Psychopathology: An Integrative Approach to Mental Disorders Ninth Edition PDF

 Psychopathology An Integrative Approach to Mental Disorders Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapte...

 Psychopathology An Integrative Approach to Mental Disorders Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Ninth Edition Psychopathology An Integrative Approach to Mental Disorders David H. Barlow Boston University V. Mark Durand University of South Florida–St. Petersburg Stefan G. Hofmann Philipps University of Marburg, Germany, and Boston University Australia Brazil Canada Mexico Singapore United Kingdom United States Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest. Important Notice: Media content referenced within the product description or the product text may not be available in the eBook version. Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Psychopathology: An Integrative Approach to Men- © 2023, 2018, 2015 Cengage Learning, Inc. ALL RIGHTS RESERVED. tal Disorders, Ninth Edition David H. Barlow, V. Mark Durand, Stefan G. Hofmann No part of this work covered by the copyright herein may be reproduced or distributed in any form or by any means, except as permitted by U.S. copyright SVP, Higher Education Product Management: law, without the prior written permission of the copyright owner. Erin Joyner Unless otherwise noted, all content is © Cengage, Inc. 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Loose-leaf Edition: ISBN: 978-0-357-65785-0 Designer: Sara Greenwood Cover Image Source: CoffeeAndMilk/Getty Images Cengage 200 Pier 4 Boulevard Boston, MA 02210 USA Cengage 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. To learn more about Cengage platforms and services, register or access your online learning solution, or purchase materials for your course, visit www.cengage.com. Printed in the United States of America Print Number: 01    Print Year: 2022 Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  To my mother, Doris To Wendy and Jonathan, whose To all of those living Elinor Barlow-Lanigan, patience, understanding, and and coping with for her multidimensional love provided me the psychopathology. influence across my opportunity to complete such S. G. H. life span. an ambitious project. D. H. B. V. M. D. Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. About the Authors David H. Barlow is his outstanding leadership in research, education, and clinical an internationally recog- care.” In 2014, he was awarded a presidential citation from the nized pioneer and leader in American Psychological Association “for his lifelong dedication clinical psychology. Cur- and passion for advancing psychology through science, education, rently professor emeritus training, and practice.” In 2018, he received a second presiden- of psychology and psychi- tial citation for his “far-reaching impact on many psychologists atry at Boston University, of color and shaping the future of the discipline in valuing and Dr. Barlow is founder and supporting the potential of all students.” director emeritus of the He also has received career or lifetime contribution awards Center for Anxiety and from the California, Connecticut, and Massachusetts Psycholog- Related Disorders, one of ical Associations, as well as the University of Mississippi Medical the largest research clinics of Center and the Association for Behavioral and Cognitive Ther- its kind in the world. From apies. In 2000, he was named honorary visiting professor at the 1996 to 2004, he directed Chinese People’s Liberation Army General Hospital and Post- the clinical psychology pro- graduate Medical School in Beijing, China, and in 2015, he was grams at Boston University. named honorary president of the Canadian Psychological Asso- From 1979 to 1996, he was ciation. In addition, the annual Grand Rounds in Clinical Psy- distinguished professor at chology at Brown University was named in his honor. During the University at Albany–State University of New York. From the 1997–1998 academic year, he was Fritz Redlich Fellow at the 1975 to 1979, he was professor of psychiatry and psychology at Center for Advanced Study in the Behavioral Sciences in Palo Brown University, where he also founded the clinical psychology Alto, California. His research has been continually funded by the internship program. From 1969 to 1975, he was professor of psy- National Institutes of Health for over 50 years. chiatry at the