Abnormal Psychology Transes PDF

PSYC 304 Abnormal Psychology relevant to the social and family situation of the individual with a TOPIC 1 : INTRODUCTION, HISTORICAL ROOTS OF psycholo...

PSYC 304 Abnormal Psychology relevant to the social and family situation of the individual with a TOPIC 1 : INTRODUCTION, HISTORICAL ROOTS OF psychological disorder. Social workers also treat disorders, often ABNORMAL BEHAVIOR AND METHODS OF RESEARCH concentrating on family problems associated with them. Psychiatric nurses have advanced degrees, such as a master’s or even a Ph.D., and specialize in the care and treatment of MENTAL DISORDER patients with psychological disorders, usually in hospitals as part of a treatment team. Marriage and family therapists and mental health counselors Definition from the 5th Edition of Diagnostic and Statistical Manual of Mental typically spend 1–2 years earning a master’s degree and are Disorders (DSM-5), which is the American Diagnostic Manual released in May employed to provide clinical services by hospitals or clinics, usually 2013, includes a number of characteristics essential to the concept of mental under the supervision of a doctoral-level clinician. disorder (Stein et al., 2010), including the following; The disorder occurs within the individual. It involves clinically significant difficulties in thinking, feeling, or PSYCHOPATHOLOGY TERMS TO REMEMBER behaving. It involves dysfunction in processes that support mental Psychopathology - is the field concerned with the nature, development, and functioning. treatment of mental disorders. It is not a culturally specific reaction to an event (e.g., death of a Prevalence - is the figure that shows how many people in the population have loved one). the disorder. It is not primarily a result of social deviance or conflict with society. Incidence - is the statistics on how many new cases occur during a given period. 4Ds of Abnormal Behavior Chronic course - disorders that tend to last a long time, sometimes a lifetime. Episodic course - the individual is likely to recover within a few months only to suffer a recurrence of the disorder at a later time. Time-limited course - the disorder will improve without treatment in a relatively short period. Prognosis - is the anticipated course of a disorder. So, we might say, “the prognosis is good”, meaning the individual will probably recover, or “the prognosis is guarded”, meaning the probable outcome doesn’t look good. Etiology - the study of origins, has to do with why a disorder begins (what causes it) and includes biological, psychological, and social dimensions. HISTORICAL CONCEPTIONS OF ABNORMAL BEHAVIOR Psychological Disorder - a psychological dysfunction within an individual The Supernatural Tradition associated with distress or impairment in functioning and a response that is not typical or culturally expected. Humans have always supposed that agents outside our bodies Psychological dysfunction refers to a breakdown in cognitive, and environment influence our behavior, thinking, and emotions. emotional, or behavioral functioning. These agents—which might be divinities, demons, spirits, or That the behavior must be associated with distress to be other phenomena such as magnetic fields or the moon or the classified as abnormal adds an important component and seems stars—are the driving forces behind the supernatural model. clear: the criterion is satisfied if the individual is extremely upset. Most philosophers looked for causes of abnormal behavior in one The concept of impairment is useful, although not entirely or the other. This split gave rise to two traditions of thought about satisfactory. For example, many people consider themselves shy abnormal behavior, summarized as the biological model and the or lazy. This doesn’t mean that they’re abnormal. But if you are so psychological model. shy that you find it impossible to date or even interact with people During the last quarter of the 14th century, religious and lay and you make every attempt to avoid interactions even though you authorities supported these popular superstitions and society as would like to have friends, then your social functioning is impaired. a whole began to believe more strongly in the existence and power Atypical or not culturally expected. At times, something is of demons and witches. considered abnormal because it occurs infrequently; it deviates During these turbulent times, the bizarre behavior of people from the average. The greater the deviation, the more abnormal it afflicted with psychological disorders was seen as the work of is. the devil and witches. Treatments included exorcism, in which various religious rituals were performed in an effort to rid the victim of evil spirits. THE MENTAL HEALTH PROFESSIONS Other approaches included shaving the pattern of a cross in the hair of the victim’s head and securing sufferers to a wall near Counseling psychologists tend to study and treat adjustment the front of a church so that they might benefit from hearing and vocational issues encountered by healthy individuals. Mass. Clinical psychologists usually concentrate on more severe Mental depression and anxiety were recognized as illnesses, psychological disorders. although symptoms such as despair and lethargy were often Psy.D. focus on clinical training and de-emphasize or eliminate identified by the church with the sin of acedia, or sloth. research training. Common treatments were rest, sleep, and a healthy and happy Ph.D. integrate clinical and research training. environment. Other treatments included baths, ointments, and Psychiatrists first earn an M.D. degree in medical school and then various potions. specialize in psychiatry during residency training that lasts 3 to 4 years. Psychiatrists also investigate the nature and causes of psychological disorders, often from a biological point of view; make In the 14th century, one of the chief advisers to the king of France, diagnoses; and offer treatments. a bishop and philosopher named Nicholas Oresme, also Psychiatric social workers typically earn a master’s degree in suggested that the disease of melancholy (depression) was the social work as they develop expertise in collecting information source of some bizarre behavior, rather than demons.  King Charles VI of France experienced severe psychological In addition to rest, good nutrition, and exercise, two treatments disorder, he was under a great deal of stress, partly because of the were developed. In one, bleeding or bloodletting, a carefully division of the Catholic Church. A variety of remedies and rituals of measured amount of blood was removed from the body, often with all kinds were tried, but none worked. High-ranking officials and leeches. The other was to induce vomiting; indeed, in a well- doctors of the university called for the “sorcerers” to be known treatise on depression published in 1621, Anatomy of discovered and punished. Melancholy, Robert Burton recommended eating tobacco and a With a perceived connection between evil deeds and sin on the half-boiled cabbage to induce vomiting. one hand and psychological disorders on the other, it is logical In ancient China and throughout Asia, a similar idea existed. But to conclude that the sufferer is largely responsible for the rather than “humors,” the Chinese focused on the movement of disorder, which might well be a punishment for evil deeds. air or “wind” throughout the body. Unexplained mental In the Middle Ages, if exorcism failed, some authorities thought disorders were caused by blockages of wind or the presence of that steps were necessary to make the body uninhabitable by evil cold, dark wind (yin) as opposed to warm, life-sustaining wind spirits, and many people were subjected to confinement, (yang). Treatment involved restoring proper flow of wind beatings, and other forms of torture. through various methods, including acupuncture. Mass hysteria may simply demonstrate the phenomenon of Hippocrates also coined the word hysteria to describe a concept emotion contagion, in which the experience of an emotion seems he learned about from the Egyptians, who had identified what we to spread to those around us. now call the somatic symptom disorders. In these disorders, the Paracelsus, a Swiss physician who lived from 1493 to 1541, physical symptoms appear to be the result of a medical problem rejected notions of possession by the devil, suggesting instead that for which no physical cause can be found, such as paralysis and the movements of the moon and stars had