Abnormal Psychology: An Integrative Approach PDF

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Barlow Durand Hofmann Abnormal Psychology An Integrative Approach An Integrative Approach eighth edition To register or access your online learning solution or purchase materials David H. Barlow for your course, visit www.cengagebrain.com. e i gh t h V. Mark Durand edition Stefan G. Hofmann Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 This template is provided in accordance with Transcontinental’s specifications for this particular trim size. If provided SE/Barlow/Durand/Hofmann - Abnormal Psychology: An Integrative Approach, 8e   ISBN-13: 978-1-305-95044-3 ©2018 Designer: Denise Davidson 50443_cvr_ptg01_hr.indd 1 as a preliminary mechanical, bulk (spine) size will be adjusted to the final page count at a later time. Printer: TransCon  Binding: Casebound  Trim: 9" x 10.875"  CMYK 28/09/16 2:04 PM Want to turn your C into an A? Obviously, right? But the right way to go about it isn’t always so obvious. Go digital to get the grades. MindTap’s customizable study tools and eTextbook give you everything you need all in one place. Engage with your course content, enjoy the flexibility of studying anytime and anywhere, stay connected to assignment due dates and instructor notifications with the MindTap Mobile app... and most of all…EARN BETTER GRADES. TO GET STARTED VISIT WWW.CENGAGE.COM/STUDENTS/MINDTAP Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203  Eighth Edition Abnormal Psychology A n I n t e g r at i v e A p p r o a c h David H. Barlow Boston University V. Mark Durand U n i v e r s i t y o f S o u t h F l o r i d a – S t. P e t e r s bu r g Stefan G. Hofmann Boston University Australia Brazil Mexico Singapore United Kingdom United States Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 1 14/10/16 10:41 AM  Abnormal Psychology: An Integrative Approach, © 2018, 2015 Cengage Learning Eighth Edition ALL RIGHTS RESERVED. No part of this work covered by the copyright herein David H. Barlow, V. Mark Durand, may be reproduced or distributed in any form or by any means, except as Stefan G. Hofmann permitted by U.S. copyright law, without the prior written permission of the Product Director: Star M. Burruto copyright owner. Product Manager: Carly McJunkin Unless otherwise noted, all art is © Cengage Learning. Content Developer: Tangelique Williams-Grayer For product information and technology assistance, contact us at Product Assistant: Katie Chen Cengage Learning Customer & Sales Support, 1-800-354-9706. Marketing Manager: James Finlay For permission to use material from this text or product, Content Project Manager: Ruth Sakata Corley submit all requests online at www.cengage.com/permissions Art Director: Vernon Boes Further permissions questions can be e-mailed to [email protected] Manufacturing Planner: Karen Hunt Production Service: Graphic World Inc. Library of Congress Control Number: 2016950499 Photo and Text Researcher: Lumina Datamatics Student Edition: Cover and Text Designer: Cheryl Carrington ISBN: 978-1-305-95044-3 Cover Image: dundanim/iStock / Getty Images Plus/ Getty Images Loose-leaf Edition: ISBN: 978-1-337-27721-1 Compositor: Graphic World Inc. Cengage Learning 20 Channel Center Street Boston, MA 02210 USA Cengage Learning is a leading provider of customized learning solutions with employees residing in nearly 40 different countries and sales in more than 125 countries around the world. Find your local representative at www.cengage.com Cengage Learning products are represented in Canada by Nelson Education, Ltd. To learn more about Cengage Learning Solutions, visit www.cengage.com Purchase any of our products at your local college store or at our preferred online store www.cengagebrain.com Printed in Canada Print Number: 01   Print Year: 2016 Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 2 14/10/16 10:41 AM  To my mother, Doris To Wendy and Jonathan, whose To Benjamin and Lukas for Elinor Barlow-Lanigan, patience, understanding, helping me integrate the for her multidimensional and love provided me the many dimensions of life. influence across my opportunity to complete such S. G. H. life span. an ambitious project. D. H. B. V. M. D. Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 3 14/10/16 10:41 AM  About the Authors David H. Barlow is an from the American Psychological Association “for his lifelong dedi­ internationally recognized cation and passion for advancing psychology through science, edu­ pioneer and leader in clini­ cation, training, and practice.” cal psychology. Currently He also has received career/lifetime contribution awards from Professor Emeritus of Psy­ the Massachusetts, Connecticut, and California Psychological Asso­ chology and Psychiatry at ciations, as well as the University of Mississippi Medical Center and Boston University, Dr. Barlow the Association for Behavioral and Cognitive Therapies. In 2000, he is Founder and Director was named Honorary Visiting Professor at the Chinese People’s Lib­ Emeri­tus of the Center eration Army General Hospital and Postgraduate Medical School in for Anxiety and Related Beijing, China, and in 2015 was named Honorary President of the Disorders, one of the largest Canadian Psychological Association. In addition, the annual Grand research clinics of its kind Rounds in Clinical Psychology at Brown University was named in the world. From 1996 to in his honor. During the 1997–1998 academic year, he was Fritz 2004, he directed the clini­ Redlich Fellow at the Center for Advanced Study in the Behavioral cal psychology programs at Sciences in Palo Alto, California. His research has been continually Boston University. From 