University of Mississippi Medical Center, where he Dr. Barlow has edited several journals, including Clinical founded the psychology residency program. Psychology: Science and Practice and Behavior Therapy, has served on Growing up in sports-obsessed Boston, he reached what turned the editorial boards of more than 20 different journals, and is currently out to be the peak of his athletic career at age 12 when his team went editor in chief of the “Treatments That Work” series for Oxford Uni- to the Little League Baseball World Series. When it became clear that versity Press. He has published more than 650 scholarly articles and his athletic career was going no further, he hit the books, receiving chapters and written or edited more than 90 books and clinical man- his B.A. from the University of Notre Dame, his M.A. from Boston uals, including Anxiety and Its Disorders, second edition (Guilford College, and his Ph.D. from the University of Vermont. Press); Clinical Handbook of Psychological Disorders: A Step-by-Step A fellow of every major psychological association, Dr. Barlow Treatment Manual, fifth edition (Guilford Press); Single-Case Exper- has received many awards in honor of his excellence in schol- imental Designs: Strategies for Studying Behavior Change, third edi- arship, including the National Institute of Mental Health Merit tion (Allyn & Bacon) (with Matthew Nock and Michael Hersen); The Award for his long-term contributions to the clinical research Scientist–Practitioner: Research and Accountability in the Age of Man- effort. He has also received the two highest awards in psychology— aged Care, second edition (Allyn & Bacon) (with Steve Hayes and the Distinguished Scientist Award from the American Psycho- Rosemary Nelson-Gray); Mastery of Your Anxiety and Panic (Oxford logical Association, which is given for applications of psychology, University Press) (with Michelle Craske); and, more recently, The and the James McKeen Cattell Fellow Award from the Association Unified Protocol for Transdiagnostic Treatment of Emotional Disor- for Psychological Science, which honors individuals for a lifetime ders, second edition (Oxford University Press) (with the Unified of significant intellectual achievements in applied psychologi- Protocol team at Boston University). The books and manuals have cal research. Other awards include the Distinguished Scientist been translated into more than 20 languages, including Arabic, Award from the Society of Clinical Psychology of the American Chinese, Hindi, and Russian. His research has been cited over Psychological Association and a certificate of appreciation from 130,000 times with a Google scholar h-index of 160. the APA section on the clinical psychology of women for “out- Dr. Barlow was one of three psychologists on the task force standing commitment to the advancement of women in psychol- that was responsible for reviewing the work of more than 1,000 ogy.” He was awarded an honorary doctorate of science from the mental health professionals who participated in the creation of University of Vermont, an honorary doctorate of humane letters DSM-IV, and he continued on as an adviser to the DSM-5 task from William James College, as well as the C. Charles Burlingame force. He also chaired the APA task force on Psychological Inter- Award from the Institute of Living in Hartford Connecticut “for vention Guidelines, which created a template for the creation of vi   Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. clinical practice guidelines. His current research program focuses At leisure, he plays golf, skis, and retreats to his home on on the nature and treatment of anxiety and related emotional Nantucket Island, where he loves to write, walk on the beach, disorders. and visit with his island friends. V. Mark Durand is known disorder. Dr. Durand was elected to serve as president of the worldwide as an authority in ­ merican Psychological Association’s Division 33 (Intellectual A the area of autism spectrum and Developmental Disabilities / Autism Spectrum Disorders) disorder. He is a Distinguished for 2019. Un i v e r s i t y P r o f e s s o r o f Dr. Durand is currently a member of the Professional psychology at the University of ­Advisory Board for the Autism Society of America and was on South Florida–St. Petersburg, the board of directors of the International Association of Positive where he was the founding Behavioral Support. He was