profound effects on some kinds of blindness. people’s psychological functioning. Behavioral and cognitive symptoms of what we now know as The Roman Catholic Church requires that all healthcare advanced syphilis, a sexually transmitted disease caused by a resources be exhausted first before spiritual solutions such as bacterial microorganism entering the brain, include believing that exorcism can be considered. everyone is plotting against you (delusion of persecution) or that you are God (delusion of grandeur), as well as other bizarre behaviors. The Biological Tradition Louis Pasteur’s germ theory of disease, developed in about 1870, facilitated the identification of the specific bacterial The Greek physician Hippocrates is considered to be the father microorganism that causes syphilis. of modern Western medicine. He and his associates left a body of John P. Grey’s position was that the causes of insanity were work called the Hippocratic Corpus, written between 450 and 350 always physical. Therefore, the mentally ill patient should be B.C., in which they suggested that psychological disorders treated as physically ill. The emphasis was again on rest, diet, could be treated like any other disease. and proper room temperature and ventilation, approaches Hippocrates considered the brain to be the seat of wisdom, used for centuries by previous therapists in the biological tradition. consciousness, intelligence, and emotion. Therefore, disorders ○ Under Grey’s leadership, the conditions in hospitals involving these functions would logically be located in the brain. greatly improved and they became more humane, Hippocrates also recognized the importance of psychological livable institutions. But in subsequent years, they also and interpersonal contributions to psychopathology, such as became so large and impersonal that individual the sometimes-negative effects of family stress; on some attention was not possible. occasions, he removed patients from their families. In the 1930s, the physical interventions of electric shock and The Roman physician Galen, later adopted the ideas of brain surgery were often used. Benjamin Franklin made Hippocrates and his associates and developed them further, numerous discoveries during his life with which we are familiar, but creating a powerful and influential school of thought within the most people don’t know that he discovered accidentally, and then biological tradition that extended well into the 19th century. confirmed experimentally in the 1750s, that a mild and modest One of the more interesting and influential legacies of the electric shock to the head produced a brief convulsion and memory Hippocratic-Galenic approach is the humoral theory of loss (amnesia) but otherwise did little harm. disorders. Emil Kraepelin was the dominant figure during this period and one ○ Hippocrates assumed that normal brain functioning was of the founding fathers of modern psychiatry. He was extremely related to four bodily fluids or humors: blood that influential in advocating the major ideas of the biological tradition, came from the heart, black bile from the spleen, phlegm but he was little involved in treatment. His lasting contribution was from the brain, and choler or yellow bile from the liver. in the area of diagnosis and classification. ○ Physicians believed that disease resulted from too much or too little of one of the humors; for example, too much black bile was thought to cause melancholia (depression). ○ The humoral theory was, perhaps, the first example of associating psychological disorders with a “chemical imbalance”, an approach that is widespread today. ○ Terms derived from the four humors are still sometimes applied to personality traits. For example, sanguine (literal meaning “red, like blood”) describes someone who is ruddy in complexion, presumably from copious blood flowing through the body, and cheerful and optimistic, although insomnia and delirium were thought to be caused by excessive blood in the brain. The Psychological Tradition ○ Melancholic means depressive (depression was thought to be caused by black bile flooding the brain). ○ A phlegmatic personality (from the humor phlegm) During the first half of the 19th century, a strong psychosocial indicates apathy and sluggishness but can also mean approach to mental disorders called moral therapy became being calm under stress. influential. The term moral actually referred more to emotional or ○ A choleric person (from yellow bile or choler) is hot psychological factors rather than to a code of conduct. Its basic tempered. tenets included treating institutionalized patients as normally as ○ King Charles VI’s physician moved him to the less possible in a setting that encouraged and reinforced normal stressful countryside to restore the balance in his social interaction. humors.  Moral therapy as a system originated with the well-known French psychiatrist Philippe Pinel and his close associate Jean-Baptiste Pussin. When Pinel arrived in 1791, Pussin had already instituted remarkable reforms by removing all chains used to restrain patients and instituting humane and positive psychological interventions. Pussin persuaded Pinel to go along with the changes. After William Tuke followed Pinel’s lead in England, Benjamin Rush, often considered the founder of U.S. psychiatry, introduced moral therapy in his early work at Pennsylvania Hospital. Asylums had appeared in the 16th century, but they were more like prisons than hospitals. It was the rise of moral therapy in Europe and the United States that made asylums habitable and even therapeutic. Unfortunately, after the mid-19th century, humane treatment declined because of a convergence of factors. First, it was widely recognized that moral therapy worked best when the number of patients in an institution was 200 or fewer, allowing for a great deal of individual attention. A second reason for the decline of moral therapy has an unlikely source. The great crusader Dorothea Dix campaigned endlessly for reform in the treatment of insanity. ○ A schoolteacher who had worked in various institutions, she had firsthand knowledge of the deplorable conditions imposed on patients with insanity, and she made it her life’s work to inform the American public and their leaders of these abuses. Her work became known as the mental hygiene movement. ○ In addition to improving the standards of care, Dix worked hard to make sure that everyone who needed care received it, including the homeless. Through her efforts, humane treatment became more widely available in U.S. institutions. As her career drew to a close, she was rightly acknowledged as a hero of the 19th century. Franz Mesmer suggested to his patients that their problem was caused by an undetectable fluid found in all living organisms called “animal magnetism”, which could become blocked. ○ Mesmer is widely regarded as the father of hypnosis, a state in which extremely suggestible subjects sometimes appear to be in a trance. Many distinguished scientists and physicians were interested in Mesmer’s powerful methods of suggestion. One of the best known, Jean-Martin Charcot. A distinguished neurologist, Charcot demonstrated that some techniques of mesmerism were effective with a number of psychological disorders, and he did much to legitimize the fledgling practice of hypnosis. A close second was their discovery that it is therapeutic to recall and relive emotional trauma that has been made unconscious and to release the accompanying tension. This release of emotional material became known as catharsis. TOPIC 2 : CONTEMPORARY PERSPECTIVES ON ABNORMAL BEHAVIOR AND METHODS OF TREATMENT AN INTEGRATIVE APPROACH TO PSYCHOPATHOLOGY No influence operates in isolation. Each dimension—biological or psychological—is strongly influenced by the others and by development, and they weave together in various complex and intricate ways to create a psychological disorder.  