CHAPTER 2

One-Dimensional versus Multidimensional Models

What Caused Janelle’s Phobia?

 Behavioral Influences
 Biological Influences
 Emotional Influences
 Social Influences
 Developmental Influences

Genetic Contributions to Psychopathology

 Genes are long molecules of deoxyribonucleic acid (DNA) at various locations on chromosomes,
within the cell nucleus.
 Genes you inherit are from your parents and from your ancestors before them.
 Gregor Mendel’s pioneering work in the 19th century, we have known that some physical
characteristics are influenced by our genetic endowment. But other factors in the environment
also influence our physical appearance.
 Huntington’s disease has been traced to a genetic defect that causes deterioration in a
specific area of the brain, the basal ganglia.
 Another example of genetic influence is a disorder known as phenylketonuria (PKU),
which can result in intellectual disability. This disorder, present at birth, is caused by the
inability of the body to metabolize (break down) phenylalanine, a chemical compound
found in many foods.
 Like Huntington’s disease, PKU is caused by a defect in a single gene, with little
contribution from other genes or the environmental background.
 PKU is inherited when both parents are carriers of the gene and pass it on to the child.
Fortunately, researchers have discovered a way to correct this disorder: We can change
the way the environment interacts with and affects the genetic expression of this
disorder. Specifically, by detecting PKU early enough (which is now routinely done), we
can simply restrict the amount of phenylalanine in the baby’s diet until the child
develops to the point where a normal diet does not harm the brain, usually 6 or 7 years
of age.

The Nature of Genes

 The DNA contains the complete set of genetic instructions (the genome).
 We have known for a long time that each normal human cell has 46 chromosomes arranged in
23 pairs.
 One chromosome in each pair comes from the father, and one comes from the mother.
 The first 22 pairs of chromosomes (called autosomes) provide programs or directions for the
development of the body and brain, and the last pair, called the sex chromosomes, also
determines an individual’s sex.
 In females, both chromosomes in the 23rd pair are called X chromosomes.
  In males, the mother contributes an X chromosome, but the father contributes a Y
chromosome
 The chromosomes contain DNA, which includes the genetic blueprint.
 The DNA molecule has a certain structure. It is a double helix, resembling a twisted ladder or
spiral staircase.
 The steps of the ladder are the four nucleotides with their nucleobases: adenine,
cytosine, guanine, or thymine.
 These bases form pairs: Adenine forms a pair with thymine, and cytosine forms a pair
with guanine.
 The DNA sequence that defines a gene is called coding DNA.
 For a gene to be expressed, the DNA code is first copied (or transcribed) into a strand of
ribonucleic acid (RNA).
 On the level of the DNA, therefore, a gene may be defined as a sequence of nucleotides
on the DNA that codes for a specific protein or piece of RNA.
 The specific location on a chromosome that codes for a gene is the genetic locus.
 Because we have pairs of chromosomes, we always have two alternative forms of a
gene at each genetic locus inherited from each parent (except for genes on the Y
chromosome).
 In the population, the same gene can of course have many different additional forms (or
variants) because people can differ in the DNA sequence coding for a particular gene.
 Alternative (or variant) forms of genes are called alleles.
 The outward appearance of the person (or any organism) is called the person’s phenotype.
 Each pair of alleles represents the genotype of a specific gene.
 The different forms of alleles are called polymorphism (poly stands for many and morphism for
form).
 One type of polymorphism is caused by differences in one single nucleotide in the sequence of
the coding DNA. In fact, the most common polymorphism in the human genome is the single
nucleotide polymorphism (SNP, which is pronounced snip). This occurs when one nucleotide
replaces another.
 For example, the nucleotide thymine (T) might replace the nucleotide cyctosine (C) in a
particular stretch of the DNA (such as GCATCG versus GCACCG)
 A dominant allele is one of a pair of genes that strongly influences a particular trait, and we
need only one of them to determine.
 A recessive allele, by contrast, must be paired with another (recessive) allele to determine a
trait. Otherwise, it won’t have any effect.
 Color-blindness is an example of a recessive allele on the X chromosome, and sickle cell disease
is an example of a recessive autosomal allele.
 Dominance occurs when one member of a gene pair is consistently expressed over the other.
When we have a dominant allele, using Mendelian laws of genetics we can predict fairly
accurately how many offspring will develop a certain trait, characteristic, or disorder, depending
on whether one or both parents carry that dominant gene. However, Mendelian inheritance in
humans is rare.
 human genome—an individual’s complete set of genes—consists of more than 20,000 genes.
Two models have received the most attention: the diathesis–stress model and the reciprocal gene–
environment model (or gene– environment correlations)

 diathesis–stress model, individuals inherit tendencies to express certain traits or behaviors,

which may then be activated under conditions of stress.
 Gene–environment correlation model, some evidence now indicates that genetic endowment
may increase the probability that an individual will experience stressful life events