coeditor of the Journal of Positive dean of Arts and Sciences and Behavior Interventions, serves on a number of editorial boards, vice chancellor for academic and has more than 145 publications on functional communication affairs. Dr. Durand is a fellow training, educational programming, and behavior therapy. His of the American Psychological books include Severe Behavior Problems: A Functional Communi- Association. He has received cation Training Approach (Guilford Press); Sleep Better! A Guide more than $4 million in federal to Improving Sleep for Children with Special Needs (Brookes); funding since the beginning of Helping Parents with Challenging Children: Positive Family Inter- his career to study the nature, vention (Oxford University Press) (with Meme Hieneman); the assessment, and treatment of multiple national award-winning Optimistic Parenting: Hope and behavior problems in children Help for You and Your Challenging Child (Brookes); and most with disabilities. Before moving to Florida, he served in a variety of recently Autism Spectrum Disorder: A Clinical Guide for General leadership positions at the University at Albany, including associate Practitioners (American Psychological Association). director for clinical training for the doctoral psychology program Dr. Durand developed a unique treatment for severe behavior from 1987 to 1990, chair of the clinical department from 1995 to problems that is currently mandated by states across the country 1998, and interim dean of Arts and Sciences from 2001 to 2002. and is used worldwide. He also developed an assessment tool There he established the Center for Autism and Related Disabilities that is used internationally and has been translated into more at the University at Albany–SUNY. He received his B.A., M.A., than 15 languages. Most recently, he developed an innovative and Ph.D.—all in psychology—at the State University of New approach to help families work with their challenging child York–Stony Brook. (Optimistic Parenting), which was validated in a 5-year clinical Dr. Durand was awarded the University Award for Excellence in trial and is being used all over the world. He has been consulted Teaching at SUNY–Albany in 1991 and was given the Chancellor’s by the departments of education in numerous states and by the Award for Excellence in Research and Creative Scholarship at the U.S. Departments of Justice and Education. His current research University of South Florida–St. Petersburg in 2007. He was named a ­program includes the study of prevention models and treatments 2014 Princeton Lecture Series Fellow and received the 2015 Jacobson for such serious problems as self-injurious behavior. Award for Critical Thinking from the American Psychological In his leisure time, he enjoys long-distance running and has Association for his body of work in the field of autism spectrum completed three marathons. About the Author   vii Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Stefan G. Hofmann is mindfulness approaches, such as yoga and meditation practices, an international expert on as treatment strategies of emotional disorders. Furthermore, he psychotherapy for emotional has been one of the leaders in translational research methods to disorders. He is the Alexander enhance the efficacy of psychotherapy and to predict treatment von Humboldt Professor outcome using neuroscience methods. He is codeveloper (with of Translational Clinical Steven Hayes) of process-based therapy. Psychology at the Philipps He has won many prestigious professional awards, including University of Marburg and the Aaron T. Beck Award for Significant and Enduring Contri- professor of psychology at butions to the Field of Cognitive Therapy by the Academy of Boston University. He was Cognitive Therapy. He is a fellow of the American Psychological born in a little town near Association and the Association for Psychological Science and Stuttgart in Germany, which was president of various national and international professional may explain his German societies, including the Association for Behavioral and Cognitive accent. He studied psychol- Therapies and the International Association for Cognitive ogy at the Philipps Univer- Psychotherapy. He was an adviser to the DSM-5 Development sity of Marburg, Germany, Process and a member of the DSM-5 Anxiety Disorder Sub- where he received his B.A., Work Group. As part of this, he participated in the discussions