowed the government to become the Beginning in the 13th century, people in guardian of the lunatic's estate. Europe turned to demonology to explain widespread social unrest and recurrent famines and Lunacy - This term came from a theory of plagues. Then, as today, when faced with inexplicable Swiss physician Paracelsus (1493-1541), who and frightening occurrences, people tended to seize attributed odd behavior to a misalignment of the moon on whatever explanation seemed most plausible. and stars. Even today, many people believe that a full moon is linked to odd behavior; however, there is no The times conspired to heap enormous scientific evidence to support this belief. blame on those regarded as witches, who were persecuted with great zeal. DEVELOPMENT OF ASYLUMS In 1484, Pope Innocent VIII urged the clergy of Europe to hunt witches. Two years later they issued Until the 15th century, fewer hospitals for a comprehensive and explicit manual, Malleus people with mental illness were available. But, in the Maleficarum, as their guide to hunting witches. 12th century, in England and Scotland, there had 220 leprosy hospitals that later became abandoned as The primary indication used was the sudden cases of the said illness diminished. Thus, leprosarium loss of reason was a symptom of demonic possession, was converted to asylums: refuges for the and burning was the usual method used. confinement and care of people with mental illness. Those accused of witchcraft were tortured if they did not confess; those convicted and repentant were imprisoned for life; and, those convicted and  Bethlehem and Other Early Asylums Pinel’s Reforms In the eighteenth-century painting by Hogarth, two upper-class women find amusement in touring St. Mary’s of Betlehem. The Priory of St. Mary of Bethlehem was founded in 1243. Records The freeing of the patients at La Bicêtre is often indicate that in 1403 it housed six men with mental considered to mark the beginning of more illness. In 1547, Henry VIII handed it over to the city of humanitarian treatment of people with mental illness. London, thereafter, to be a hospital devoted solely to the confinement of people with mental illness. Philippe Pinel (1745-1826) has often been considered a primary figure in the movement for the The conditions in Bethlehem were humanitarian treatment of people with mental illness deplorable. The word bedlam, the popular name for in asylums. In 1793, while the French Revolution this hospital, came to mean a place or scene of wild raged, he was put in charge of a large asylum in Paris uproar and confusion. known as La Bicêtre. Bethlehem eventually became one of He removed the chains of the people London's great tourist attractions, by the eighteenth imprisoned in La Bicêtre, an event that was century. Even as late as the nineteenth century, memorialized in well-known paintings. viewing the patients was considered entertainment, and people bought tickets to see He surmised that if their reason had left them them. because of severe personal and social problems, it might be restored to them through comforting counsel Similarly, in the Lunatics Tower, which was and purposeful activity. constructed in Vienna in 1784, patients were confined in the spaces between inner square rooms and the Pinel did much good for people with mental outer walls, where they could be viewed by passersby. illness, but he was no paragon of enlightenment and egalitarianism. He reserved more humanitarian treatment for the upper classes; patients of the Medical treatments were often crude and lower classes were still subjected to terror and painful. Benjamin Rush (1745- 1813), for example, coercion as a means of control, with straitjackets began practicing medicine in Philadelphia in 1769 and replacing chains. is considered the father of American psychiatry. Yet Also, historical research indicates that it was he believed that mental disorder was caused by an not Pinel who released the patients from their excess of blood in the brain, for which his favored chains. Rather, it was a former patient, Jean-Baptiste treatment was to draw great quantities of blood from Pussin, who had become an orderly at the hospital. In disordered individuals (Farina, 1976). fact, Pinel was not even present when the patients Rush also believed that many people with were released (Weiner, 1994). mental illness could be cured by being frightened. Thus, one of his recommended procedures was for the Moral Treatment physician to convince the patient that death was near! Mental hospitals established in Europe and the United States were relatively small, privately supported, and operated along the lines of the humanitarian changes at La Bicêtre. In the United States, the Friends' Asylum, founded in 1817 in Pennsylvania, and the Hartford Retreat, established in 1824 in Connecticut, were to medical science, which emphasized gathering established to provide humane treatment or called knowledge by direct observation. moral treatment: patients had close contact with attendants, who talked and read to them and encouraged them to engage in purposeful activity. However, moral treatment was largely BIOLOGICAL APPROACHES abandoned in the latter part of the nineteenth century. lronically, the efforts of Dorothea Dix (1802- Discovering Biological Origins 1887), a crusader for improved conditions for people with mental illness who fought to have hospitals The anatomy and workings of the nervous created for their care, helped effect this change. system were partially understood by the mid-1800s, but not enough was known to let investigators conclude In the nineteenth century, Dorothea Dix played a major whether the structural brain abnormalities presumed to role in establishing more mental hospitals in the United cause various mental disorders were present or not. States. General Paresis INSPIRATION: She is a Boston schoolteacher, taught Since the late 1700s, it had been known that a a Sunday school class at the local prison, and was number of people with mental illness manifested a shocked at the deplorable conditions in which the syndrome characterized by a steady deterioration of inmates lived. Her interest spread to the conditions at both mental and physical abilities, including symptoms mental hospitals and to people with mental illness who such as delusions of grandeur (i.e., the belief that you had nowhere to go for treatment. hold special and great power or can accomplish more She campaigned vigorously to improve the than any other person on the planet) and progressive lives of people with mental illness and personally paralysis, in which this presumed disease was named helped see that 32 state hospitals general paresis. were built. These large public By the mid-1800s, it had been established that hospitals took in many of the patients some patients with general paresis also had syphilis, whom the private hospitals could not but a connection between the two conditions had not accommodate. yet been made. In the 1860s and 1870s, Louis Pasteur REASONS FOR ABANDONING established the germ theory of disease, which posited MORAL TREATMENT: that disease is caused by infection of the body by minute organisms, which laid the groundwork for 1. The small staffs of these new hospitals were unable demonstrating the relationship between the two to provide individual attention which was a hallmark of conditions. moral treatment (Bockhoven, 1963). Finally, in 1905, the specific microorganism 2. The hospitals came to be administered by that causes syphilis was discovered. For the first physicians, most of whom were interested in the time, a causal link had been established between biological aspects of illness and in the physical, rather infection, destruction of certain areas of the brain, and than the psychological well-being of patients with a form of psychopathology (general paresis). mental illness. THEREFORE, if one type of psychopathology 3. The money that had once paid the salaries of had a biological cause, so could others. Biological personal attendants now paid for equipment and approaches gained credibility, and searches for more laboratories. biological causes were off and running. EVOLUTION OF CONTEMPORARY THOUGHT Genetics During the late Middle Ages, new facts began to emerge, all due to an emerging empirical approach  cognitive capacities-for example, becoming unable to carry on a coherent conversation with another person- Francis Galton is considered the which is not surprising given the destruction of parts of originator of genetics research. their brains that support thought and language. Francis Galton (1822- 1911) is often considered the originator of genetic research with twins, because his study of twins in the late 1800s in England, attributed PSYCHOLOGICAL APPROACHES many behavioral characteristics to heredity. He is also credited with coining the terms nature and nurture to The search for talk about differences in genetics (nature) and biological causes environment (nurture). dominated the field of Unfortunately, Galton is also credited with psychopathology until creating the eugenics movement in 1883 (Brooks, well into the twentieth 2004). Advocates of this movement sought to eliminate century. But undesirable characteristics from the population by beginning in the late restricting the ability of certain people to have eighteenth century, various psychological points of children (e.g., by enforced sterilization). view emerged that attributed mental disorders to psychological malfunctions. During the eighteenth century in Western Biological Treatments Europe, many people were observed to be subject to hysteria, which referred to physical incapacities, In the early 1930s, the practice of inducing a such as blindness or paralysis, for which no physical coma with large dosages of insulin was introduced by cause could be found. Sakel (1938), who claimed that up to three-quarters of Franz Anton Mesmer (1734-1815) the people with schizophrenia whom he treated showed significant improvement. Later findings by others were He's an Austrian physician who believed that less encouraging, and insulin-coma therapy - which hysteria was caused by a particular distribution of presented serious risks to health, including irreversible a universal magnetic fluid in the body that other coma and death-was gradually abandoned. person could influence or change to bring change in others' behavior. Meanwhile, in the early twentieth century, electroconvulsive therapy (ECT) was originated by Hence, Mesmer's treatment included patients two Italian physicians, Ugo Cerletti and Lucino Bini, sitting around a covered wooden tub with iron rods that aimed to induce electric shocks to the sides of the protruding through the cover from bottles containing human head to produce full epileptic seizures. chemicals. Then, Mesmer would enter the room, take various rods from the tub, and touch the afflicted parts In the decades that followed, ECT was of the patient's body. Because he believed that the rods administered to people with schizophrenia and severe could transmit animal magnetism and adjust the depression, usually in hospital settings. distribution of magnetic fluid, thereby removing the hysteria. In 1935, Egas Moniz, a Portuguese His work was regarded as one of the earlier psychiatrist, introduced the prefrontal lobotomy, a practices of contemporary hypnosis. surgical procedure that destroys the tracts connecting the frontal lobes to other areas of the brain. Hypnosis gradually became respectable... The procedure was used especially for those whose behavior was violent. Many people did Jean-Martin Charcot (1825-1893) indeed quiet down and could even be discharged from He also studied hysteria through a biological hospitals, largely because their brains were damaged. viewpoint believing it might be caused by problems in But, after surgery, many people became dull the nervous system. Later, Charcot was persuaded by and listless and suffered serious losses in their psychological explanations.  One day, some of his enterprising students by forces that are inaccessible to awareness. The hypnotized a healthy woman and, by central assumption of Freud's theorizing, often referred suggestion, induced her to display certain to as psychoanalytic theory, is that psychopathology hysterical symptoms. Charcot was deceived results from unconscious conflicts in the individual. into believing that she was an actual patient with Although the theories of Freud and his hysteria. When the students showed him how followers have been criticized over the years, readily they could remove the symptoms by they continue to have a significant impact on the field of waking the woman, Charcot became interested psychopathology: in psychological interpretations of these very puzzling phenomena. 1. Childhood experiences help shape adult personality Given his prominence in 2. There are unconscious influences on behavior. Parisian society, his support of 3. The causes and purposes of human behavior are not hypnosis as a treatment for hysteria always obvious. This tendency to look under the helped legitimize its use by medical surface, to find hidden meanings in behavior, is perhaps professionals of the time. the best-known legacy of Freud. Josef Breuer (1842-1925) Behaviorism Josef Breuer, an Austrian physician and physiologist, collaborated with Freud in the early Behavior therapy emerged in the 1950s. In its development of psychoanalysis. initial form, this therapy applied procedures based on classical and operant conditioning to alter clinical problems. He's a Viennese physician in the 19th century who treated a young woman under the pseudonym of 1. Systematic Desensitization - developed by Joseph Anna O. who had different hysterical symptoms: partial Wolpe in 1958, which includes two paralysis, impairment of sight and hearing, and, often, components: difficulty speaking. 