1979 funded by the National Institute of Mental Health for over 40 years. to 1996, he was distinguished Dr. Barlow has edited several journals including Clinical Psychol- professor at the University at ogy: Science and Practice and Behavior Therapy, has served on the Albany–State University of New York. From 1975 to 1979, he was editorial boards of more than 20 different journals, and is current­ professor of psychiatry and psychology at Brown University, where ly Editor in Chief of the “Treatments that Work” series for Oxford he also founded the clinical psychology internship program. From University Press. He has published more than 600 scholarly articles 1969 to 1975, he was professor of psychiatry at the University of and written or edited more than 75 books and clinical manuals, Mississippi Medical Center, where he founded the psychology resi­ including Anxiety and Its Disorders, 2nd edition, Guilford Press; dency program. Dr. Barlow received his B.A. from the University of Clinical Handbook of Psychological Disorders: A Step-by-Step Treat- Notre Dame, his M.A. from Boston College, and his Ph.D. from the ment Manual, 5th edition, Guilford Press; Single-Case Experimental University of Vermont. Designs: Strategies for Studying Behavior Change, 3rd edition, Allyn A fellow of every major psychological association, Dr. Barlow & Bacon (with Matthew Nock and Michael Hersen); The Scientist– has received many awards in honor of his excellence in scholarship, Practitioner: Research and Accountability in the Age of Managed Care, including the National Institute of Mental Health Merit Award for 2nd edition, Allyn & Bacon (with Steve Hayes and Rosemary Nelson- his long-term contributions to the clinical research effort; the Dis­ Gray); Mastery of Your Anxiety and Panic, Oxford University Press tinguished Scientist Award for applications of psychology from the (with Michelle Craske); and, more recently, The Unified Protocol for American Psychological Association; and the James McKeen Cattell Transdiagnostic Treatment of Emotional Disorders with the Unified Fellow Award from the Association for Psychological Science hon­ Team at BU. The books and manuals have been translated into more oring individuals for their lifetime of significant intellectual achieve­ than 20 languages, including Arabic, Chinese, and Russian. ments in applied psychological research. Other awards include the Dr. Barlow was one of three psychologists on the task force that Distinguished Scientist Award from the Society of Clinical Psychol­ was responsible for reviewing the work of more than 1,000 mental ogy of the American Psychological Association and a certificate health professionals who participated in the creation of DSM-IV, of appreciation from the APA section on the clinical psychology and he continued on as an Advisor to the DSM-5 task force. He also of women for “outstanding commitment to the advancement of chaired the APA task force on Psychological Intervention Guide­ women in psychology.” He was awarded an Honorary Doctorate of lines, which created a template for the creation of clinical practice Science from the University of Vermont, an Honorary Doctorate guidelines. His current research program focuses on the nature and of Humane Letters from William James College, as well as the C. treatment of anxiety and related emotional disorders. Charles Burlingame Award from the Institute of Living in Hartford At leisure he plays golf, skis, and retreats to his home on Nan­ Connecticut “for his outstanding leadership in research, education, tucket Island, where he loves to write, walk on the beach, and visit and clinical care.” In 2014 he was awarded a Presidential Citation with his island friends. iv   Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 4 14/10/16 10:41 AM  V. Mark Durand is known the American Psychological Association for his body of work in worldwide as an authority the field of autism spectrum disorder. Dr. Durand was elected to in the area of autism spec­ serve as President of the American Psychological Association’s trum disorder. He is a pro­ Division 33 (Intellectual and Developmental Disabilities/Autism fessor of psychology at the Spectrum Disorders) for 2019. Dr. Durand is currently a mem­ University of South Florida– ber of the Professional Advisory Board for the Autism Society of St. Petersburg, where he was America and was on the board of directors of the International the founding Dean of Arts & Association of Positive Behavioral Support. He was co-editor of Sciences and Vice Chancellor the Journal of Positive Behavior Interventions, serves on a num­ for Academic Affairs. Dr. ber of editorial boards, and has more than 125 publications on Durand is a fellow of the functional communication, educational programming, and American Psychological Asso­ behavior therapy. His books include Severe Behavior Problems: cia­tion. He has received more A Functional Communication Training Approach; Sleep Better! A than $4 million in federal Guide to Improving Sleep for Children with Special Needs; Help- funding since the beginning ing Parents with Challenging Children: Positive Family Interven- of his career to study the tion; the multiple national award winning Optimistic Parenting: nature, assessment, and treat­ Hope and Help for You and Your Challenging Child; and most ment of behavior problems in recently Autism Spectrum Disorder: A Clinical Guide for General children with disabilities. Before moving to Florida, he served in a Practitioners. variety of leadership positions at the University at Albany, including Dr. Durand developed a unique treatment for severe behav­ associate director for clinical training for the doctoral psychology ior problems that is currently mandated by states across the program from 1987 to 1990, chair of the psychology department country and is used worldwide. He also developed an assessment from 1995 to 1998, and interim dean of Arts and Sciences from 2001 tool that is used internationally and has been translated into to 2002. There he established the Center for Autism and Related more than 15 languages. Most recently he developed an innova­ Disabilities at the University at Albany–SUNY. He received his B.A., tive approach to help families work with their challenging child M.A., and Ph.D.