M.S., and Ph.D. A brief dissertation fellowship to spend some time at about the revisions of the DSM-5 criteria for various anxiety Stanford University turned into a longer research career in the United disorders, especially social anxiety disorder, panic disorder, and States. He eventually moved to the United States in 1994 to join Dr. agoraphobia. Dr. Hofmann is a Thomson Reuters’ Highly Cited Barlow’s team at the University at Albany–State University of New Researcher. York. He has been a professor at Boston University since 1996 and Dr. Hofmann has been the editor in chief of Cognitive Therapy received an Alexander von Humboldt Professorship for the Philipps and Research, and he has published more than 400 peer-reviewed University of Marburg, Germany, in 2021. He now lives in Frankfurt, journal articles and 20 books, including An Introduction of Modern Germany, Boston, and Cape Cod. CBT (Wiley-Blackwell) and Emotion in Therapy (Guilford Press). Dr. Hofmann has an actively funded research program At leisure, he enjoys playing with his sons. He likes traveling studying various aspects of emotional disorders with a particular to immerse himself into new cultures, make new friends, and emphasis on anxiety disorders, cognitive behavioral therapy, reconnect with old ones. When time permits, he occasionally gets and neuroscience. More recently, he has been interested in out his flute. viii  About the Author Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Brief Contents 1 Psychopathology in Historical Context  2 2 An Integrative Approach to Psychopathology  30 3 Clinical Assessment and Diagnosis  72 4 Research Methods  102 5 Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders  124 6 Somatic Symptom and Related Disorders and Dissociative Disorders  180 7 Mood Disorders and Suicide  210 8 Eating and Sleep–Wake Disorders  266 9 Physical Disorders and Health Psychology  318 10 Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria  356 11 Substance-Related, Addictive, and Impulse-Control Disorders  400 12 Personality Disorders  444 13 Schizophrenia Spectrum and Other Psychotic Disorders  480 14 Neurodevelopmental Disorders  516 15 Neurocognitive Disorders  548 16 Mental Health Services: Legal and Ethical Issues  574   ix Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Contents 1 Psychopathology in Historical Context   2 Understanding Psychopathology 3 Consequences of the Biological Tradition / 14 What Is a Psychological Disorder? / 3 The Science of Psychopathology / 6 The Psychological Historical Conceptions of Abnormal Behavior / 8 Tradition 15 Moral Therapy / 15 The Supernatural Tradition 8 Asylum Reform and the Demons and Witches / 8 Decline of Moral Therapy / 16 Stress and Melancholy / 9 Psychoanalytic Theory / 17 Treatments for Possession / 10 Humanistic Theory / 22 Mass Hysteria / 11 The Cognitive-Behavioral Model / 23 Modern Mass Hysteria / 11 The Moon and the Stars / 11 The Present: The Scientific Method and an Integrative Approach 25 The Biological Tradition 12 Hippocrates and Galen / 12 Summary 26 The 19th Century / 13 Key Terms 27 The Development of Biological Treatments / 14 Answers to Concept Checks 27 2 An Integrative Approach to Psychopathology   30 One-Dimensional versus The Structure of the Brain / 43 Multidimensional Models 31 The Peripheral Nervous System / 45 What Caused Janelle’s Phobia? / 31 Neurotransmitters / 47 Outcome and Comments / 33 Implications for Genetic Contributions to Psychopathology / 51 Psychopathology 34 Psychosocial Influences on Brain Structure and Function / 52 The Nature of Genes / 34 Interactions of Psychosocial Factors New Developments in the Study of Genes and and Neurotransmitter Systems / 54 Behavior / 35 Psychosocial Effects on the Development The Interaction of Genes of Brain Structure and Function / 55 and the Environment / 36 The Brain–Gut Connection / 56 Epigenetics and the Nongenomic “Inheritance” Comments / 56 of Behavior / 39 Neuroscience and Its Contributions to Behavioral and Cognitive Science 57 Psychopathology 41 Conditioning and Cognitive Processes / 57 Learned Helplessness / 58 The Central Nervous System / 41   xi Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Social Learning / 58 Voodoo, the Evil Eye, and Other Fears / 63 Prepared Learning / 58 Gender / 64 Cognitive Science and the Unconscious / 59 Social Effects on Health and Behavior / 65 Global Incidence of Psychological Emotions 60 Disorders / 67 The