1.1. Muscle relaxation. When he hypnotized her, she began talking 1.2. Gradual exposure to a list of feared more freely and, ultimately, with considerable emotion situations, starting with those that arouse about upsetting events from her past and later, after the minimal anxiety and progressing to those that are the hypnotic phase, felt relieved. Thus, he concluded that most frightening. reliving an earlier emotional trauma and releasing emotional tension by expressing previously forgotten 2. Modeling - People reduced their fear of snakes, for thoughts about the event became known as catharsis instance, by viewing both live and filmed encounters in (or cathartic method). which other people gradually approached and successfully handled snakes (Bandura, Blanchard, & In 1895, Breuer and a younger colleague, Ritter, 1969). Sigmund Freud (1856-1939), jointly published Studies in Hysteria, partly based on the case of Anna O. 3. Intermittent Reinforcement - rewarding a response with only a portion of the times it Initially, the case of Anna O was reported as a appears, it makes new behavior more enduring, than a successful treatment. However, Henri Ellenberger continuous schedule of reinforcement. (1972) reported that it was only a temporary effect for Anna O, as she later continued to rely on using Cognition morphine to ease the hysterical problems. This was supported by Carl Jung who quoted that Freud admitted Although behaviorism remains influential in they had never cured Anna O. many ways today, clinicians and researchers have begun to recognize the limitations of focusing only on Continuing Influence of Freud behavior. The apparently powerful role played by factors Beginning in the 1960's, the study of cognition of which patients seemed unaware led Freud to began to become very prominent. Researchers and postulate that much of human behavior is determined clinicians realized that the ways in which people think  about, or appraise, situations can influence behavior in The exposure component of this treatment dramatic ways. That is, how people construe approach is the most influential component as it themselves and the world is a major determinant of extinguishes the anxiety from the feared situation or psychological disorders. objects through long exposure to it without any danger. 1. Rational-Emotive Behavior Therapy (REBT) - its 1. In vivo exposure - in-person exposure. underlying thesis is that sustained emotional reactions 2. Imaginal exposure - it is applicable to events that are caused by internal sentences that people repeat to are unethical to recreate. themselves. Hence, the aim is to eliminate self- In other situations, both types of exposure are defeating beliefs. used. For instance, a person with depression, for The person is taught to relax deeply. Next, the example, may say several times a day, "What a person develops a list of situations with snakes that vary worthless person I am." in how frightening or anxiety-producing they are. Chapter 2: Approaches in Psychopathology Examples of hierarchy items for someone who has a specific phobia of snakes might include the following: Overview  You hear the word snake. - Genetic Paradigm  You look at an illustration of a snake in a children's - Cognitive Behavioral Paradigm book. - Neuroscience Paradigm  You look at a photo of a snake. - Factors That Cut Across Paradigms  You look at a nature program on DVD about - Diathesis-Stress Model snakes.  You look at a snake in a glass case at the zoo.  You look at a live snake from several feet away. PARADIGM  You look at a live snake up close. INFLUENCES OF BEHAVIOR THERAPY EXPOSURE THERAPY Problem behavior is likely to continue if it is In general, it has been guiding a lot of new reinforced (Carr et al, 1994); findings: 1. Getting attention 1. Exposure in person is more effective than imaginal. 2. Escaping (from fear gives a sense of relief but it’s only for temporary) 2. Relaxation exercise has no significance in the 3. Generating sensory feedback treatment effect of exposure therapy, making it possible 4. Gaining access to desirable things or situations to design a treatment plan that is shorter. HOWEVER, the behavioral approach is criticized for However, desired behavior can be increased oversimplifying the human complexity as in frequency by making positive reinforcers contingent behaviorists did not take into account the importance of on behavior. For example, a socially withdrawn child mental processes: thinking & feeling. could be reinforced for playing with others. Once desirable behavior is attained, the next goal is to maintain it. According to research, intermittent COGNITIVE SCIENCE reinforcement makes new behavior more enduring than continuous schedules. It focuses on how people structure their experiences, how they make sense of them, and how they relate their current experiences to past ones stored Systematic desensitization in memory. Moreover, cognitive scientists refer to individuals as active interpreters. It is composed of deep muscle relaxation and gradual exposure to a Schema hierarchy of feared situations. Schema, or cognitive set, describes that a person may fit new information into an organized network of already accumulated knowledge. There are The way the unconscious is discussed today different possibilities (Cherry, 2023): changed from how Freud and his followers did. 1. In assimilation, new information is incorporated Cognitive neuroscientists have explored how the brain into pre-existing schemas. supports behavior that is outside 2. In accommodation, existing schemas might be consciousness. altered, or new schemas might be formed They also regarded it as the incredibly efficient as a person learns new information and has new and automatic aspect of the brain. That is, amid the vast experiences. information from the environment, the brain has developed the capacity to register information for later use even if we are not aware of it. Implicit Memory A person can, without being aware of it, be influenced by prior learning. It is adopted by Attention psychopathology researchers who have found that people with social anxiety and depression have trouble People with disorders as diverse as anxiety with it (Amir, Foa, & Coles, 1998; Watkins, 2002). disorders, mood disorders, and schizophrenia have problems with attention. For example, individuals with COGNITIVE-BEHAVIOR THERAPY anxiety disorders tend to focus their attention on threatening or anxiety-producing events or situations in It incorporates theory and research on the environment. cognitive processes. Practitioners pay attention to It is considered another important contribution thoughts, perceptions, judgments, self-statements, and of cognitive science. It is studied through the Stroop assumptions that are being manipulated in an attempt task, where interference, measured as a lengthening of to understand and modify overt and covert behavior. response time, occurs because the words are more Cognitive Restructuring - it is the process of changing attention-grabbing than the ink color. a pattern of thought. For example, those with anxiety The Stroop task has been modified to focus on disorders may not realize that they tend to be overly emotion rather than colors. In this emotion Stroop task, sensitive to possible threats in the world. participants are still instructed to name the color of the The therapist begins by tracking the daily ink rather than saying