—all in psychology—at the State University of New (Optimistic Parenting), which was validated in a 5-year clinical York–Stony Brook. trial. He has been consulted by the departments of education Dr. Durand was awarded the University Award for Excel­ in numerous states and by the U.S. Departments of Justice and lence in Teaching at SUNY–Albany in 1991 and was given the Education. His current research program includes the study of Chancellor’s Award for Excellence in Research and Creative prevention models and treatments for such serious problems as Scholarship at the University of South Florida–St. Petersburg in self-injurious behavior. 2007. He was named a 2014 Princeton Lecture Series Fellow and In his leisure time, he enjoys long-distance running and has received the 2015 Jacobson Award for Critical Thinking from completed three marathons.   v Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 5 14/10/16 10:41 AM  Stefan G. Hofmann emotional disorders. Furthermore, he has been one of the leaders is an international expert in translational research methods to enhance the efficacy of psy­ on psychotherapy for emo­ chotherapy and to predict treatment outcome using neuroscience tional disorders. He is a methods. professor of psychology at He has won many prestigious professional awards, including Boston University, where he the Aaron T. Beck Award for Significant and Enduring Contribu­ directs the Psychotherapy tions to the Field of Cognitive Therapy by the Academy of Cognitive and Emotion Research Therapy. He is a fellow of the American Psychological Association Laboratory. He was born in and the Association for Psychological Science and was president of a little town near Stuttgart in various national and international professional societies, includ­ Germany, which may explain ing the Association for Behavioral and Cognitive Therapies and his thick German accent. the International Association for Cognitive Psychotherapy. He was He studied psychology at an advisor to the DSM-5 Development Process and a member of the University of Marburg, the DSM-5 Anxiety Disorder Sub-Work Group. As part of this, he Germany, where he received participated in the discussions about the revisions of the DSM-5 his B.A., M.S., and Ph.D. criteria for various anxiety disorders, especially social anxiety dis­ A brief dissertation fellow­ order, panic disorder, and agoraphobia. Dr. Hofmann is a Thomson ship to spend some time Reuters’ Highly Cited Researcher. at Stanford University turned into a longer research career in the Dr. Hofmann has been the editor in chief of Cognitive Therapy United States. He eventually moved to the United States in 1994 to and Research and is also the incoming Associate Editor of Clinical join Dr. Barlow’s team at the University at Albany–State University Psychological Science. He has published more than 300 peer-reviewed of New York, and has been living in Boston since 1996. journal articles and 15 books, including An Introduction of Modern Dr. Hofmann has an actively funded research program studying CBT (Wiley-Blackwell) and Emotion in Therapy (Guilford Press). various aspects of emotional disorders with a particular emphasis on At leisure, he enjoys playing with his sons. He likes traveling to anxiety disorders, cognitive behavioral therapy, and neuroscience. immerse himself into new cultures, make new friends, and recon­ More recently, he has been interested in mindfulness approaches, nect with old ones. When time permits, he occasionally gets out his such as yoga and meditation practices, as treatment strategies of flute. vi   Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 6 14/10/16 10:41 AM  Brief Contents 1 Abnormal Behavior in Historical Context 2 2 An Integrative Approach to Psychopathology 32 3 Clinical Assessment and Diagnosis 74 4 Research Methods 104 5 Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders 126 6 Somatic Symptom and Related Disorders and Dissociative Disorders 184 7 Mood Disorders and Suicide 216 8 Eating and Sleep–Wake Disorders 272 9 Physical Disorders and Health Psychology 322 10 Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria 360 11 Substance-Related, Addictive, and Impulse-Control Disorders 404 12 Personality Disorders 448 13 Schizophrenia Spectrum and Other Psychotic Disorders 484 14 Neurodevelopmental Disorders 520 15 Neurocognitive Disorders 552 16 Mental Health Services: Legal and Ethical Issues 580   vii Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 7 14/10/16 10:41 AM  Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 8 14/10/16 10:41 AM  Contents 1 Abnormal Behavior in Historical Context   2 Understanding Psychopathology 3 Consequences of the Biological Tradition / 16 What Is a Psychological Disorder? / 4 The Science of Psychopathology / 6 The Psychological Historical Conceptions of Abnormal Behavior / 9 Tradition 16 Moral Therapy / 16 The Supernatural Tradition 9 Asylum Reform and the Decline Demons and Witches / 10 of Moral Therapy / 17 Stress and Melancholy / 10 Psychoanalytic Theory / 18 Treatments for Possession / 11 Humanistic Theory / 