Physiology and Purpose of Fear / 60 Emotional Phenomena / 60 Life-Span Development 67 The Components of Emotion / 61 Conclusions 69 Anger and Your Heart / 62 Emotions and Psychopathology / 63 Summary 70 Key Terms 71 Cultural, Social, and Interpersonal Answers to Concept Checks 71 Factors 63 3 Clinical Assessment and Diagnosis   72 Assessing Psychological Disorders 73 Diagnosis before 1980 / 93 Key Concepts in Assessment / 74 DSM-III and DSM-III-R / 93 The Clinical Interview / 75 DSM-IV and DSM-IV-TR / 94 Physical Examination / 80 DSM-5 and DSM-5-TR / 94 Behavioral Assessment / 80 Creating and Abandoning Diagnoses / 97 Psychological Testing / 82 Beyond DSM-5: Dimensions Neuropsychological Testing / 86 and Spectra / 99 Neuroimaging: Pictures of the Brain / 87 Psychophysiological Assessment / 88 Summary 100 Key Terms 100 Diagnosing Psychological Disorders 90 Answers to Concept Checks 100 Classification Issues / 91 4 Research Methods  102 Examining Psychopathology 103 Genetics and Behavior Important Concepts / 103 across Time and Basic Components of a Research Study / 103 Cultures 114 Statistical versus Clinical Significance / 105 Studying Behavior over Time / 117 The “Average” Client / 106 Power of a Program of Research / 120 Types of Research Methods 106 Replication / 121 Studying Individual Cases / 106 Research Ethics / 121 Research by Correlation / 107 Summary 123 Research by Experiment / 109 Single-Case Experimental Designs / 111 Key Terms 123 Answers to Concept Checks 123 xii  C o n t e n t s Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 5 Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders   124 The Complexity of Anxiety Trauma and Stressor- Disorders 125 Related Disorders 157 Anxiety, Fear, and Panic: Some Posttraumatic Stress Disorder Definitions / 125 (PTSD) / 157 Causes of Anxiety and Related Disorders / 126 Prolonged Grief Disorder / 163 Comorbidity of Anxiety and Related Disorders / 130 Obsessive-Compulsive and Related Comorbidity with Physical Disorders / 131 Disorders 165 Suicide / 131 Obsessive-Compulsive Disorder / 165 Body Dysmorphic Disorder / 169 Anxiety Disorders 132 Other Obsessive-Compulsive and Generalized Anxiety Disorder / 132 Related Disorders / 173 Panic Disorder and Agoraphobia / 137 Summary 175 Specific Phobia / 145 Social Anxiety Disorder (Social Phobia) / 151 Key Terms 177 Answers to Concept Checks 177 6 Somatic Symptom and Related Disorders and Dissociative Disorders  180 Somatic Symptom and Related Dissociative Disorders 181 Disorders 193 Somatic Symptom Disorder / 181 Depersonalization-Derealization Illness Anxiety Disorder / 182 Disorder / 194 Psychological Factors Affecting Dissociative Amnesia / 195 Medical Condition / 188 Dissociative Identity Disorder / 198 Conversion Disorder (Functional Neurological Symptom Disorder) / 189 Summary 207 Key Terms 207 Answers to Concept Checks 207 7 Mood Disorders and Suicide   210 Understanding and Defining Mood Bipolar Disorders / 224 Disorders 211 Additional Defining Criteria for Bipolar An Overview of Depression and Mania / 212 Disorders / 226 The Structure of Mood Disorders / 213 Depressive Disorders / 214 Prevalence of Mood Additional Defining Criteria for Depressive Disorders 227 Disorders / 216 Prevalence in Children, Other Depressive Disorders / 222 Adolescents, and Older Adults / 228 C o n t e n t s   xiii Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Life Span Developmental Influences on Mood Combined Treatments for Depression / 252 Disorders / 229 Preventing Relapse of Depression / 252 Across Cultures / 231 Psychological Treatments for Bipolar Among Creative Individuals / 231 Disorder / 254 Causes of Mood Disorders 232 Suicide 254 Biological Dimensions / 233 Statistics / 255 Additional Studies of Brain Structure Causes / 257 and Function / 236 Risk Factors / 257 Psychological Dimensions / 236 Existing Psychological Disorders and Other Social and Cultural Dimensions / 240 Psychological Risk Factors / 258 Marital Relations / 240 Stressful Life Events / 258 An Integrative Theory / 243 Is Suicide Contagious? / 259 Treatment / 259 Treatment of Mood Disorders 244 Medications / 245 Summary 262 Electroconvulsive Therapy and Transcranial Key Terms 263 Magnetic Stimulation / 248 Answers to Concept Checks 263 Psychological Treatments for Depression / 249 8 Eating and Sleep–Wake Disorders   266 Major Types of Eating Disorders 267 Sleep–Wake Bulimia Nervosa / 268 Disorders: The Major Anorexia