Epigenetics and the Nongenomic “Inheritance” of Behavior

 Telomeres are certain structures that cap the ends of chromosomes to protect the chromosome
from deteriorating or getting entangled with neighboring chromosomes. Telomere length
appears to be positively correlated with lifespan and might be a marker.
 The investigators examined stress reactivity and the ways it is passed through generations, using
a powerful experimental procedure called cross-fostering
 Although the environment cannot change our DNA sequence, it can have an influence on the
DNA by changing the gene expression. This phenomenon is referred to as epigenetics (the prefix
epi means “above” or “over” the gene)

Neuroscience and Its Contributions to Psychopathology

 The human nervous system includes the

 central nervous system, consisting of the brain and the spinal cord,
 and the peripheral nervous system, consisting of the somatic nervous system and the
autonomic nervous system.
 Peripheral Nervous System
 Somatic (blue): Controls voluntary muscles and conveys sensory information to the
central nervous system
 Autonomic (red): Controls involuntary muscles
 Sympathetic: Expends energy
 Parasympathetic: Conserves energy
 The brain contains neurons to control our thoughts and actions.
 Neurons transmit information throughout the nervous system
 The typical neuron contains a central cell body with two kinds of branches.
 One kind of branch is called a dendrite.
 Dendrites have numerous receptors that receive messages in the form of chemical impulses
from other nerve cells, which are converted into electrical impulses.
 The other kind of branch, called an axon, transmits these impulses to other neurons.
 Any one nerve cell may have multiple connections to other neurons. These connections are
called synapses.
 The smallest building blocks of the brain are the neurons that form a highly complex network of
information flow. Within each neuron, information is transmitted through electrical impulses,
called action potentials, traveling along the axon of a neuron. The end of an axon is called a
terminal button.
  Neurons are not actually connected directly to each other. There is a small space through which
the impulse must pass to get to the next neuron. The space between the terminal button of one
neuron and the dendrite of another is called the synaptic cleft.
 The biochemicals that are released from the axon of one neuron and transmit the impulse to the
dendrite receptors of another neuron are called neurotransmitters, which are chemicals stored
in vesicles in the terminal buttons.
 In addition to neurons, there is another type of cell that comprises the nervous system—glia (or
glial) cells.
 Major neurotransmitters relevant to psychopathology include norepinephrine (also known as
noradrenaline), serotonin, dopamine, gamma-aminobutyric acid (GABA), and glutamate (which
is the most common neurotransmitter).
 Some neurotransmitters are primarily excitatory (such as glutamate) because they increase the
likelihood that the connecting neuron will fire, whereas other neurotransmitters are primarily
inhibitory (such as GABA) because they decrease the likelihood that the connecting neuron will
fire.
 Neurons can receive input from both excitatory and inhibitory neurotransmitters.
 Excesses or insufficiencies in some neurotransmitters are associated with different groups of
psychological disorders. For example, reduced levels of GABA were initially thought to be
associated with excessive anxiety (Costa, 1985). Early research (Snyder, 1976, 1981) linked
increases in dopamine activity to schizophrenia.

The Structure of the Brain

 One way to view the brain is to see it in two parts—the brain stem and the forebrain.
 The brain stem is the lower and more ancient part of the brain. Found in most animals, this
structure handles most of the essential automatic functions, such as breathing, sleeping, and
moving around in a coordinated way.
 The forebrain is more advanced and evolved more recently.
 The lowest part of the brain stem, the hindbrain, contains the medulla, the pons, and the
cerebellum.
 The hindbrain regulates many automatic activities, such as breathing, the pumping
action of the heart (heartbeat), and digestion.
 The cerebellum controls motor coordination, and abnormalities in the cerebellum may
be associated with autism, although the connection with motor coordination is not
clear.
 Also located in the brain stem is the midbrain, which coordinates movement with sensory input
and contains parts of the reticular activating system, which contributes to processes of arousal
and tension, such as whether we are awake or asleep.
 At the top of the brain stem are the thalamus and hypothalamus, which are involved broadly
with regulating behavior and emotion. These structures function primarily as a relay between
the forebrain and the remaining lower areas of the brain stem. Some anatomists even consider
the thalamus and hypothalamus to be parts of the forebrain.
 At the base of the forebrain, just above the thalamus and hypothalamus, is the limbic system.
Limbic means border, so named because it is located around the edge of the center of the brain.
 The limbic system, which figures prominently in much of psychopathology, includes such
structures as the hippocampus (sea horse), cingulate gyrus (girdle), septum (partition), and
amygdala (almond), all of which are named for their approximate shapes.
 This system helps regulate our emotional experiences and expressions and, to some
extent, our ability to learn and to control our impulses.
 It is also involved with the basic drives of sex, aggression, hunger, and thirst.
 The basal ganglia, also at the base of the forebrain, include the caudate (tailed) nucleus. Because
damage to these structures is involved in changing our posture or twitching or shaking, they are
believed to control motor activity
 The largest part of the forebrain is the cerebral cortex, which contains more than 80% of all
neurons in the central nervous system.
 This part of the brain provides us with our distinctly human qualities, allowing us to look
to the future and plan, to reason, and to create.
 The cerebral cortex is divided into two hemispheres.
 Although the hemispheres look alike structurally and operate relatively independently
(both are capable of perceiving, thinking, and remembering), research indicates that
each has different specialties.
 The left hemisphere seems to be chiefly responsible for verbal and other cognitive processes.
 The right hemisphere seems to be better at perceiving the world around us and creating images.
 The hemispheres may play differential roles in specific psychological disorders.
 Each hemisphere consists of four separate areas, or lobes: temporal, parietal, occipital, and
frontal.
 Each is associated with different processes. Of the first three areas,
 the temporal lobe is associated with recognizing various sights and sounds and with
long-term memory storage,
 the parietal lobe is associated with recognizing various sensations of touch and
monitoring body positioning, and
 the occipital lobe is associated with integrating and making sense of various visual
inputs. These three lobes, located toward the back (posterior) of the brain, work
together to process sight, touch, hearing, and other signals from our senses.
 The frontal lobe is the most interesting from the point of view of psychopathology.
 The front (or anterior) of the frontal lobe is called the prefrontal cortex, and this is the
area responsible for higher cognitive functions such as thinking and reasoning, planning
for the future, and long-term memory.
 This area of the brain synthesizes all information received from other parts of the brain
and decides how to respond.
 It is what enables us to relate to the world around us and the people in it. When
studying areas of the brain for clues to psychopathology, most researchers focus on the
frontal lobe of the cerebral cortex, as well as on the limbic system, the hippocampus,
and the basal ganglia