23 Mass Hysteria / 11 The Behavioral Model / 24 Modern Mass Hysteria / 12 The Moon and the Stars / 12 The Present: The Scientific Method Comments / 12 and an Integrative Approach 27 The Biological Tradition 13 Summary 28 Hippocrates and Galen / 13 Key Terms 29 The 19th Century / 14 Answers to Concept Checks 29 The Development of Biological Treatments / 15 2 An Integrative Approach to Psychopathology   32 One-Dimensional versus The Peripheral Nervous System / 47 Multidimensional Models 33 Neurotransmitters / 49 What Caused Judy’s Phobia? / 33 Implications for Psychopathology / 53 Outcome and Comments / 35 Psychosocial Influences on Brain Genetic Contributions to Structure and Function / 54 Psychopathology 36 Interactions of Psychosocial Factors and Neurotransmitter Systems / 56 The Nature of Genes / 36 Psychosocial Effects on the Development of Brain New Developments in the Study of Genes Structure and Function / 57 and Behavior / 37 Comments / 58 The Interaction of Genes and the Environment / 38 Epigenetics and the Nongenomic “Inheritance” Behavioral and Cognitive Science 58 of Behavior / 41 Conditioning and Cognitive Processes / 58 Neuroscience and Its Contributions to Learned Helplessness / 59 Psychopathology 42 Social Learning / 60 Prepared Learning / 60 The Central Nervous System / 43 Cognitive Science and the Unconscious / 61 The Structure of the Brain / 44   ix Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 9 14/10/16 10:41 AM  Emotions 62 Social Effects on Health and Behavior / 67 The Physiology and Purpose of Fear / 62 Global Incidence of Psychological Disorders / 69 Emotional Phenomena / 62 Life-Span Development 69 The Components of Emotion / 63 Anger and Your Heart / 64 Conclusions 70 Emotions and Psychopathology / 65 Summary 72 Cultural, Social, and Interpersonal Key Terms 73 Factors 65 Answers to Concept Checks 73 Voodoo, the Evil Eye, and Other Fears / 65 Gender / 66 3 Clinical Assessment and Diagnosis   74 Assessing Psychological Disorders 75 DSM-III and DSM-III-R / 95 Key Concepts in Assessment / 77 DSM-IV and DSM-IV-TR / 96 The Clinical Interview / 78 DSM-5 / 96 Physical Examination / 80 Creating a Diagnosis / 99 Behavioral Assessment / 80 Beyond DSM-5: Dimensions and Spectra / 101 Psychological Testing / 84 Neuropsychological Testing / 88 Summary 103 Neuroimaging: Pictures of the Brain / 89 Key Terms 103 Psychophysiological Assessment / 90 Answers to Concept Checks 103 Diagnosing Psychological Disorders 92 Classification Issues / 92 Diagnosis before 1980 / 95 4 Research Methods  104 Examining Abnormal Genetics and Behavior Behavior 105 across Time and Important Concepts / 105 Cultures 116 Basic Components of a Research Studying Genetics / 117 Study / 106 Studying Behavior over Time / Statistical versus Clinical Significance / 108 119 The “Average” Client / 108 Studying Behavior across Cultures / 121 Power of a Program of Research / 122 Types of Research Replication / 123 Methods 108 Research Ethics / 123 Studying Individual Cases / 109 Research by Correlation / 109 Summary 125 Research by Experiment / 111 Key Terms 125 Single-Case Experimental Designs / 113 Answers to Concept Checks 125 x  c o n t e n t s Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 10 14/10/16 10:41 AM  5 Anxiety, Trauma- and Stressor-Related, and Obsessive- Compulsive and Related Disorders   126 The Complexity of Anxiety Trauma- and Disorders 127 Stressor- Related Anxiety, Fear, and Panic: Some Definitions / 127 Disorders 160 Causes of Anxiety and Related Disorders / 129 Posttraumatic Stress Comorbidity of Anxiety and Related Disorders / 132 Disorder (PTSD) 160 Comorbidity with Physical Disorders / 133 Clinical Description / 160 Suicide / 133 Statistics / 161 Anxiety Disorders 134 Causes / 162 Treatment / 165 Generalized Anxiety Disorder 134 Clinical Description / 135 Obsessive-Compulsive and Related Statistics / 135 Disorders 168 Causes / 136 Obsessive-Compulsive Disorder 168 Treatment / 137 Clinical Description / 168 Panic Disorder and Agoraphobia 139 Statistics / 170 Clinical Description / 140 Causes / 170 Statistics / 140 Treatment / 171 Causes / 143 Body Dysmorphic Disorder 172 Treatment / 145 Plastic Surgery and Other Medical Treatments / 176 Specific Phobia 147 Other Obsessive-Compulsive and Related Clinical Description / 147 Disorders 176 Statistics / 150 Hoarding Disorder / 176 Causes / 151 Trichotillomania (Hair Pulling Disorder) and Treatment / 153 Excoriation (Skin Picking Disorder) / 177 Social Anxiety Disorder (Social Summary 180 Phobia) 154 Key Terms 181 Clinical Description / 154 Answers to Concept Checks 181 Statistics / 155 Causes / 156 Treatment / 157 6 Somatic Symptom and Related Disorders and Dissociative Disorders   184 Somatic Symptom and Related Illness Anxiety Disorders 185 Disorder 187 Clinical Description / 187 Somatic Symptom Disorder 186 Statistics / 188 c o n t e n t s   xi Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 11 14/10/16 10:41 AM  Causes / 189 Dissociative Amnesia 200 Treatment / 191 Dissociative Identity Disorder 203 Psychological Factors Affecting Medical Clinical Description / 203 Condition 192 Characteristics / 204 Conversion Disorder (Functional Can DID Be Faked? / 204 Neurological Symptom Disorder) 193 Statistics / 206 Causes / 207 Clinical Description / 193 Suggestibility / 207 Closely Related Disorders / 193 Biological Contributions / 208 Unconscious Mental Processes / 195 Real Memories and False / 208 Statistics / 196 Treatment / 210 Causes / 197 Treatment / 198 Summary 212 Dissociative Disorders 198 Key Terms 213 Answers to Concept Checks 213 Depersonalization-Derealization Disorder 199 7 Mood Disorders and Suicide   216 Understanding and Defining Mood Social