Nervosa / 271 Dyssomnias 295 Binge-Eating Disorder / 273 An Overview of Sleep–Wake Statistics / 274 Disorders / 295 Insomnia Disorder / 297 Causes of Eating Disorders 278 Hypersomnolence Disorders / 301 Social Dimensions / 278 Narcolepsy / 302 Biological Dimensions / 281 Breathing-Related Sleep Disorders / 303 Psychological Dimensions / 282 Circadian Rhythm Sleep Disorder / 304 An Integrative Model / 283 Treatment of Sleep Disorders 307 Treatment of Eating Disorders 283 Medical Treatments / 307 Drug Treatments / 283 Environmental Treatments / 308 Psychological Treatments / 284 Psychological Treatments / 308 Preventing Eating Disorders / 288 Preventing Sleep Disorders / 309 Parasomnias and Their Treatment / 309 Obesity 289 Statistics / 289 Summary 313 Disordered Eating Patterns in Cases of Key Terms 314 Obesity / 290 Answers to Concept Checks 314 Causes / 291 Treatment / 291 xiv  C o n t e n t s Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 9 Physical Disorders and Health Psychology   318 Psychological and Social Factors That Chronic Pain / 337 Influence Health 319 Chronic Fatigue Syndrome / 341 Health and Health-Related Behavior / 320 Psychosocial The Nature of Stress / 321 Treatment of Physical The Physiology of Stress / 321 Disorders 344 Contributions to the Stress Response / 322 Biofeedback / 344 Stress, Anxiety, Depression, and Excitement / 323 Relaxation and Meditation / 345 Stress and the Immune Response / 324 A Comprehensive Stress- and Pain-Reduction Program / 346 Psychosocial Effects on Physical Drugs and Stress-Reduction Programs / 347 Disorders 327 Denial as a Means of Coping / 347 AIDS / 327 Modifying Behaviors to Promote Health / 348 Cancer / 329 Cardiovascular Problems / 331 Summary 352 Hypertension / 332 Key Terms 353 Coronary Heart Disease / 334 Answers to Concept Checks 353 10 Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria  356 What Is “Normal” Sexuality? 357 Paraphilic Gender Differences / 359 Disorders: Clinical Cultural Differences / 360 Descriptions 378 The Development of Sexual Orientation / 361 Fetishistic Disorder / 379 Voyeuristic and Exhibitionistic An Overview of Sexual Disorders / 379 Dysfunctions 362 Transvestic Disorder / 380 Sexual Desire Disorders / 363 Sexual Sadism and Sexual Masochism Sexual Arousal Disorders / 364 Disorders / 382 Orgasm Disorders / 366 Pedophilic Disorder and Incest / 383 Sexual Pain Disorder / 368 Paraphilic Disorders in Women / 384 Causes of Paraphilic Disorders / 385 Assessing Sexual Behavior 369 Interviews / 369 Assessing and Treating Paraphilic Medical Examinations / 369 Disorders 386 Psychophysiological Assessments / 369 Psychological Treatment / 387 Drug Treatments / 388 Causes and Treatment of Sexual Dysfunction 370 Gender Dysphoria / 389 Causes of Sexual Dysfunction / 370 Defining Gender Dysphoria / 390 Treatment of Sexual Dysfunction / 375 Causes / 391 C o n t e n t s   xv Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Treatment / 393 Key Terms 397 Summary 396 Answers to Concept Checks 397 11 Substance-Related, Addictive, and Impulse-Control Disorders  400 Perspectives on Substance-Related and Causes of Substance- Addictive Disorders 401 Related Disorders 424 Levels of Involvement / 402 Biological Dimensions / 424 Diagnostic Issues / 404 Psychological Dimensions / 426 Depressants 405 Cognitive Dimensions / 427 Alcohol-Related Disorders / 405 Social Dimensions / 428 Sedative-, Hypnotic-, or Anxiolytic-Related Cultural Dimensions / 429 Disorders / 410 An Integrative Model / 429 Stimulants 411 Treatment of Substance-Related Stimulant-Related Disorders / 411 Disorders 430 Tobacco-Related Disorders / 415 Biological Treatments / 432 Caffeine-Related Disorders / 417 Psychosocial Treatments / 433 Prevention / 436 Opioid-Related Disorders 418 Gambling Disorder 437 Cannabis-Related Disorders 419 Impulse-Control Disorders 438 Hallucinogen-Related Disorders 420 Intermittent Explosive Disorder / 439 Other Commonly Misused Kleptomania / 439 Substances 422 Pyromania / 439 Inhalants / 422 Summary 440 Steroids / 423 Key Terms 441 Designer Drugs / 424 Answers to Concept Checks 441 12 Personality Disorders  444 An Overview of Personality Cluster A Personality Disorders 445 Disorders 451 Aspects of Personality Disorders / 445 Paranoid Personality Categorical and Dimensional Models / 445 Disorder / 452 Personality Disorder Clusters / 447 Schizoid Personality Disorder / 453 Statistics and Development / 447 Schizotypal