the word. However, the list of thoughts expressed by a person and then moves on to words now contains emotion words (e.g., threat, understand more about core cognitive biases and danger, happy) instead of color words. schemata that might shape those negative thoughts. Research has shown that people with anxiety Therapists hope that people can change their disorders show more interference for threatening words feelings, behaviors, and symptoms by changing their (i.e., they say these words more slowly) than for non- cognition. threatening words; this is used as evidence of an attention bias toward threatening information. Schema and attention are related to each Cognitive Restructuring: Beck's Cognitive Therapy other. If a person has a particular schema about the  Aaron Beck is known for developing a cognitive world as dangerous, that person may be more likely to therapy for depression based on the idea that pay attention to threatening or dangerous things in the depressed mood is caused by distortions in the environment. way people perceive life experiences (Beck,1976; Cognitive explanations are now central in the Salkovskis, 1996). For example, a person with search for the causes of psychopathology and for new depression may focus exclusively on negative methods of intervention. happenings and ignore positive ones.  GOAL: provide people with experiences that will THE ROLE OF UNCONSCIOUS alter their negative schemas, enabling them to have hope rather than despair.  Beck's therapy addresses the biases by trying to For example, knowing that the heritability persuade patients to change their opinions of ADHD is around 0.70 does not mean that 70 of themselves and the way they interpret events. percent of Jane's ADHD is because of her genes and 30 percent is due to other factors. It means that in a population (e.g., a large sample in a study), the GENETIC PARADIGM variation in ADHD is understood as being attributed to 70 percent genes and 30 percent environment. It is the approach to human behavior that Environment focuses on both the heritability of traits and complex  Shared environment - things that family members interactions between genes and the environment. It have in common. guides a lot of discoveries about human behavior, which  Nonshared environment - things distinct among leads to revolutionary thinking regarding the common members of a family; it has more to do with the notion of nature and nurture. development of mental illness than the shared It is now concluded that almost all behaviors environment. are heritable to some degree and that genes do not operate in isolation from the environment: BEHAVIOR GENETICS The study of the degree to which genes and GENES ENVIRONMENT environmental factors influence behavior. Many behavior genetics studies estimate the heritability of a The environment shapes how our genes are mental illness, without providing any information about expressed, and our genes also shape our environments how the genes might work. (Plomin et al., 2003; Rutter & Silberg, 2002; E. The total genetic makeup of an individual, Turkheimer, 2000). consisting of inherited genes, is referred to as the genotype (physical sequence of DNA). In contrast, the Remember! totality of observable behavioral characteristics, such as the level of anxiety, is referred to as the phenotype. Initially, scientists thought that the human genome was around 100, 000. But, later on, they found The genotype should not be viewed as a out it's only around 20,000-25,000. Therefore, the static entity. Genes switch off and on at specific times, number of genes was not at all important, instead, it is for example, to control various aspects of development. the sequencing and expressions of the genes that Meanwhile, the phenotype changes over time matter. and is the product of an interaction between the The data do not support the supposition that if genotype and the environment. For example, a person a person has genes for condition X, he or she will may be born with the capacity for high intellectual necessarily get condition X. There's no only one gene achievement, but whether he or she develops this that contributes to vulnerability since psychopathology genetically given potential depends on environmental is polygenic (i.e., meaning several genes, perhaps factors such as upbringing and education. operating at different times during the course of development, turning themselves on and off as they MOLECULAR GENETICS interact with a person's environment). In other words, a person does not inherit mental illness from a gene; it develops through the interaction between genes and the environment. Heritability  It is the extent to which variability in a particular Molecular genetics studies seek to identify behavior in a population can be accounted for by particular genes and their functions. Molecular research genetic factors. has focused on identifying differences between people  It ranges from 0.0 to 1.0 and should not be in the sequence and structure of their genes. interpreted individually. Polymorphism - the difference in the DNA sequence of a gene that has occurred in a population. Differential sensitivity or susceptibility to their 1. Gene Sequencing environments by people who have different genotypes. An approach that focuses on the identification A person's sensitivity to an environmental of single nucleotide polymorphisms (SNPs), these event is influenced by genes. For instance, the gene are differences between people in a single nucleotide in called serotonin transporter (5-HTT) has a a DNA sequence of a particular gene. polymorphism such that some people have 2 short alleles, 2 long alleles, and 1 short, 1 long alleles. For instance, if we want to identify genetic contributors to a common complex disease like According to research, a person with a short- diabetes, we can group together thousands of people short allele and short-long allele of this gene (5-HTT) who have diabetes and compare their SNP patterns to developed more vulnerability to Major Depressive thousands of people who do not have diabetes. With Disorder as an adult when they had been maltreated enough people in our study, we can use the SNPs as during childhood than those who did not receive markers to see that certain areas of the genome appear maltreatment or maltreated but had a long-long allele. to be the same in people who have diabetes, and that Thus, having the gene was not enough to tells us where we should look in more detail for a genetic predict an episode of depression, nor was the presence cause (Gunter, 2023). of childhood maltreatment. Rather, it was the specific combination of the gene configuration and environmental events that predicted depression. GENE-ENVIRONMENT CORRELATION When the genotype shapes the environmental experiences of a person, we refer to this phenomenon as a genotype-environment correlation (Plomin et al., 2008; Rutter, 2006, 2007). 