and Cultural Dimensions / 247 Disorders 217 An Integrative Theory / 249 An Overview of Depression and Mania / 218 The Structure of Mood Disorders / 219 Treatment of Mood Depressive Disorders / 220 Disorders 251 Additional Defining Criteria for Depressive Medications / 251 Disorders / 222 Electroconvulsive Therapy and Transcranial Other Depressive Disorders / 229 Magnetic Stimulation / 254 Bipolar Disorders / 231 Psychological Treatments for Depression / 255 Additional Defining Criteria for Bipolar Combined Treatments for Depression / 258 Disorders / 232 Preventing Relapse of Depression / 259 Prevalence of Mood Disorders 234 Psychological Treatments for Bipolar Disorder / 260 Prevalence in Children, Adolescents, and Older Adults / 235 Suicide 262 Life Span Developmental Influences on Mood Statistics / 262 Disorders / 235 Causes / 263 Across Cultures / 237 Risk Factors / 263 Among Creative Individuals / 237 Is Suicide Contagious? / 265 Causes of Mood Disorders 238 Treatment / 265 Biological Dimensions / 239 Summary 268 Additional Studies of Brain Structure and Function / 242 Key Terms 269 Psychological Dimensions / 242 Answers to Concept Checks 269 xii  c o n t e n t s Copyright 2018 Cengage Learning. 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WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 12 14/10/16 10:41 AM  8 Eating and Sleep–Wake Disorders   272 Major Types of Eating Disorders 273 Sleep–Wake Bulimia Nervosa / 275 Disorders: The Major Anorexia Nervosa / 277 Dyssomnias 301 Binge-Eating Disorder / 279 An Overview of Sleep–Wake Statistics / 280 Disorders / 301 Insomnia Disorder / 302 Causes of Eating Disorders 284 Hypersomnolence Disorders / 307 Social Dimensions / 284 Narcolepsy / 308 Biological Dimensions / 287 Breathing-Related Sleep Disorders / 309 Psychological Dimensions / 288 Circadian Rhythm Sleep Disorder / 310 An Integrative Model / 289 Treatment of Sleep Disorders 311 Treatment of Eating Disorders 289 Medical Treatments / 311 Drug Treatments / 289 Environmental Treatments / 313 Psychological Treatments / 290 Psychological Treatments / 313 Preventing Eating Disorders / 294 Preventing Sleep Disorders / 314 Parasomnias and Their Treatment / 314 Obesity 295 Statistics / 295 Summary 318 Disordered Eating Patterns in Cases of Obesity / 296 Key Terms 319 Causes / 297 Answers to Concept Checks 319 Treatment / 298 9 Physical Disorders and Health Psychology   322 Psychological and Social Factors That Psychosocial Influence Health 323 Treatment of Physical Health and Health-Related Behavior / 323 Disorders 348 The Nature of Stress / 325 Biofeedback / 348 The Physiology of Stress / 325 Relaxation and Contributions to the Stress Response / 326 Meditation / 349 Stress, Anxiety, Depression, and Excitement / 327 A Comprehensive Stress- and Pain-Reduction Program / 349 Stress and the Immune Response / 328 Drugs and Stress-Reduction Programs / 351 Psychosocial Effects on Physical Denial as a Means of Coping / 351 Disorders 331 Modifying Behaviors to Promote Health / 352 AIDS / 331 Summary 356 Cancer / 334 Cardiovascular Problems / 336 Key Terms 357 Hypertension / 336 Answers to Concept Checks 357 Coronary Heart Disease / 339 Chronic Pain / 342 Chronic Fatigue Syndrome / 345 c o n t e n t s   xiii Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 13 14/10/16 10:41 AM  10 Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria   360 What Is Normal Sexuality? 361 Voyeuristic and Exhibitionistic Disorders / 384 Gender Differences / 363 Transvestic Disorder / 384 Cultural Differences / 364 Sexual Sadism and Sexual The Development of Sexual Orientation / 365 Masochism Disorders / 386 An Overview of Sexual Pedophilic Disorder and Incest / 387 Dysfunctions 366 Paraphilic Disorders in Women / 388 Sexual Desire Disorders / 368 Causes of Paraphilic Disorders / 389 Sexual Arousal Disorders / 369 Orgasm Disorders / 370 Assessing and Treating Paraphilic Sexual Pain Disorder / 372 Disorders 390 Psychological Treatment / 390 Assessing Sexual Behavior 373 Drug Treatments / 392 Interviews / 373 Medical Examination / 373 Gender Dysphoria 393 Psychophysiological Assessment / 374 Defining Gender Dysphoria / 393 Causes / 395 Causes and Treatment of Sexual Treatment / 396 Dysfunction 374 Causes of Sexual Dysfunction / 374 Summary 400 Treatment of Sexual Dysfunction / 379 Key Terms 401 Paraphilic Disorders: Clinical Answers to Concept Checks 401 Descriptions 382 Fetishistic Disorder / 383 11 Substance-Related, Addictive, and Impulse-Control Disorders  404 Perspectives on Substance-Related Opioid-Related and Addictive Disorders 405 Disorders 422 Levels of Involvement / 406 Cannabis-Related Diagnostic Issues / 408 Disorders 423 Depressants 409 Hallucinogen-Related Disorders 424 Alcohol-Related Disorders / 409 Sedative-, Hypnotic-, or Anxiolytic-Related Other Drugs of Abuse 427 Disorders / 414 Causes of Substance-Related Stimulants 416 Disorders 428 Stimulant-Related Disorders / 416 Biological Dimensions / 428 Tobacco-Related Disorders / 420 Psychological Dimensions / 431 Caffeine-Related Disorders / 421 Cognitive Dimensions / 432 xiv  c o n t e n t s Copyright 2018 Cengage Learning. 