Personality Gender Differences / 449 Disorder / 455 Comorbidity / 450 Personality Disorders under Study / 450 Cluster B Personality Disorders 457 xvi  C o n t e n t s Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Antisocial Personality Disorder / 457 Dependent Personality Disorder / 473 Borderline Personality Disorder / 465 Obsessive-Compulsive Personality Histrionic Personality Disorder / 469 Disorder / 474 Narcissistic Personality Disorder / 470 Summary 477 Cluster C Personality Disorders 472 Key Terms 477 Avoidant Personality Disorder / 472 Answers to Concept Checks 477 13 Schizophrenia Spectrum and Other Psychotic Disorders  480 Perspectives on Schizophrenia 481 Cultural Factors / 494 Early Figures in Diagnosing Schizophrenia / 481 Genetic Influences / 495 Identifying Symptoms / 482 Neurobiological Influences / 499 Clinical Description, Symptoms, and Psychological and Social Subtypes 483 Influences / 502 Positive Symptoms / 484 Treatment of Schizophrenia 504 Negative Symptoms / 487 Biological Interventions / 505 Disorganized Symptoms / 488 Psychosocial Interventions / 507 Historic Schizophrenia Subtypes / 489 Treatment across Cultures / 510 Other Psychotic Disorders / 489 Prevention / 511 Prevalence and Causes of Summary 512 Schizophrenia 493 Key Terms 513 Statistics / 494 Answers to Concept Checks 513 Development / 494 14 Neurodevelopmental Disorders  516 Overview of Neurodevelopmental Specific Learning Disorders 517 Disorder 525 What Is Typical? What Is Not Typical? / 518 Clinical Description / 525 Statistics / 526 Attention-Deficit/Hyperactivity Causes / 528 Disorder 518 Treatment of Learning Clinical Description / 518 Disorders / 529 Statistics / 520 Causes / 521 Autism Spectrum Disorder 530 Treatment of ADHD / 523 Treatment of Autism Spectrum Disorder / 534 Psychosocial Interventions / 524 Intellectual Disability (Intellectual Biological Interventions / 524 Developmental Disorder) 536 Combined Approach to Causes / 539 Treatment / 525 C o n t e n t s   xvii Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Prevention of Neurodevelopmental Key Terms 545 Disorders 543 Answers to Concept Checks 545 Summary 545 15 Neurocognitive Disorders  548 Perspectives on Neurocognitive Other Medical Conditions That Cause Neurocognitive Disorders 549 Disorder / 558 Delirium 549 Substance/Medication-Induced Neurocognitive Clinical Description and Statistics / 549 Disorder / 563 Treatment / 551 Causes of Neurocognitive Prevention / 551 Disorder / 563 Treatment / 566 Major and Mild Neurocognitive Prevention / 570 Disorders 552 Clinical Description and Statistics / 554 Summary 571 Neurocognitive Disorder Due to Alzheimer’s Key Terms 571 Disease / 555 Answers to Concept Checks 571 Vascular Neurocognitive Disorder / 558 16 Mental Health Services: Legal and Ethical Issues   574 Perspectives on Mental Health Law 575 Patients’ Rights and Clinical Practice Civil Commitment 575 Guidelines 586 Criteria for Civil Commitment / 576 The Right to Treatment / 586 Procedural Changes Affecting Civil The Right to Refuse Commitment / 578 Treatment / 587 An Overview of Civil Commitment / 580 The Rights of Research Participants / 587 Criminal Commitment 581 Evidence-Based Practice and Clinical Practice Guidelines / 588 The Insanity Defense / 581 Reactions to the Insanity Defense / 582 Conclusions 590 Therapeutic Jurisprudence / 584 Summary 591 Competence to Stand Trial / 585 Duty to Warn / 585 Key Terms 591 Mental Health Professionals as Expert Answers to Concept Checks 591 Witnesses / 585 Appendix-A: D  SM-5 Classifications A-1 References R-1 Appendix-B: DSM-5 Disorders for Name Index I-1 Further Study B-1 Subject Index I-29 Glossary G-1 xviii  C o n t e n t s Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 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 understand that psychological and social factors directly affect neu- rotransmitter function and even genetic expression. Similarly, we cannot study behavioral, cognitive, or emotional processes without appreciating the contribution of biological and social factors to psy- chological and psychopathological expression. Instead of compart- and starts in response to such cataclysmic environmental events as mentalizing psychopathology, we use a more accessible approach meteor impacts. Similarly, geology has been revolutionized by the that accurately reflects the current state of our 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 