2. Gene Structure 1. Passive gene-environment correlation - occurs An approach focuses on the identification of when genetically influenced traits in parents constitute copy number variations (CNV), wherein there's a the environment for their children. difference between people in gene structure through an abnormal copy of one or more sections of DNA within For instance, depression is partially heritable the genes: additions (extra copies are abnormally and leads to poorer parenting practices. Parents could present) or deletions (copies are missing). Likewise, it also pass down genetic risk for depression to their was found that 5% of CNV are inherited, or maybe a children. The genetic factors that influence depression spontaneous (de novo) mutation - appearing for the first in the children would correlate with the greater time in an individual. likelihood of receiving inconsistent parenting.  SNPs: more common  Mutation: rare 2. Evocative gene-environment correlation - occurs when genetically influenced traits elicit or GENE-ENVIRONMENT INTERACTIONS evoke environmental responses from others. For example, active, happy babies evoke more positive responses from others than do passive, unresponsive infants (Lytton, 1980). 3. Active gene-environment correlation - occurs when an individual selects environments based on genetically influenced traits that are conducive to As the neurotransmitter flows into the developing his or her inherited tendencies. synapse, some of the molecules reach the receiving, or postsynaptic, neuron. The cell membrane of the For example, students with greater intellectual postsynaptic neuron contains receptors. Receptors are abilities may select classes that are more challenging, configured so thot only specific neurotransmitters can fit which further increases their knowledge. into them. When a neurotransmitter fits into a receptor Developmental psychologists have postulated site, a message can be sent to the postsynaptic cell. a shift from passive to reactive and then to active GE What actually happens to the postsynaptic correlation during childhood, as children begin to select neuron depends on integrating thousands of similar more of their own experiences and environments. messages. Sometimes these messages are excitatory, (Goldsmith, 2009) leading to the creation of a nerve impulse in the NEUROSCIENCE PARADIGM postsynaptic cell; at other times the messages are inhibitory, making the postsynaptic cell less likely to It holds that mental disorders are linked to create a nerve impulse. aberrant processes in the brain. For instance, The last step is for the synapse to return to its depression is associated with neurotransmitter normal state. Not all of the released neurotransmitter problems within the brain; anxiety disorders may be has found their way to postsynaptic receptors. Some of related to a detect within the autonomic nervous system what remains in the synapse are broken down by that causes a person to be too easily aroused; dementia enzymes, and some are taken back into the presynaptic can be traced to impairments in structures of the brain. cell through a process called reuptake. Several key neurotransmitters have been Three Components of Neuroscience Paradigm: implicated in psychopathology, including dopamine, serotonin, norepinephrine, and gamma- 1. Neurons and Neurotransmitters aminobutyric acid (GABA). For instance, serotonin 2. Brain Structure and Function and dopamine may be involved in depression, mania, and schizophrenia. GA8A inhibits nerve impulses 3. The Neuroendocrine system throughout most areas of the brain and may be involved in anxiety disorders. NEURONS AND NEUROTRANSMITTERS A given disorder was caused by cither too much or too little of a particular transmitter. For example, mania is associated with too much norepinephrine and anxiety disorders with too little GABA). But more detailed research found that in the process of the metabolic steps in producing neurotransmitters, problems may arise. Similarly, disturbances in the amounts of transmitters may be the result of problems in the reuptake process that would leave excess transmitters in the synapse. The method that investigators use to study how neurotransmitters are working in the brain is: 1. Agonist drugs - to have people take a drug that stimulates a particular neurotransmitter's receptors, For neurons to send a signal to the next serotonin agonist, for example, is a drug that stimulates neuron so that communication can occur, the nerve serotonin receptors to produce the same effects as impulse must have a way of bridging the synaptic serotonin does naturally. space. The terminal buttons of each axon contain 2. Antagonist drugs - work on a neurotransmitter's synaptic vesicles, small structures that are filled with receptors to dampen the activity of that neurotransmitters. neurotransmitter. For example, many drugs used to treat schizophrenia are dopamine antagonists that work ubiquity of emotional problems in psychological by blacking dopamine receptors. disorders. For example, people with depression show more activity in the amygdala when watching pictures STRUCTURE AND FUNCTION OF THE BRAIN of emotional faces than do people without depression (Sheline et al., 2001). Neuroscience is the common explanation that will be included in most of the discussion of mental disorders. For example, people with schizophrenia have been found to have enlarged ventricles of the brain; the size of the hippocampus is reduced among some people with posttraumatic stress disorder, depression, and schizophrenia, perhaps due to overactivity of their stress response systems; brain size among some children with autism expands at a much greater rate than it should in typical development. NEUROENDOCRINE SYSTEM HYPOTHALAMIC- PITUITARY-ADRENAL AXIS (HPA AXIS): It is central to the body's response to stress, and stress figures prominently in many disorders. 1. When people are faced with a threat, the hypothalamus releases corticotropin-releasing factor (CRF), which then communicates with the pituitary gland. 2. The pituitary then releases adrenocorticotropic hormone, which travels via the blood to the adrenal glands. 3. The outer layers of the adrenal glands are referred to as the adrenal cortex; this area promotes the release of the hormone cortisol. (stress hormone) 4. It takes about 20 to 40 minutes for cortisol release to peak. After the stress or threat has remitted, it can take up to an hour for cortisol to return to baseline (i.e., before the stress) levels (Dickerson & Kemeny,2004). Studies of stress and the HPA axis are The amygdala is also an important area for uniquely integrative. attention to emotionally salient stimuli and memory of emotionally relevant events. This is one of the key brain For example, in a series of animal studies, structures for psychopathology researchers, given the researchers have shown that rats and primates that are exposed to early trauma, such as being separated from  their mothers, show elevated activity in the HPA axis In connection to psychopathology, it will be when they are exposed to stressors later in life (Gutman important to consider which of the emotional & Nemeroff, 2003). components are affected. For example, people with schizophrenia may not show the facial expressions