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WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 14 14/10/16 10:41 AM  Social Dimensions / 432 Gambling Disorder 441 Cultural Dimensions / 433 An Integrative Model / 434 Impulse-Control Disorders 442 Intermittent Explosive Disorder / 442 Treatment of Substance-Related Kleptomania / 443 Disorders 435 Pyromania / 443 Biological Treatments / 436 Psychosocial Treatments / 437 Summary 444 Prevention / 440 Key Terms 445 Answers to Concept Checks 445 12 Personality Disorders  448 An Overview of Personality Histrionic Personality Disorder / 472 Disorders 449 Narcissistic Personality Aspects of Personality Disorders / 449 Disorder / 474 Categorical and Dimensional Models / 450 Personality Disorder Clusters / 451 Cluster C Personality Statistics and Development / 451 Disorders 476 Gender Differences / 452 Avoidant Personality Disorder / 476 Comorbidity / 454 Dependent Personality Disorder / 477 Personality Disorders under Study / 455 Obsessive-Compulsive Personality Disorder / 478 Cluster A Personality Disorders 455 Summary 480 Paranoid Personality Disorder / 455 Key Terms 481 Schizoid Personality Disorder / 457 Answers to Concept Checks 481 Schizotypal Personality Disorder / 459 Cluster B Personality Disorders 461 Antisocial Personality Disorder / 461 Borderline Personality Disorder / 469 13 Schizophrenia Spectrum and Other Psychotic Disorders  484 Perspectives on Schizophrenia 485 Historic Schizophrenia Subtypes / 493 Early Figures in Diagnosing Schizophrenia / 485 Other Psychotic Disorders / 494 Identifying Symptoms / 486 Prevalence and Causes Clinical Description, Symptoms, of Schizophrenia 497 and Subtypes 488 Statistics / 497 Positive Symptoms / 488 Development / 498 Negative Symptoms / 491 Cultural Factors / 499 Disorganized Symptoms / 492 Genetic Influences / 499 c o n t e n t s   xv Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 15 14/10/16 10:41 AM  Neurobiological Influences / 502 Treatment across Cultures / 513 Psychological and Social Influences / 506 Prevention / 514 Treatment of Schizophrenia 508 Summary 516 Biological Interventions / 508 Key Terms 517 Psychosocial Interventions / 510 Answers to Concept Checks 517 14 Neurodevelopmental Disorders  520 Overview of Neurodevelopmental Prevention of Disorders 521 Neurodevelopmental What Is Normal? What Is Abnormal? / 522 Disorders 547 Attention-Deficit/Hyperactivity Summary 549 Disorder 522 Key Terms 549 Specific Learning Disorder 529 Answers to Concept Checks 549 Autism Spectrum Disorder 534 Treatment of Autism Spectrum Disorder / 538 Intellectual Disability (Intellectual Development Disorder) 540 Causes / 543 15 Neurocognitive Disorders  552 Perspectives on Neurocognitive Other Medical Conditions That Cause Neurocognitive Disorders 553 Disorder / 563 Delirium 554 Substance/Medication- Induced Neurocognitive Clinical Description and Statistics / 554 Disorder / 567 Treatment / 555 Causes of Neurocognitive Prevention / 555 Disorders / 567 Treatment / 570 Major and Mild Neurocognitive Prevention / 574 Disorders 556 Clinical Description and Statistics / 558 Summary 575 Neurocognitive Disorder Due to Alzheimer’s Key Terms 576 Disease / 559 Answers to Concept Checks 577 Vascular Neurocognitive Disorder / 562 xvi  c o n t e n t s Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 16 14/10/16 10:41 AM  16 Mental Health Services: Legal and Ethical Issues   580 Perspectives on Mental Health Law 581 Patients’ Rights and Clinical Practice Civil Commitment 581 Guidelines 592 Criteria for Civil Commitment / 582 The Right to Treatment / 592 Procedural Changes Affecting Civil The Right to Refuse Commitment / 584 Treatment / 593 An Overview of Civil Commitment / 586 The Rights of Research Participants / 593 Criminal Commitment 587 Evidence-Based Practice and Clinical Practice The Insanity Defense / 587 Guidelines / 594 Reactions to the Insanity Defense / 588 Therapeutic Jurisprudence / 590 Conclusions 596 Competence to Stand Trial / 590 Duty to Warn / 591 Summary 597 Mental Health Professionals as Expert Key Terms 597 Witnesses / 591 Answers to Concept Checks 597 Glossary G-1 References R-1 Name Index I-1 Subject Index I-27 c o n t e n t s   xvii Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 17 14/10/16 10:41 AM  Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 18 14/10/16 10:41 AM  Preface S cience is a constantly evolving field, but every now and then something groundbreaking occurs that alters our way of thinking. For example, evolutionary biologists, who long assumed that the process of evolution was gradual, sud­ denly had to adjust to evidence that says evolution happens in fits affect neurotransmitter function and even genetic expression. Similarly, we cannot study behavioral, cognitive, or emotional processes without appreciating the contribution of biological and social factors to psychological and psychopathological expression. Instead of compartmentalizing psychopathology, we use a more and starts in response to such cataclysmic environmental events as accessible approach that accurately reflects the current state of our meteor impacts. Similarly, geology has been revolutionized by the clinical science. discovery of plate tectonics. As colleagues, you are aware that we understand some disor­ Until recently, the science of psychopathology had been com­ ders better than others. But we hope you will share our excitement partmentalized, with psychopathologists examining the separate in conveying to students both what we currently know about the effects of psychological, biological, and social influences. This causes and treatments of psychopathology and how far we have approach is still reflected in popular media accounts that describe, yet to go in understanding these complex interactions. for example, a newly discovered gene, a biological dysfunction (chemical imbalance), or early childhood experiences as a “cause” of a psychological disorder. This way of thinking still dominates Integrative Approach discussions of causality and treatment in some psychology text­ As noted earlier, the first edition of Abnormal Psychology pio­ books: “The psychoanalytic views of this disorder are... ,” “the neered a new generation of abnormal