Huntington’s disease - a degenerative brain disease that Neurotransmitters - the biochemicals that are released from the appears in early to middle age, usually the early 40s. This disease axon of one neuron and transmit the impulse to the dendrite has been traced to a genetic defect that causes deterioration in a receptors of another neuron. specific area of the brain, the basal ganglia. It causes broad Brain stem - is the lower and more ancient part of the brain. Found changes in personality, cognitive functioning, and, particularly, in most animals, this structure handles most of the essential motor behavior, including involuntary shaking or jerkiness automatic functions, such as breathing, sleeping, and moving throughout the body. around in a coordinated way. Phenylketonuria (PKU) - which can result in intellectual disability The forebrain is more advanced and evolved more recently. (previously called “mental retardation”). This disorder, present at Hindbrain - lowest part of the brain stem, contains the medulla, birth, is caused by the inability of the body to metabolize (break the pons, and the cerebellum. The hindbrain regulates many down) phenylalanine, a chemical compound found in many foods. autonomic activities, such as breathing, the pumping action of the Like Huntington’s disease, PKU is caused by a defect in a single heart (heartbeat), and digestion. gene, with little contribution from other genes or the environmental ○ Cerebellum - controls motor coordination, and recent background. research suggests that abnormalities in the cerebellum In linkage studies, scientists study individuals who have the may be associated with the psychological disorder same disorder, such as bipolar disorder, and also share other autism, although the connection with motor features, this allows scientists to attempt to “link” known gene coordination is not clear. locations with the possible location of a gene contributing to the Midbrain - coordinates movement with sensory input and contains disorder. parts of the reticular activating system, which contributes to The environment may occasionally turn on certain genes. This type processes of arousal and tension, such as whether we are awake of mechanism may lead to changes in the number of receptors or asleep. at the end of a neuron, which, in turn, would affect biochemical Thalamus & Hypothalamus - top of the brain stem, which are functioning in the brain. involved broadly with regulating behavior and emotion. These The brain and its functions are plastic, subject to continual structures function primarily as a relay between the forebrain and change in response to the environment, even at the level of the remaining lower areas of the brain stem. genetic structure. Limbic system - base of the forebrain, just above the thalamus For years, scientists have assumed a specific method of and hypothalamus. Located around the edge of the center of the interaction between genes and environment. According to this brain. diathesis–stress model, individuals inherit tendencies to ○ Figures prominently in much of psychopathology, express certain traits or behaviors, which may then be activated includes such structures as the hippocampus (sea under conditions of stress. horse), cingulate gyrus (girdle), septum (partition), and ○ Each inherited tendency is a diathesis (vulnerability), amygdala (almond), all of which are named for their which means, literally, a condition that makes approximate shapes. someone susceptible to developing a disorder. ○ This system helps regulate our emotional experiences When the right kind of life event, such as a certain type and expressions and, to some extent, our ability to learn of stressor, comes along, the disorder develops. and to control our impulses. It is also involved with the ○ The smaller the vulnerability, the greater the life stress basic drives of sex, aggression, hunger, and thirst. required to produce the disorder; conversely, with Basal ganglia - also at the base of the forebrain, include the greater vulnerability, less life stress is required. caudate (tailed) nucleus. Because damage to these structures may There was reason to believe, from prior work with animals, that make us change our posture or twitch or shake, they are believed individuals with at least two copies of the long allele (LL) were to control motor activity. able to cope better with stress than individuals with two copies Cerebral cortex - largest part of the forebrain which contains more of the short allele (SS). than 80% of all neurons in the central nervous system. This part of Gene–environment correlation model or reciprocal gene– the brain provides us with our distinctly human qualities, allowing environment model. Some evidence now indicates that genetic us to look to the future and plan, to reason, and to create. endowment may increase the probability that an individual will ○ Left hemisphere - responsible for verbal and other experience stressful life events. cognitive processes. ○ For example, people with a genetic vulnerability to ○ Right hemisphere - better at perceiving the world develop a certain disorder, such as blood–injection– around us and creating images. injury phobia, may also have a personality trait—let’s ○ Each hemisphere consists of four separate areas, or say impulsiveness— that makes them more likely to be lobes: temporal, parietal, occipital, and frontal. involved in minor accidents that would result in their Temporal lobe - associated with seeing blood. In other words, they may be accident recognizing various sights and sounds and prone because they are continually rushing to complete with long-term memory storage. things or to get to places without regard for their Parietal lobe - associated with recognizing physical safety. various sensations of touch and monitoring Neither nature (genes) nor nurture (environmental events) alone, body positioning. but rather a complex interaction of the two, influences the Occipital lobe - associated with integrating development of our behavior and personalities. and making sense of various visual inputs. Frontal lobe - the most interesting from the point of view of psychopathology. The front THE CENTRAL NERVOUS SYSTEM (or anterior) of the frontal lobe is called the prefrontal cortex, and this is the area Central Nervous System - consisting of the brain and the spinal responsible for higher cognitive functions cord. such as thinking and reasoning, planning for Peripheral Nervous System - consisting of the somatic nervous the future, as well as long-term memory. system and the autonomic nervous system. This area of the brain synthesizes all Dendrites - have numerous receptors that receive messages in information received from other parts of the the form of chemical impulses from other nerve cells, which are brain and decides how to respond. converted into electrical impulses. Axon - transmits these impulses to other neurons. THE PERIPHERAL NERVOUS SYSTEM Synaptic cleft - the space between the axon of one neuron and the dendrite of another. Peripheral Nervous System - coordinates with the brain stem to make sure the body is working properly.  Its two major components are the somatic nervous system and the autonomic nervous system. AMINO-ACID NEUROTRANSMITTERS Somatic Nervous System - controls the muscles, so damage in this area might make it difficult for us to engage in any voluntary Glutamate - an excitatory transmitter that “turns on” many different movement, including talking. neurons, leading to action. Autonomic Nervous System - regulate the cardiovascular Gamma-aminobutyric acid (GABA) - an inhibitory system (for example, the heart and blood vessels) and the neurotransmitter. It inhibits (or regulates) the transmission of endocrine system (for example, the pituitary, adrenal, thyroid, and information and action potentials. gonadal glands) and to perform various other functions, including Because these two neurotransmitters work in concert to balance aiding digestion and regulating body temperature. functioning in the brain, they have been referred to as the ○ Includes the sympathetic nervous system and “chemical brothers”. parasympathetic nervous system. GABA was discovered before glutamate and has been studied for ○ Sympathetic Nervous System - responsible for a longer period; its best-known effect is to reduce anxiety. mobilizing the body during times of stress or danger by ○ Scientists have discovered that a particular class of rapidly activating the organs and glands under its drugs, the benzodiazepines, or minor tranquilizers, control. When the sympathetic division goes on alert, makes it easier for GABA molecules to attach three things happen. The heart beats faster, thereby themselves to the receptors of specialized neurons. increasing the flow of blood to the muscles; respiration Thus, the higher the level of benzodiazepine, the increases, allowing more oxygen to get into the blood more GABA becomes attached to neuron receptors and brain; and the adrenal glands are stimulated. and the calmer we become (to a point). ○ Parasympathetic Nervous System - balance the The GABA system rides on many circuits