As we will see, chronic stress and its effects (expressive component) associated with the reported on the HPA axis are linked to disorders as diverse as (experiential component) schizophrenia, depression, and posttraumatic stress emotions. disorder. >> Ideal Affect - refers to the kinds of emotional states that a person ideally wants to feel, it is culturally dependent. For instance, Western cultures value happiness, while East Asian cultures value less arousing positive emotions, like calmness. It is important to consider as research has proven that it has a connection, for instance, with drug usage. The study of emotion figures prominently in the work of neuroscientists who are examining ways in Another important system, the autonomic nervous which the brain contributes to the different emotion system (ANS) components. Geneticists have also begun to examine how tendencies to experience a lot of positive or The autonomic nervous system figures negative emotions may run in families. Even cognitive prominently in many of the anxiety disorders, such as behavioral therapies consider how emotion influences panic disorder and posttraumatic stress disorder. thinking and behavior. For example, people with panic disorder tend to misinterpret normal changes in their nervous system. SOCIOCULTURAL FACTORS & In essence, they come to fear the sensations of their PSYCHOPATHOLOGY own autonomic nervous system. Researchers have concluded that  Parasympathetic: conservation of energy sociocultural factors can trigger, exacerbate, or  Sympathetic: consumption of energy maintain the symptoms of different disorders. FACTORS THAT CUT ACROSS THE PARADIGMS 1. Gender - some disorders affect men and women EMOTION & PSYCHOPATHOLOGY differently. For example, depression is twice as common among women, while antisocial personality As many as 85% of psychological disorders disorder and alcohol use disorder are more common include emotional disturbances of some kind (Thoits, among men than women. 1985). However, a recent approach is looking beyond Emotions are fairly short-lived states or effect, whether men and women differ in prevalence rates to while mood is an emotional experience that endures for inquiries about factors that may differently impact men a longer period of time. and women in the development of disorders. Components of Emotion: For example, father-to-son genetic 1. Expressive (Behavioral) - refers to facial expressions transmission appears to be an important risk factor in of emotion. the development of alcohol use disorder for men, whereas sociocultural standards of thinness may be a 2. Experiential (Cognition) - refers to how someone risk factor in the development of eating disorders for reports he or she feels at any given women. moment or responds to some event. 3. Physiological - it involved bodily experiences along with emotions. 2. Cultural and Ethnic Factors: CAUSAL FACTORS 2.1. A number of disorders are observed in diverse parts of the world. For example, in Eskimos, there's a condition called nuthkavihak that is similar to  NECESSARY CAUSE - a particular condition that Western schizophrenia with symptoms of talking to must exist for a disorder to occur. oneself, refusing to converse, delusional beliefs, and bizarre behavior. Also, the were in Yorba. For example, general paresis (Y) - a degenerative brain disorder, cannot develop unless a 2.2. A number of disorders are only specific to person has previously contracted syphilis (X). However, particular cultures. For example, the Japanese term most mental disorders have not been found to have the hikikomori refers to a condition where a person necessary causes. completely withdraws from his social world. Moreover, symptoms of different disorders, the availability of treatment, and the willingness to seek  SUFFICIENT CAUSE - a condition that guarantees treatment are culturally influenced. the occurrence of a disorder. 2.3. Eating disturbances and body For example, one current theory hypothesizes dissatisfaction are greater among white women than that hopelessness (X) is a sufficient cause of black women, but differences in actual eating disorders depression (Y) (Abramson et al., 1995; Abramson et al., do not appear to be as great. However, the reasons for 1989). Or, more generally, if X occurs, then Y will also these differences are not yet well understood and are occur. According to this theory, if you are hopeless the focus of current research. enough about your future, then you will become depressed. However, a sufficient cause may not be a Sociocultural factors have become more necessary cause, there are other causes of depression prominent in recent years in genetics and neuroscience. as well. For example, social neuroscience seeks to understand what happens in the brain during complex social situations.  CONTRIBUTORY CAUSE - Increases the probability of a developing disorder (commonly DIATHESIS-STRESS MODEL studied in psychopathology) but is neither necessary nor sufficient for the disorder to occur. Why? For example, parental rejection could increase Central to the field of abnormal psychology are the probability that a child will later have difficulty in questions about what causes people to experience handling close personal relationships or could increase mental distress and to behave maladaptively: the probability that being rejected in a relationship in 1. We might be able to prevent conditions that lead to adulthood will precipitate depression. them and perhaps reverse those that maintain them. The time frame under which different causes 2. We could also classify and diagnose disorders better operate: if we clearly understood their causes rather than relying 1. DISTAL CAUSAL FACTOR - Causes occur early in on clusters of symptoms, as we usually must do now. life, but the effects may not show for many years. Although understanding the causes of abnormal For example, loss of a parent early in life, or behavior is clearly a desirable goal, it is enormously having abusive or neglectful parents as a child or difficult to achieve because human behavior is so adolescent, may serve as a distal contributory cause complex. predisposing a person to depression or antisocial behaviors later in life. As a result, many investigators now prefer to speak of risk factors (variables correlated with an abnormal outcome) rather than of causes 2. PROXIMAL CAUSAL FACTOR - Causal factors operate shortly before the occurrence of symptoms.  