psychology textbooks, biological views are... ,” and, often in a separate chapter, “psycho­ which offer an integrative and multidimensional perspective. (We analytic treatment approaches for this disorder are... ,” “cognitive acknowledge such one-dimensional approaches as biological, psy­ behavioral treatment approaches are... ,” or “biological treatment chosocial, and supernatural as historic perspectives on our field.) approaches are...” We include substantial current evidence of the reciprocal influ­ In the first edition of this text, we tried to do something very ences of biology and behavior and of psychological and social different. We thought the field had advanced to the point that it influences on biology. Our examples hold students’ attention; for was ready for an integrative approach in which the intricate inter­ example, we discuss genetic contributions to divorce, the effects actions of biological, psychological, and social factors are expli­ of early social and behavioral experience on later brain function cated in as clear and convincing a manner as possible. Recent and structure, new information on the relation of social networks explosive advances in knowledge confirm this approach as the to the common cold, and new data on psychosocial treatments for only viable way of understanding psychopathology. To take just cancer. We note that in the phenomenon of implicit memory and two examples, Chapter 2 contains a description of a study demon­ blind sight, which may have parallels in dissociative experiences, strating that stressful life events can lead to depression but that not psychological science verifies the existence of the unconscious everyone shows this response. Rather, stress is more likely to cause (although it does not much resemble the seething caldron of con­ depression in individuals who already carry a particular gene flicts envisioned by Freud). We present new evidence confirming that influences serotonin at the brain synapses. Similarly, Chap­ the effects of psychological treatments on neurotransmitter flow ter 9 describes how the pain of social rejection activates the same and brain function. We acknowledge the often-neglected area of neural mechanisms in the brain as physical pain. In addition, the emotion theory for its rich contributions to psychopathology (e.g., entire section on genetics has been rewritten to highlight the new the effects of anger on cardiovascular disease). We weave scien­ emphasis on gene–environment interaction, along with recent tific findings from the study of emotions together with behavioral, thinking from leading behavioral geneticists that the goal of bas­ biological, cognitive, and social discoveries to create an integrated ing the classification of psychological disorders on the firm foun­ tapestry of psychopathology. dation of genetics is fundamentally flawed. Descriptions of the emerging field of epigenetics, or the influence of the environment on gene expression, is also woven into the chapter, along with new Life-Span Developmental Influences studies on the seeming ability of extreme environments to largely No modern view of abnormal psychology can ignore the impor­ override the effects of genetic contributions. Studies elucidating tance of life-span developmental factors in the manifestation the mechanisms of epigenetics or specifically how environmental and treatment of psychopathology. Studies highlighting devel­ events influence gene expression are described. opmental windows for the influence of the environment on gene These results confirm the integrative approach in this book: expression are explained. Accordingly, although we include a Psychological disorders cannot be explained by genetic or envi­ Neurodevelopmental Disorders chapter (Chapter 14), we con­ ronmental factors alone but rather arise from their interaction. sider the importance of development throughout the text; we dis­ We now understand that psychological and social factors directly cuss childhood and geriatric anxiety, for example, in the context   xix Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 19 14/10/16 10:41 AM  of the Anxiety, Trauma- and Stressor-Related, and Obsessive- have retained this integrative format and have improved upon Compulsive and Related Disorders chapter (Chapter 5). This sys­ it, and we include treatment procedures in the key terms and tem of organization, which is for the most part consistent with glossary. DSM-5, helps students appreciate the need to study each disorder from childhood through adulthood and old age. We note findings Legal and Ethical Issues on developmental considerations in separate sections of each dis­ In our closing chapter, we integrate many of the approaches and order chapter and, as appropriate, discuss how specific develop­ themes that have been discussed throughout the text. We include mental factors affect causation and treatment. case studies of people who have been involved directly with many legal and ethical issues and with the delivery of mental health ser­ Scientist–Practitioner Approach vices. We also provide a historical context for current perspectives We go to some lengths to explain why the scientist–practitioner so students will understand the effects of social and cultural influ­ approach to psychopathology is both practical and ideal. Like ences on legal and ethical issues. most of our colleagues, we view this as something more than sim­ ple awareness of how scientific findings apply to psychopathol­ Diversity ogy. We show how every clinician contributes to general scientific Issues of culture and gender are integral to the study of psychopa­ knowledge through astute and systematic clinical