distributed widely sympathetic system. In other words, because we could throughout the brain. GABA seems to reduce overall arousal not operate in a state of hyperarousal and somewhat and to temper our emotional responses. preparedness forever, the parasympathetic nervous In addition to reducing anxiety, minor tranquilizers have an system takes over after the sympathetic nervous anticonvulsant effect, relaxing muscle groups that may be system has been active for a while, normalizing our subject to spasms. arousal and facilitating the storage of energy by helping ○ Furthermore, the GABA system seems to reduce the digestive process. levels of anger, hostility, aggression, and perhaps Endocrine System - each endocrine gland produces its own even positive emotional states such as eager chemical messenger, called a hormone, and releases it directly anticipation and pleasure, making GABA a into the bloodstream. generalized inhibiting neurotransmitter, much as ○ Adrenal glands - produce epinephrine (also called glutamate has a generalized excitatory function. adrenaline) in response to stress, as well as saltregulating hormones. ○ Thyroid gland - produces thyroxine, which facilitates SEROTONIN energy metabolism and growth. ○ Pituitary gland - master gland that produces a variety Serotonin / 5-hydroxytryptamine (5HT) - influences a great deal of regulatory hormones. of our behavior, particularly the way we process information. ○ Gonadal glands - produce sex hormones such as Serotonin system - regulates our behavior, moods, and thought estrogen and testosterone. processes. Extremely low activity levels of serotonin are The hypothalamus connects to the adjacent pituitary gland, which associated with less inhibition and with instability, impulsivity, and is the master or coordinator of the endocrine system. The pituitary the tendency to overreact to situations. gland, in turn, may stimulate the cortical part of the adrenal glands Low serotonin activity has been associated with aggression, on top of the kidneys. As we noted previously, surges of suicide, impulsive overeating, and excessive sexual behavior. epinephrine tend to energize us, arouse us, and get our bodies Several classes of drugs primarily affect the serotonin system, ready for threat or challenge. When athletes say their adrenaline including the tricyclic antidepressants such as imipramine was really flowing, they mean they were highly aroused and up for (known by its brand name, Tofranil). the competition. The cortical part of the adrenal glands also However, the class of drugs called selective-serotonin reuptake produces the stress hormone cortisol. This system is called the inhibitors (SSRIs), including fluoxetine (Prozac), affects hypothalamic–pituitary–adrenocortical axis, or HPA axis. serotonin more directly than other drugs, including the tricyclic antidepressants. SSRIs are used to treat a number of psychological disorders, particularly anxiety, mood, and eating disorders. NEUROTRANSMITTERS NOREPINEPHRINE Research on neurotransmitter function focuses primarily on Norepinephrine (Noradrenaline) - seems to stimulate at least two what happens when activity levels change. We can study this in groups (and probably several more) of receptors called alpha- several ways. We can introduce substances called agonists that adrenergic and beta-adrenergic receptors. effectively increase the activity of a neurotransmitter by mimicking In the central nervous system, a number of norepinephrine circuits its effects; substances called antagonists that decrease, or block, have been identified. One major circuit begins in the hindbrain, an a neurotransmitter; or substances called inverse agonists that area that controls basic bodily functions such as respiration. produce effects opposite to those produced by the Another circuit appears to influence the emergency reactions or neurotransmitter. alarm responses that occur when we suddenly find ourselves After a neurotransmitter is released, it is quickly drawn back in a dangerous situation, suggesting that norepinephrine may from the synaptic cleft into the same neuron. This process is bear some relationship to states of panic. called reuptake. Some drugs work by blocking the reuptake More likely, however, is that this system, with all its varying circuits process, thereby causing continued stimulation along the brain coursing through the brain, acts in a more general way to regulate circuit. or modulate certain behavioral tendencies and is not directly involved in specific patterns of behavior or in psychological disorders.  Affect - refers to the feeling state that accompanies what we say at a given point. Usually our affect is “appropriate”; that is, we laugh DOPAMINE when we say something funny or look sad when we talk about something sad. Dopamine - is a major neurotransmitter that is in the monoamine class and that is also termed a catecholamine because of the The first neuroimaging technique, developed in the early 1970s, similarity of its chemical structure to epinephrine and uses multiple X-ray exposures of the brain from different angles; norepinephrine. that is, X-rays are passed directly through the head. As with any Dopamine has been implicated in the pathophysiology of X-ray, these are partially blocked or attenuated more by bone and schizophrenia and disorders of addiction. Some research also less by brain tissue. Detectors on the opposite side of the head indicates it may play a significant role in depression and attention pick up the degree of blockage. A computer then reconstructs deficit hyperactivity disorder. pictures of various slices of the brain. This procedure, which takes Remember the wonder drug reserpine that reduced psychotic about 15 minutes, is called a computerized axial tomography behaviors associated with schizophrenia? This drug and more (CAT) scan or CT scan. This gives an image of the brain structure. modern antipsychotic treatments affect a number of Several more recently developed procedures give greater neurotransmitter systems, but their greatest impact may be that resolution (specificity and accuracy) than a CT scan without the they block specific dopamine receptors, thus lowering inherent risks of X-ray tests. A now commonly used scanning dopamine activity. technique is called nuclear magnetic resonance imaging (MRI). Dopamine circuits merge and cross with serotonin circuits at many The patient’s head is placed in a high-strength magnetic field points and therefore influence many of the same behaviors. For through which radio frequency signals are transmitted. These example, dopamine activity is associated with exploratory, signals “excite” the brain tissue, altering the protons in the outgoing, pleasure seeking behaviors, and serotonin is hydrogen atoms. This gives an image of the brain structure. associated with inhibition and constraint; thus, in a sense they Subjects undergoing a positron emission tomography (PET) balance each other. scan are injected with a tracer substance attached to One of a class of drugs that affects the dopamine circuits radioactive isotopes, or groups of atoms that react specifically is L-dopa, which is a dopamine agonist (increases distinctively. This substance interacts with blood, oxygen, or levels of dopamine). One of the systems that dopamine switches glucose. When parts of the brain become active, blood, oxygen, or on is the locomotor system, which regulates ability to move in glucose rushes to these areas of the brain, creating “hot spots” a coordinated way and, once turned on, is influenced by serotonin picked up by detectors that identify the location of the activity. Because of these connections, deficiencies in dopamine isotopes. Thus, we can learn what parts of the brain are working have been associated with disorders such as Parkinson’s and what parts are not. This gives an image of the brain disease, in which a marked deterioration in motor behavior functioning. includes tremors, rigidity of muscles, and difficulty with A second procedure used to assess brain functioning is called judgment. L-dopa has been successful in reducing some of these single photon emission computed tomography (SPECT). It motor disabilities. works much like PET, although a different tracer substance is used, and this procedure is somewhat less accurate. It is also less expensive, however, and requires far less sophisticated COGNITIVE SCIENCE equipment to pick up the signals. Therefore, SPECT is used more often than PET scans. This gives an image of the brain functioning. Cognitive