For example, rushing disappointment at In this manner, each opportunity for a new school or work, severe difficulties with a school friend or experience and new learning is in fact subverted and a marital partner, of damage to the brain, which are too becomes yet another encounter with a social much for a child or adult and triggers the onset of a environment that seems perversely and persistently disorder. hostile-exactly in line with the boy's expectations. DIATHESIS-STRESS MODEL 3. REINFORCING CONTRIBUTORY CAUSE - This is a condition that tends to maintain maladaptive behavior DIATHESIS: A predisposition toward developing a that is already occurring. disorder; it can be derived from biological, psychological, or sociocultural causal factors. An example is the extra attention, sympathy, and relief from unwanted responsibility that may come STRESS: The response or experience of an individual when a person is ill; these pleasant experiences may to demands that he or she perceives as taxing or unintentionally discourage recovery. exceeding his or her personal resources (Folkman  Feedback and Bidirectionality in Abnormal &Moskovitz, 2004; Monroe et al., 2009; Taylor & Behavior Stanton, 2007). The common pathways in most sciences: NOTE! Factors contributing to the development of a Simple Linear Model diathesis are themselves sometimes highly potent X (cause) Y (effect) stressors. For instance, when a child experiences the death of a parent, and may thereby acquire a predisposition or diathesis for becoming depressed later in life. In the behavioral sciences, however, not only do we usually deal with a multitude of interacting causes, but we also often have difficulty distinguishing between what is cause and what is effect because effects can serve as feedback that can in turn influence the causes. CASE A boy with a history of disturbing interactions with his parents routinely misinterprets the intentions of his peers as being hostile. Additive Model He develops defensive strategies to  Individuals who have a high level of diathesis may counteract the supposed hostility of those around him need only a small amount of stress before a such as rejecting the efforts of others to be friendly, disorder develops, but those who have a very low which he misinterprets as patronizing. Confronted by level of diathesis may need to experience a large the boy's prickly behavior, those around him become amount of stress for a disorder to develop. defensive, hostile, and rejecting, thus confirming and strengthening the boy's distorted expectations.  A person with no diathesis or a very low level promote a sense of self-confidence or self-esteem and of diathesis could still develop a disorder when faced thereby serve as a protective factor. with truly severe stress. And some protective factors have nothing to do with experiences at all but are simply some quality or attribute of a person (Rutter, 2006a). Examples of this are achievement, all of which can help protect against a variety of stressors (Masten, easygoing temperament, high self-esteem, high intelligence, and school 2001;Rutter, 1987; Sapienza & Masten, 2011). Protective factors most often, but not always, Interactive Model lead to resilience - the ability to adapt successfully to even very difficult circumstances.  Some amount of diathesis must be present before stress will have any effect. An example is the child who perseveres and  Someone with no diathesis will never develop does well in school despite his or her parent's drug the disorder, no matter how much stress is addiction or physical abuse (Garmezy, 1993; Luthar, experienced. 2003; Sapienza & Masten,2011). To translate these terms into the types of However, resilience should not be thought of causal factors described earlier, the diathesis or as an all-or-none capacity, and some research has vulnerability results from one or more relatively distal shown that resilient children may nonetheless also necessary or contributory causes but is generally not experience considerable self-reported emotional sufficient to cause the disorder. Instead, there generally distress. must be a more proximal undesirable event or situation Moreover, children who show resilience in one (the stressor), which may also be contributory or domain may show significant difficulties in other necessary but is generally not sufficient by itself to domains. cause the disorder except in someone with the diathesis. CASE Melinda and Tracy were identical twins whose  Protective Factors parents were killed in a car accident when they were a year old. Their mother and grandmother both had The influences that modify a person's histories of recurrent clinical depression. The twins response to environmental stressors, making it less were adopted into two loving middle-class families likely that the person will experience the adverse without a history of depression. Melinda's adoptive consequences of the stressors (Cicchetti & Garmezy, family provided a loving and supportive environment 1993; Masten et al., 2004: Rutter, 2006a, 2011). and supported her through school and college. Tracy's For instance, an important protective factor in adoptive parents, by contrast, soon divorced, and she childhood is having a family environment in which at was raised by her adoptive mother, who developed a least one parent is warm and supportive, which can serious dependence on alcohol and could not hold a protect against the harmful effects of an abusive parent job. Her mother's living circumstances deteriorated, and (Masten & Caatsworth, 1998). Tracy was forced to change schools four times. Protective factors operate only to help resist Because of her adoptive mother's alcohol and the effects of a risk factor rather than to provide any other mental problems, she was unable to provide benefits to people without risk factors. Tracy with a consistently loving and supportive environment, and when she was drunk, she frequently punished Tracy for no good reason. Tracy somehow Protective factors are not necessarily positive managed to graduate from high school and supported experiences. Indeed, sometimes exposure to stressful herself through a state college. Both Tracy and Melinda experiences that are dealt with successfully can married after they graduated from college but, by age 27, both marriages resulted in divorce. Although  Melinda developed some depressive symptoms for the Development of the W.H.O. & DSM Systems first 6 weeks following the divorce, the depression was 1939 - The World Health Organization (WHO) added not severe, and she quickly recovered. Tracy, by mental disorders to the International List of Causes of contrast, developed a major depressive episode that Death (ICD). lasted for over a year. 1948 - The former list became a comprehensive list of all In this example, both Tracy and Melinda have diseases called the International Statistical Classification identical genetic makeup and therefore the same genetic diathesis for depression. of Diseases, Injuries, and Causes of wealth, which includes a classification of abnormal behavior. But this Both had experienced the same distal stressor section was not accepted. Despite the contribution of (death of parents at an early age), and the same American Psychiatrists. in WHO, they published their own proximal stressor (divorce) at age 27. classification in 1952, called the Diagnostic and Statistical But Melinda had many protective factors Manual of Mental Disorders (DSM) growing up (loving and supportive family and adequate resources) that Tracy did not have (lack of a loving and 1969 - The WHO published a new classification system, supportive mother and inadequate resources). Thus, which was more widely accepted In the United Kingdom, Melinda showed resilience