observations, thology. Throughout the text, we describe current thinking about functional analyses of individual case studies, and systematic which aspects of the disorders are culturally specific and which observations of series of cases in clinical settings. For example, are universal, and about the strong and sometimes puzzling effects we explain how information on dissociative phenomena provided of gender roles. For instance, we discuss the current information by early psychoanalytic theorists remains relevant today. We also on such topics as the gender imbalance in depression, how panic describe the formal methods used by scientist–practitioners, disorders are expressed differently in various Asian cultures, the showing how abstract research designs are actually implemented ethnic differences in eating disorders, treatment of schizophrenia in research programs. across cultures, and the diagnostic differences of attention deficit/ hyperactivity disorder (ADHD) in boys and girls. Clearly, our field Clinical Cases of Real People will grow in depth and detail as these subjects and others become We have enriched the book with authentic clinical histories to standard research topics. For example, why do some disorders illustrate scientific findings on the causes and treatment of psy­ overwhelmingly affect females and others appear predominantly chopathology. We have run active clinics for years, so 95% of in males? And why does this apportionment sometimes change the cases are from our own files, and they provide a fascinating from one culture to another? In answering questions like these, frame of reference for the findings we describe. The beginnings we adhere closely to science, emphasizing that gender and cul­ of most chapters include a case description, and most of the ture are each one dimension among several that constitute discussion of the latest theory and research is related to these psychopathology. very human cases. Disorders in Detail New to This Edition We cover the major psychological disorders in 11 chapters, A Thorough Update focusing on three broad categories: clinical description, causal This exciting field moves at a rapid pace, and we take particular factors, and treatment and outcomes. We pay considerable pride in how our book reflects the most recent developments. attention to case studies and DSM-5 criteria, and we include Therefore, once again, every chapter has been carefully revised statistical data, such as prevalence and incidence rates, sex to reflect the latest research studies on psychological disorders. ratio, age of onset, and the general course or pattern for the dis­ Hundreds of new references from 2015 to 2016 (and some still order as a whole. Since several of us were appointed Advisors “in press”) appear for the first time in this edition, and some of to the DMS-5 task force, we are able to include the reasons for the information they contain stuns the imagination. Nonessential changes as well as the changes themselves. Throughout, we material has been eliminated, some new headings have been explore how biological, psychological, and social dimensions added, and DSM-5 criteria are included in their entirety as tables may interact to cause a particular disorder. Finally, by covering in the appropriate disorder chapters. treatment and outcomes within the context of specific disor­ Anxiety, Trauma- and Stressor-Related, and Obsessive- ders, we provide a realistic sense of clinical practice. Compulsive and Related Disorders (Chapter 5), Mood Disor­ ders and Suicide (Chapter 7), Eating and Sleep–Wake Disorders Treatment (Chapter 8), Physical Disorders and Health Psychology (Chapter 9), One of the best received innovations in the first seven editions was Substance-Related, Addictive, and Impulse-Control Disorders our strategy of discussing treatments in the same chapter as the (Chapter 11), Schizophrenia Spectrum and Other Psychotic Disor­ disorders themselves instead of in a separate chapter, an approach ders (Chapter 13), and Neurodevelopmental Disorders (Chapter 14) that is supported by the development of specific psychosocial and have been the most heavily revised to reflect new research, but all pharmacological treatment procedures for specific disorders. We chapters have been significantly updated and freshened. xx  P R E FA C E Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 50443_fm_ptg01_hr_i-1.indd 20 14/10/16 10:41 AM  Chapter 1, Abnormal Behavior in Historical Context, features Updated generalized anxiety disorder discussion, espe­ updated nomenclature to reflect new titles in DSM-5, updated cially about newer treatment approaches; descriptions of research on defense mechanisms, and fuller and Updated information on description, etiology, and treat­ deeper descriptions of the historical development of psychody­ ment for specific phobia, social anxiety disorder, and namic and psychoanalytic approaches. posttraumatic stress disorder. Chapter 2, An Integrative Approach to Psychopathology, includes an updated discussion of developments in the study of The grouping of disorders in Chapter 6, now titled Somatic genes and behavior with a focus on gene–environment interaction; Symptom and Related Disorders and Dissociative Disorders, new data illustrating the gene–environment correlation model; new reflects a major overarching change, specifically for somatic studies illustrating the psychosocial influence on the development symptom disorder, illness anxiety disorder (formerly known as of brain structure and function in general and on neurotransmit­ hypochondriasis), and psychological factors affecting medical ter systems specifically; updated, revised, and refreshed sections on