science - concerned with how we acquire and process Functional Magnetic Resonance Imaging (fMRI) procedures information and how we store and ultimately retrieve it (one of the have largely replaced PET scans in the leading brain-imaging processes involved in memory). centers because they allow researchers to see the immediate Along similar lines, Martin Seligman, and his colleague Steven response of the brain to a brief event, such as seeing a new Maier, also working with animals, described the phenomenon of face. learned helplessness, which occurs when rats or other animals In an electroencephalogram (EEG), electrodes are placed encounter conditions over which they have no control. directly on various places on the scalp to record the different Another influential psychologist, Albert Bandura, observed that low-voltage currents. organisms do not have to experience certain events in their When brief periods of EEG patterns are recorded in response to environment to learn effectively. Rather, they can learn just as specific events, such as hearing a psychologically meaningful much by observing what happens to someone else in a given stimulus, the response is called an event-related potential situation. This fairly obvious discovery came to be known as (ERP) or evoked potential. modeling or observational learning. According to the concept of prepared learning, we have become If we want to determine what is unique about an individual’s highly prepared for learning about certain types of objects or personality, cultural background, or circumstances, we use what is situations over the course of evolution because this knowledge known as an idiographic strategy. contributes to the survival of the species. But to take advantage of the information already accumulated on The alarm reaction that activates during potentially life-threatening a particular problem or disorder, we must be able to determine a emergencies is called the flight or fight response. general class of problems to which the presenting problem Emotion scientists now agree that emotion is composed of three belongs. This is known as a nomothetic strategy. related components—behavior, physiology, and cognition. ○ The term classification itself is broad, referring simply to The principle of equifinality is used in developmental any effort to construct groups or categories and to psychopathology to indicate that we must consider a number of assign objects or people to these categories on the paths to a given outcome. basis of their shared attributes or relations—a nomothetic strategy. CLINICAL ASSESSMENT AND DIAGNOSIS If the classification is in a scientific context, it is most often called taxonomy, which is the classification of entities for scientific Clinical assessment - is the systematic evaluation and purposes, such as insects, rocks, or—if the subject is measurement of psychological, biological, and social factors in an psychology—behaviors. individual presenting with a possible psychological disorder. If you apply a taxonomic system to psychological or medical Diagnosis - is the process of determining whether the particular phenomena or other clinical areas, you use the word nosology. problem afflicting the individual meets all criteria for a All diagnostic systems used in healthcare settings, such as psychological disorder, as set forth in the fifth edition of the those for infectious diseases, are nosological systems. Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.  The term nomenclature describes the names or labels of the disorders, previously coded on Axis II, were now all disorders that make up the nosology (for example, anxiety or mood coded-on Axis I. disorders). ○ Axis II. Only personality disorders and intellectual The classical (or pure) categorical approach to classification disability were now coded on Axis II. originates in the work of Emil Kraepelin and the biological tradition ○ Axis III. Consisted of any physical disorders and in the study of psychopathology. conditions that might be present. ○ Emil Kraepelin was one of the first psychiatrists to ○ Axis IV. The new Axis IV is used for reporting classify psychological disorders from a biological point psychosocial and environmental problems that might of view. have an impact on the disorder. ○ Kraepelin first identified what we now know as the ○ Axis V. Axis V was essentially unchanged. It indicates disorder of schizophrenia. His term for the disorder at the current level of adaptive functioning. the time was dementia praecox. Dementia praecox In 2000, a committee updated the text that describes the research refers to deterioration of the brain that sometimes literature accompanying the DSM-IV diagnostic category and occurs with advancing age (dementia) and develops made minor changes to some of the criteria themselves to improve earlier than it is supposed to, or “prematurely” consistency. This text revision (DSM-IV-TR) helped clarify (praecox). many issues related to the diagnosis of psychological disorders. In the almost 20 years since the publication of DSM-IV our THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL knowledge has advanced considerably and, after over 10 years of DISORDERS (DSM) concerted effort, DSM-5 was published in the spring of 2013. The manual is divided into three main sections. The first section The first Diagnostic and Statistical Manual (DSM-I), published in introduces the manual and describes how best to use it. The 1952 by the American Psychiatric Association. Only in the late second section presents the disorders themselves, and section 3 1960s did systems of nosology begin to have some real influence includes descriptions of disorders or conditions that need on mental health professionals. further research before they can qualify as official diagnoses. In 1968, the American Psychiatric Association published a second Perhaps the most notable change is the removal of the multiaxial edition of its Diagnostic and Statistical Manual (DSM-II). system since the former axes I, II, and III have been combined into The year 1980 brought a landmark in the history of nosology: the the descriptions of the disorders themselves, and clinicians can third edition of the Diagnostic and Statistical Manual (DSM-III). make a separate notation for relevant psychosocial or contextual Under the leadership of Robert Spitzer, DSM-III departed radically factors (formerly axis IV) or extent of disability (formerly axis V) from its predecessors. associated with the diagnosis. Three changes stood out; The use of dimensional axes for rating severity, intensity 1. First, DSM-III attempted to take a theoretical approach frequency, or duration of specific disorders in a relatively uniform to diagnosis, relying on precise descriptions of the manner across all disorders has also been substantially expanded disorders as they presented to clinicians rather than in DSM-5, as previously proposed. on psychoanalytic or biological theories of In DSM-5 the term “mental retardation” has been dropped in favor etiology. of the more accurate term “intellectual disability”, which is 2. The second major change in DSM-III was that the consistent with recent changes by other organizations. specificity and detail with which the criteria for Individuals are often diagnosed with more than one psychological identifying a disorder were listed made it possible to disorder at the same time, which is called comorbidity. study their reliability and validity. 