the British Glossary of Mental Disorders, a glossary of in the face of her divorce but Tracy did not. definitions was produced to accompany the WHO system. Meanwhile, DSM-II was published and is similar to the CHAPTER 3: CLASSIFICATION AND DIAGNOSIS WHO system. Even though DSM and BGMD both specify History Of Classification and Diagnosis symptoms of disorders, they define different symptoms for a given disorder. By the end of the 19th century, the medical profession advanced as physicians began to connect different 1980 - The DSM-III was released in an extensively revised diagnoses and appropriate treatments; the same with version, and, in 1987, a somewhat revised edition of it other branches of science. Hence, researchers of followed (DSM-III-R). psychopathology sought to develop their own classification system, but it was not easy 1988 - The American Psychiatric Association prepared for Early Efforts at Classification of Mental Disorders a major revision, which was published as DSM-IV in 1994. Emil Kraepelin was known for his influential classification The preparation included 13 working groups, in which each system incorporated in his psychiatry textbook in 1883. His work group tackled a different cluster of disorders. In the classification system attempted to definitively establish the previous versions, reasons for revisions had not always biological nature of mental illnesses. been explicit. But, beginning the revision of DSM-III-R, there was a review of the literature, analysis of previous For him, symptoms clustered together as a syndrome, data, and collection of new data by the workgroups. which has its own course, outcome, and biological cause; he labeled, or gave a name, to every syndrome. Although 1999 - There were plans for DSM-5. The process was the treatments were not identified, the course was much more same with DSM-IV, wherein 13 work groups reviewed the important at that time. designated clusters of disorder. However, study groups were also formed to review cut-across issues: lifespan The two major groups of severe mental illnesses were development, gender and cross-cultural issues, general proposed by him: medical issues, impairment and disability, and diagnostic assessment instruments.  Dementia praecox - schizophrenia  Manic-depressive psychosis - bipolar disorder 2008-2010 - Work groups drafted the DSM-5 diagnostic criteria and made changes to address the feedback from According to him, the biological cause of the former was a the public and scientific community. chemical imbalance, while the latter was due to irregularity in metabolism. Although his postulates were not true, his 2010-2011 - Field trials were conducted to test whether the attempt to classify abnormal behavior was the beginning draft criteria can be applied reliably. of the current diagnostic categories. 2012 - The APA board of trustees and governance bodies  AXIS V - Includes the clinician's evaluation of the suggested final revisions and voted to approve the DSM-5 person's current level of adaptive functioning, criteria. May 2013 - DSM-5 was released at the APA 2013 using ratings from 0 to 100 on the Global Annual Meeting. Assessment of Functional (GAF) scale to consider the social relationship, occupational Reliable & Valid Categories functioning, and use of leisure time. Beginning with the 3rd edition of DSM, an effort was made REVOLUTIONARY REVISIONS to create more reliable and valid diagnostic categories. The DSM-5 Includes many changes from DSM-IV-TR, even the use of Roman numerals was replaced with Arabic The two major innovations Introduced in DSM-III have numbers to facilitate electronic printing. been retained in the recent versions. 1. Removal of the Multiaxial System - the 1. Specific diagnostic criteria are spelled out multiaxial system developed for DSM-IV-TR was precisely: more detailed and concrete. removed in DSM-5: 2. Characteristics of each diagnosis are described much more extensively than in DSM-II: The first three axes were removed and clinicians  Essential features simply noted psychiatric and medical diagnoses.  Associated Features Although there is some evidence that personality  Age of Onset disorders are distinct from other clinical  Course disorders, emerging evidence indicates that  Prevalence and Sex ratio mental disorders do not factor cleanly into these  Familial Pattern classifications.  Differential Diagnosis (how to distinguish similar diagnosis from each other) At the same time, this change in coding suggests that there is no differentiation between medical Multiaxial System conditions and mental health disorders. It reinforces the assumption that mental disorders  In the DSM-IV and DSM-IV-TR, a more cultural are rooted in biological causes. approach was introduced, and a new way to rate people: The multiaxial classification system. Axis IV Beginning with the DSM-5, clinicians are Using this system, diagnosticians consider a advised to make a separate notation regarding broad range of information through judgments on contextual information, rather than including it in the five axes. axial notation. However, the APA (2013) did not provide guidance regarding how or where to do  AXIS I - it includes all diagnostic categories; so. clinical disorders. "Eliminating axis IV does not eliminate the need  AXIS II - includes personality disorders and to consider context-unless it can be shown that mental retardation. genetic and neurochemical factors alone account for the emergence, variation, and trajectory of  AXIS III - general medical conditions were mental and emotional disorder" considered since DSM has the provision for indicating that the disorder is due to a medical Axis V is removed from DSM-5; instead, the condition or substance abuse. World Health Organization Disability Assessment Schedule (WHODAS) is included in the DSM-5  AXIS IV - includes psychosocial problems that appendix of assessment measures. Because of may contribute to the disorder: primary support perceived lack of reliability and poor clinical utility. group, social environment, education, occupation, housing, economic, access to health The APA discontinued the use of the multiaxial core, legal system/crime, and other. system "despite widespread use and its adoption by certain insurance and governmental agencies,  the multiaxial system in DSM-IV was not required For example: to make a mental disorder diagnosis"  Substance abuse and dependence > Substance use disorder: 2. Organizing Diagnoses by Causes - During the development of DSM-5, some have argued that  Hypoactive sexual desire disorder and diagnoses should be based on the etiology rather Female sexual arousal disorder > Female than the symptoms. However, knowledge of the sexual interest/arousal disorder etiology of mental disorders was not strong enough and there were no laboratory tests, Mental illness is universal, but there are cultural neurobiological markers, or genetic indications to differences in risk factors, presentation of symptoms, use. Hence, DSM-5 continues to use symptoms willingness to seek help, and the treatments as the basis for diagnosis available.