domi- Integrative Approach nates discussions of causality and treatment in some psychology As noted earlier, the first edition of this book pioneered a new gen- textbooks: “The psychoanalytic views of this disorder are... ,” eration of such textbooks, which offer an integrative and multidi- “the biological views are... ,” and, often in a separate chapter, mensional perspective. (We acknowledge such one-dimensional “psychoanalytic treatment approaches for this disorder are... ,” approaches as biological, psychosocial, and supernatural as historic “cognitive behavioral treatment approaches are... ,” or “biologi- perspectives on our field.) We include substantial current evidence cal treatment approaches are...” of the reciprocal influences of biology and behavior and of psycho- In the first edition of this text, we tried to do something very logical and social influences on biology. Our examples are designed different. We thought the field had advanced to the point that it to hold students’ attention. For example, we discuss genetic contri- was ready for an integrative approach in which the intricate inter- butions to divorce, the effects of early social and behavioral experi- actions of biological, psychological, and social factors are expli- ence on later brain function and structure, new information on the cated in as clear and convincing a manner as possible. Recent relation of social networks to the common cold, and new data on explosive advances in knowledge confirm this approach as the psychosocial treatments for cancer. We note that in the phenom- only viable way of understanding psychopathology. To take just enon of implicit memory and blind sight, which may have paral- two examples, Chapter 2 contains a description of a study demon- lels in dissociative experiences, psychological science verifies the strating that stressful life events can lead to depression but that existence of the unconscious (although it does not much resemble not everyone shows this response. Rather, stress is more likely the seething caldron of conflicts envisioned by Freud). We present to cause depression in individuals who already carry a particu- new evidence confirming the effects of psychological treatments lar gene that influences serotonin at the brain synapses. Similarly, on neurotransmitter flow and brain function. We acknowledge the Chapter 9 describes how the pain of social rejection activates the often neglected area of emotion theory for its rich contributions same neural mechanisms in the brain as physical pain. In addi- to psychopathology (such as the effects of anger on cardiovascular tion, the entire section on genetics has been rewritten to highlight disease). We weave scientific findings from the study of emotions the new emphasis on gene–environment interaction, along with together with behavioral, biological, cognitive, and social discover- recent thinking from leading behavioral geneticists that the goal ies to create an integrated tapestry of psychopathology. of basing the classification of psychological disorders on the firm foundation of genetics is fundamentally flawed. Descriptions of the emerging field of epigenetics, or the influence of the environ- Life-Span Developmental Influences ment on gene expression, is also woven into the chapter, along No modern view of psychology can ignore the importance of with new studies on the seeming ability of extreme environments life-span developmental factors in the manifestation and treat- to largely override the effects of genetic contributions. Studies ment of psychopathology. Studies highlighting developmental elucidating the mechanisms of epigenetics or specifically how windows for the influence of the environment on gene expres- environmental events influence gene expression are described. sion are explained. Accordingly, although we include a chap- These results confirm the integrative approach in this book: ter on neurodevelopmental disorders (Chapter 14), we consider Psychopathology cannot be explained by genetic or environmen- the importance of development throughout the text. We discuss tal factors alone but rather arise from their interaction. We now childhood and geriatric anxiety, for example, in the context of the   xix Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. anxiety, trauma- and stressor-related, and obsessive-compulsive Legal and Ethical Issues and related disorders chapter (Chapter 5). This system of orga-