3. Third, DSM-III (and DSM-III-R) allowed individuals with possible psychological disorders to be rated on five dimensions, or axes. This framework, called the multiaxial system, allowed the clinician to gather information about the individual’s functioning in a number of areas rather than limiting information to the disorder itself. Axis I. The disorder itself, such as RESEARCH METHODS IN PSYCHOPATHOLOGY schizophrenia or mood disorder, was represented only on the first axis. Axis II. What were thought to be more Kiesler labeled the tendency to see all participants as one enduring (chronic) disorders of personality homogeneous group the patient uniformity myth. Comparing were listed on Axis II. groups according to their mean scores (“Group A improved by 50% Axis III consisted of any physical disorders over Group B”) hides important differences in individual reactions and conditions that might be present. to our interventions. Axis IV the clinician rated, in a dimensional One type of correlational research that is much like the efforts of fashion, the amount of psychosocial stress detectives is called epidemiology, the study of the incidence, the person reported. distribution, and consequences of a particular problem or set of Axis V. And the current level of adaptive problems in one or more populations. functioning was indicated on Axis V. Epidemiologists study the incidence and prevalence of disorders The fourth edition of the DSM (DSM-IV) was published in 1994. among different groups of people. Perhaps the most substantial change in DSM-IV was that the Like other types of correlational research, epidemiological distinction between organically based disorders and research can’t tell us conclusively what causes a particular psychologically based disorders that was present in previous phenomenon. Knowledge about the prevalence and course of editions was eliminated. psychological disorders is extremely valuable to our The multiaxial system remained in DSM-IV, with some changes in understanding, however, because it points researchers in the right the five axes. Specifically, only personality disorders and direction. intellectual disability were now coded on Axis II. When behavior changes as a result of a person’s expectation ○ Axis I. Pervasive developmental disorders, learning of change rather than as a result of any manipulation by an disorders, motor skills disorders, and communication experimenter, the phenomenon is known as a placebo effect (from the Latin word placebo, which means “I shall please”).  As an alternative to using no-treatment control groups to help confounding of age and experience, is a limitation of the evaluate results, some researchers compare different treatments. cross-sectional design. In this design, the researcher gives different treatments to two or more comparable groups of people with a particular Rather than looking at different groups of people of differing ages, disorder and can then assess how or whether each treatment researchers may follow one group over time and assess change in helped the people who received it. This is called comparative its members directly. The advantages of longitudinal designs are treatment research. that they do not suffer from cohort effect problems and they One of the more important strategies used in single-case allow the researchers to assess individual change. experimental design is repeated measurement, in which a Longitudinal designs can suffer from a phenomenon similar to behavior is measured several times instead of only once the cohort effect on cross-sectional designs. The cross- before you change the independent variable and once generational effect involves trying to generalize the findings to afterward. groups whose experiences are different from those of the study Endophenotypes are the genetic mechanisms that ultimately participants. contribute to the underlying problems causing the symptoms and difficulties experienced by people with psychological disorders. In the case of schizophrenia, for example, researchers are not looking for a “schizophrenia gene” (genotype); instead, they are searching for the gene or genes responsible for the working memory problems characteristic of people with this disorder (endophenotype), as well as the genes responsible for other problems experienced by people with this disorder. The basic principle of genetic linkage analysis is simple. When a family disorder is studied, other inherited characteristics are assessed at the same time. These other characteristics—called genetic markers—are selected because we know their exact location. If a match or link is discovered between the inheritance of the disorder and the inheritance of a genetic marker, the genes for the disorder and the genetic marker are probably close together on the same chromosome. The second strategy for locating specific genes, association studies, also uses genetic markers. Whereas linkage studies compare markers in a large group of people with a particular disorder, association studies compare such people to people without the disorder. PREVENTION INTERVENTION STRATEGIES Health promotion or positive development strategies involve efforts to blanket entire populations of people—even those who may not be at risk—to prevent later problems and promote protective behaviors. The intervention is not designed to fix existing problems but, instead, focuses on skill building, for example, to keep problems from developing. Universal prevention strategies focus on entire populations and target certain specific risk factors (for example, behavior problems in inner-city classrooms) without focusing on specific individuals. The third approach to prevention intervention—selective prevention—specifically targets whole groups at risk (for example, children who have parents who have died) and designs TOPIC 3 : CLASSIFICATION AND ASSESSMENT OF specific interventions aimed at helping them avoid future ABNORMAL BEHAVIOR problems. Finally, indicated prevention is a strategy for those individuals Diagnosis and Assessment are the critically important “first who are beginning to show signs of problems (for example, steps” in the study and treatment of psychopathology. depressive symptoms) but do not yet have a psychological Diagnosis enables clinicians and scientists to communicate disorder. accurately with one another about cases or research. Diagnosis is important for research on causes and treatments. A variation of correlation research is to compare different Sometimes researchers discover unique causes and treatments people at different ages. For a cross sectional design, associated with a certain set of symptoms. researchers take a cross section of a population across the different age groups and compare them on some characteristics. ○ In cross-sectional designs, the participants in each age DIAGNOSIS AND CLINICAL ASSESSMENT group are called cohorts; Brown and Finn studied three cohorts: 12-year-olds, 15-year-olds, and 17-year-olds. Diagnosis (Dx): It is the label or name given for a syndrome. The members of each cohort are the same age at the Syndrome is defined as: same time and thus have all been exposed to similar ○ (1) Disease or disorder that involves a particular group experiences. of signs and symptoms. ○ Differences among cohorts in their opinions about ○ (2) A collection or set of signs and symptoms that alcohol use may be related to their respective cognitive characterize or suggest a particular disease. and emotional development at these different ages and ○ (3) Combination of signs and symptoms. to their dissimilar experiences. This cohort effect, the  Signs: are objective observation of the syndrome by a physician 2. Criterion Validity: evaluated by determining whether a or clinician; signs are visible externally. (ex. weight loss, skin measure is associated in an expected way with some rash). other measure (the criterion). Symptoms: are subjective. It is the patient’s observation of the a. Concurrent Validity: if both variables are syndrome. It can only be described by the person feeling them. measured at the same point in time. (ex. pain, dizziness, numbness, fatigue, vision disturbance, b. Predictive Validity: assessed by evaluating lightheadedness) ability of the measure to predict some other Importance of Diagnosis: variable that is measured at some point in ○ It allows the clinician to describe base rates, causes, time in the future. and treatment 3. Construct Validity: viewed as an overarching concept ○ Often, a diagnosis can help a person to begin to that encompasses all other forms of validity. understand why certain symptoms are occuring, which Construct: an idea of an attribute or can be a huge relief. characteristics inferred. ○ It enables clinicians and scientists to communicate Standardization: process by which a certain set of standards or accurately with one another about cases or research. norms is determined for a technique to make its use consistent ○ It is important for research on causes or treatments. across different measurements. Ex. Your score on a particular psych test should be compared only to the norms of Asians and not to the scores of different people, DISEASE VS. DISORDER such as African-American males. Disease: resulting from a pathophysiological response to external or internal factors. It is mostly: CLASSIFICATION AND DIAGNOSIS ○ Organic in nature or has an organic cause ○ Observed because of structural changes to patients. Classification System (or Nomenclature): set of definitions of Physical changes may be seen in patients. syndromes and rules for determining when a patient’s symptoms ○ Can be confirmed through tests. are part of each syndrome. Disorder: a disruption to the normal or regular functions in the Classification Systems presently used by clinicians: body or a part of the body. The effect of disorder is mostly: 1. Diagnostic and Statistical Manual of Mental ○ Functional: there is an interference with the person’s Disorders 5th Edition by the American Psychiatric daily life (e.g. to hold a job or form relationships) Association ○ The detection of a disorder is dependent to the 2. International Statistical Classification of Diseases symptoms and Related Health Problems (ICD-10) by the World ○ Not confirmed by laboratory tests Health Organization 2 Essential Strategies in the Study and Treatment of Psychopathology: CLINICAL ASSESSMENT 1. Idiographic Strategy: used to determine what is unique about an individual's personality, cultural is the process of collecting information about an individual for background, or circumstances understanding and arriving at an informed decision 2. Nomothetic Strategy: taking advantage of the is the systematic evaluation and measurement of psychological, information already accumulated on a particular biological, and social factors in an individual presenting with a problem or disorder by determining a general class of possible psychological disorder. problems to which the presenting problem belongs. In other words, we are attempting to name or classify the problem CORNERSTONE OF DIAGNOSIS AND ASSESSMENT ISSUES IN CLASSIFICATION Three basic concepts that help determine the value of clinical assessments: Reliability: is the degree to which a measurement is consistent; producing the same results. 1. The subject of classification becomes controversial in humans Types of reliability that is most central to assessment and unlike classifications in the field of biology or geology courses. diagnosis: 2. Some people have questioned whether it is proper or ethical to 1. Interrater Reliability: degree to which two classify human behavior. (ex. the use of terms such as “normal” independent observers agree on what they have and “abnormal”) observed 3. Some would prefer to talk about behavior and feelings on a 2. Test-retest Reliability: extent to which people being continuum from happy to sad or fearful to non-fearful rather than observed twice or taking the same test twice, perhaps to create categories as mania, depression, and phobia. several weeks or months apart, receive similar scores. Note: this only makes sense when we can assume that people will not change appreciably between test WAYS OF CLASSIFYING HUMAN BEHAVIOR sessions on the underlying variable being measured. 3. Alternate-form Reliability: extent to which scores on 1. Categorical Approach or Classical (Pure): originates in the work the two forms of the test are consistent of Emil Kraepelin and the biological tradition in the study of 4. Internal Consistency Reliability: Assess whether the psychopathology. Here we assume that every diagnosis has a items on a test are related to one another. (ex. Items in clear underlying pathophysiological cause, such as bacterial an anxiety inventory should be interrelated or correlated infection or malfunctioning endocrine system, and that each with one another, if they truly tap anxiety.) disorder is unique. A categorical system defines a threshold for Validity: related to whether a measure measures what it is treatment that helps demarcate a point where treatment is supposed to measure. (ex. if a questionnaire is supposed to recommended. Although the cutoffs are likely to be somewhat measure a person’s hostility, does it do so?) Note: Validity is arbitrary, they can provide helpful guidance. (e.g. Does the patient related to reliability (unreliable measures will not have a good have schizophrenia or not?) validity. NOTE: Types of Validity: Despite some debate, DSM-5 preserves a categorical approach 1. Content Validity: refers to whether a measure to diagnosis. A dimensional approach to personality traits has adequately samples the domain of interest been included in the appendix, but other diagnoses are based on categorical classification. As with DSM-IV-TR, the DSM-5 includes  the category “unspecified” to be used when a person meets many Appendix but not all of the criteria for a diagnosis. A categorical system forces clinicians to define one threshold as What are the innovations observed in DSM-5? “diagnosable”. Categorical diagnoses foster a false impression 1. Multiaxial system of diagnosis (DSM-IV-TR) has been of discontinuity (Widiger, 2005). Indeed, up to half of the people removed. Now, diagnosis only includes the clinical syndrome (or seeking treatment have mild symptoms that fall just below the syndromes if co-morbid) and the general medical condition. threshold diagnosis. Many of these people with subthreshold 2. There is an ICD/DSM harmony. symptoms of a diagnosis still receive extensive treatment. 3. Chapters are reorganized in this new edition to reflect patterns of comorbidity and shared etiology 2. Dimensional Approach: describes the degree of an entity that is 4. New Diagnoses: such as Disruptive Mood Dysregulation Disorder present (e.g. a 1-to-10 scale of anxiety, where 1 represents for children and adolescents who are falsely labeled with Bipolar minimal and 10, extreme). Disorder because no category seemed to fit their symptoms. They do not meet the full criteria for mania (defining feature of bipolar). 3.Prototypical Approach: identifies certain essential Other diagnoses include: Language Impairment Disorder, characteristics of an entity so that clinicians can classify it but Premenstrual Dysphoric Disorder, Somatic Symptom Disorder, it also allows certain nonessential variations that do not and Illness Anxiety Disorder) necessarily change the classification. When this is used in 5. Combining Diagnoses: some DSM-IV-TR diagnoses were classifying psychological disorders, many possible features or combined because there is not enough evidence for differential properties of the disorder are listed and any candidate must meet etiology, course, or treatment response to justify the labeling. enough of them to fall into that category. Example: DSM-IV-TR dx of Substance Abuse and Dependence EXAMPLE: are replaced in DSM-5 as Substance Use Disorder; Hypoactive Consider diagnostic criteria defining a major depressive episode. Sexual Desire Disorder and Female Sexual Arousal Disorder are The criteria include many nonessential symptoms, but if you have replaced with Female Sexual Interest/Arousal Disorder. either depressed mood or marked loss of interest or pleasure in 6. Present DSM puts greater emphasis on the influence of age, most activities and at least four of the remaining symptoms, you gender, and culture in diagnosis. come close enough to the prototype to meet the criteria for a major depressive episode. One person might have: depressed mood, weight loss, insomnia, USE OF THE NEW DSM MANUAL psychomotor agitation, loss of energy Whereas, another person who also meets the criteria for major depressive episode might have: Marked diminished interest or pleasure in activities, fatigue, feelings of worthlessness, difficulty thinking or concentrating, ideas of committing suicide. NOTE: Although both have the requisite five symptoms that bring them close to the prototype, they look different because they share only one symptom. In the illustration, we can see that: 1. DSM-5 combines Axes I-III which are: Mental Disorders, Medical CREATING A DIAGNOSIS/DIAGNOSTIC IMPRESSION Disorders, Other Medical conditions that may be the focus of Clinical Attention Requirements for Diagnosis: 2. Expanded V codes of the DSM and Z codes of ICD-10 can be used ○ Minimum number of symptoms according to the DSM- to determine contextual or situational factors (Also, you may 5 consider including the reason for visit, factors that affect the ○ Minimum duration diagnosis, prognosis, or treatment). It was intentionally changed to ○ Clinical significance of the symptom that brings distress be more similar with other classification systems such as the ICD. or cause impairment to the patient 3. In noting disability or impairment, the World Health Organization Levels of Disorders Disability Assessment Schedule 2.0 (WHODAS 2.0), Section III is ○ Sub-threshold: 1 or 2 requirements are not met used (also included in the DSM-5 appendix of assessment ○ Subsyndromal: number or duration of symptoms are measures). lacking Note: This is not required for a diagnosis. ○ Subclinical: symptoms do not cause clinically significant distress or impairment NOTE: Essentially, these terms are used interchangeably to refer HOW TO WRITE A CORRECT DSM-5 DIAGNOSIS? to symptoms, not full-blown or not severe enough. At times, all the symptoms are there but in “too mild form” to impair functioning. 1. Determine the disorder that meets the criteria. 2. Write the name of the disorder. 3. Add any subtype or specifiers of the disorder. The Diagnostic and Statistical Manual of Mental Disorders 5th 4. Add the ICD-10 code found at the top of the diagnostic criteria Edition (DSM 5, 2013) (Starting October 2014, ICD-10 codes should be used) REMEMBER! In case of multiple diagnosis or comorbidity, the It features: principal diagnosis is listed first, followed by the other diagnoses in Descriptive not explanatory descending order of clinical importance. Categorical vs. Dimensional/Continuum Atheoretical What are the Sections of DSM-5? Section I: DSM-5 Introduction/Use of Manual Section II: Diagnostic Criteria and Codes Section III: Emerging Measures and Models  2. Ataque de Nervios: is an idiom of distress principally reported among Latinos from the Caribbean, but recognized among many Latin American and Latin Mediterranean groups. Commonly reported symptoms include: uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. A general feature of an ataque de nervios is a sense of being out of control. 3. Possession Syndrome: involuntary possession trance states are very common presentations of emotional distress around the world. 4. Shenjing Shuairuo: “weakness of the nervous system”, is a translation and cultural adaptation of the term “neurasthenia”, lack of nerve strength. CULTURAL CONCEPTS OF DISTRESS It is a syndrome of lassitude, pain, poor concentration, headache, irritability, dizziness, insomnia, and over 50 These formerly called Culture Bound Syndromes are ways that symptoms. (about 87% of those who have this actually cultural groups experience, understand, and communicate meet the criteria of major depression.) suffering, behavioral problems, or troubling thoughts and emotions 5. Koru: reported in South and East Asia, an episode of intense (APA, 2013). anxiety about the possibility that the penis or nipples will The term culture bound was used to describe patterned behaviors recede into the body, possibly leading to death. of distress or illness whose phenomenology appeared distinct from 6. Hikikomori (withdrawal): refers to a syndrome observed in psychiatric categories and were considered unique to particular Japan, Taiwan, and South Korea in which an individual, most cultural settings. often an adolescent boy or young adult man, shuts himself into a room (e.g. bedroom) for a period of 6 months or more 3 Main Types of Cultural Concepts and does not socialize with anyone outside the room. 1. Cultural Syndromes: are clusters of symptoms and attributions 7. Taijin Kyofusho: is a Japanese culture-specific syndrome. that tend to co-occur among individuals in specific cultural groups, This is the fear of interpersonal relations. Those who have this communities, or contexts and that are recognized locally as are likely to be extremely embarrassed about themselves or fearful coherent patterns of experience. of displeasing others when it comes to the functions of their bodies 2. Cultural Idioms of Distress: are ways of expressing distress that or their appearances. may not involve specific symptoms or syndromes, but that provide Symptoms of this syndrome overlap with that of social collective, shared ways of experiencing and talking about personal phobia and body dysmorphic disorder. or social concerns. (e.g. “nausog”) 3. Cultural Explanations or Perceived Causes: are labels, attributions, or features of an explanatory model that indicate CAUSAL FACTORS IN ABNORMAL PSYCHOLOGY culturally recognized meaning or etiology for symptoms, illness, or distress. Etiology: study of origins; causal patterns; it explains why a mental disorder begins and what causes it. It includes psychological, Why are Cultural Concepts Important? biological, and even social dimensions. 1. To avoid misdiagnosis: Cultural variation in symptoms and in 1. Distal/Predisposing Cause: anything that produces a explanatory models associated with these cultural concepts may susceptibility or disposition to a condition without lead clinicians to misjudge the severity of a problem or assign the actually eliciting it. This includes conditions that wrong diagnosis (e.g., unfamiliar spiritual explanations may be occurred relatively early in life but may not show its misunderstood as psychosis) effect right away. 2. To obtain useful clinical information: Cultural variations in 2. Proximal/Precipitating Cause: factor that initiates the symptoms and attributions may be associated with particular onset of manifestations of a disease process; trigger of features of risk, resilience, and outcome. the disorder. 3. To improve clinical rapport and engagement: “Speaking the 3. Reinforcing Cause: a condition that tends to maintain language of the patient” maladaptive behavior that is already occurring. 4. To improve therapeutic efficacy: Cultural influences the Illustration: Imagine a plant that starts as a seed. The psychological mechanism of disorder, which need to be seed is the distal cause. Water and soil in this case, are understood and addressed to improve clinical efficacy. For the proximal causes. Water, soil, sunlight are the example, culturally specific catastrophic cognitions can contribute reinforcing causes. to symptom escalation into panic attacks. Risk Factors: these are factors that increase the possibility of an 5. To guide clinical research: Locally perceived connections between individual to develop a disorder. cultural concepts may help identify patterns of comorbidity and Protective Factors: influences that modify a person’s response to underlying biological substrates. an environmental stressor, lessening the impact of stress. (e.g. 6. To clarify cultural epidemiology. resilience of Filipinos) Examples of Culture Bound Syndromes 1. Amok: “murderous frenzy”, is a dissociative episode that is TREATMENT AND INTERVENTIONS characterized by a period of depression followed by an outburst of violent, aggressive, or homicidal behavior. Biologically-based Therapies: Patients return to premorbid states following the episode. a. Electroconvulsive Therapy (ECT): addresses major Prevalent only among male depression. Term “amok” originated in Malaysia, but similar b. Neurosurgery: craniotomy behavior patterns can be found in Laos, Philippines, c. Psychopharmacotherapy: which drugs work to Polynesia (cafard or cathard), Papua New Guinea, and alleviate the disorders. Before, pharmacological Puerto Rico (mal de pelea), and among the Navajo treatments are divided into 4: (iich’aa). i. Antipsychotics Precipitants: Feelings of loss, shame, anger, or ii. Antidepressants lowered self-esteem although specific triggers were iii. Antianxiety/Anxiolytics very diverse in nature and presentation. iv. Mood-stabilizing drugs Now, this is less valid in DSM-5 because:  ○ Many drugs of one class are used to treat disorders previously assigned to other classes. ○ Drugs from all 4 categories are used to treat disorders not previously treatable by drugs (e.g. eating disorders, impulse-control disorder, panic disorder) ○ Other drugs such as Clonidine (catapres), Propranolol (Inderal), and Verapamil (Isoptin) can effectively treat a variety of disorders and do not fit easily into the aforementioned classification of drugs. Psychological Therapies/Psychotherapies a. Psychodynamic Therapy: aims to facilitate the client to achieve insight; uncovering the contents of the unconscious using different techniques. b. Behavior Therapy: change the maladaptive behaviors learned through the principles of learning. c. Cognitive-Behavioral Therapy: aims to change the distorted thought processes of the patient. d. Humanistic/Existential Therapies: facilitate clients to realize potentials for self-actualization. e. Family Therapy TOPIC 4 : TRAUMA AND STRESS-RELATED DISORDERS STRESS: A person’s biological and psychological response to adjustive demands from the environment. Categories of Stressors: 1. Conflict: is the presence of two or more incompatible needs. Types of Conflict: ○ Approach-avoidance conflict: occurs when there is one goal or event that has both positive and negative effects or characteristics that make the goal unappealing and appealing simultaneously. E.g. marriage ○ Double-approach conflict: choice between two or