CHAPTER 3
CLINICAL ASSESSMENT AND DAIGNOSES

Clinical assessment is the systematic evaluation and measurement of psychological, biological, and
social factors in an individual presenting with a possible Psychological disorder.

Diagnosis is the process of determining whether the particular problem afflicting the individual meets all
criteria for a psychological disorder, as set forth in the fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders, or DSM-5.

Reliability is the degree to which a measurement is consistent.

Validity is whether something measures what it is designed to measure

Standardization is the process by which a certain set of standards or norms is determined for a
technique to make its use consistent across different measurements

Mental status exam involves the systematic observation of an individual’s behavior.

 The exam covers five categories:

1. Appearance and behavior
2. Thought processes

-Delusions of persecution, in which someone thinks people are after him and out to get him
all the time,

-Delusions of grandeur, in which an individual thinks she is all-powerful in some way

-Ideas of reference, in which everything everyone else does somehow relates back to the
individual. The most common example would be thinking that a conversation between two
strangers on the other side of the room must be about you.

-Hallucinations are things a person sees or hears when those things really aren’t there. For
example, the clinician might say, “Let me ask you a couple of routine questions that we ask
everybody. Do you ever see things or maybe hear things when you know there is nothing
there?”

-Delusions of persecution, in which someone thinks people are after him and out to get him
all the time,

-Delusions of grandeur, in which an individual thinks she is all-powerful in some way

3. Mood and affect

-Mood is the predominant feeling state of the individual
-Affect, by contrast, refers to the feeling state that accompanies what we say at a given
point.
4. Intellectual functioning

5. Sensorium
 -The term sensorium refers to our general awareness of our surroundings. Does an
individual know what the date is, what time it is, where they are, who they are, and who
you are?

Unstructured interviews follow no systematic format.

Semi structured interviews are made up of questions that have been carefully phrased and tested to
elicit useful information in a consistent manner so that clinicians can be sure they have inquired about
the most important aspects of particular disorders

Physical Examination

- If the patient presenting with psychological problems has not had a physical exam in the past year, a
clinician might recommend one, with particular attention to the medical conditions sometimes
associated with the specific psychological problem

Behavioral Assessment

- takes this process one step further by using direct observation to formally assess an individual’s
thoughts, feelings, and behavior in specific situations or contexts

The ABCs of Observation

- Observational assessment is usually focused on the here and now. Therefore, the clinician’s attention is
usually directed to the immediate behavior, its antecedents (what happened just before the behavior),
and its consequences (what happened afterward)

Informal observation. A problem with this type of observation is that it relies on the observer’s
recollection, as well as interpretation, of the events.

Formal observation involves identifying specific behaviors that are observable and measurable (called
an operational definition).

Self-Monitoring People can also observe their own behavior to find patterns, a technique known as self-
monitoring or self-observation

Psychological Testing

- Psychological tests include specific tools to determine cognitive, emotional, or behavioral responses
that might be associated with a specific disorder and more general tools that assess long-standing
personality features, such as a tendency to be suspicious.

Projective Testing

- Rorschach test. t people project their own personality and unconscious fears onto other people and
things—in this case, the ambiguous stimuli—and, without realizing it, reveal their unconscious thoughts
to the therapist

The Thematic Apperception Test (TAT) is perhaps the best known projective test after the Rorschach. It
was developed in 1935 by Christiana Morgan and Henry Murray at the Harvard Psychological Clinic

Personality Inventories
- Minnesota Multiphasic Personality Inventory (MMPI). The MMPI was developed in the late 1930s and
early 1940s and first published in 1943

- Following are some statements from the MMPI:

• Cry readily

• Often happy for no reason

• Am being followed

• Fearful of things or people that can’t hurt me

Intelligence Testing

- Intelligence tests were developed for one specific purpose: to predict who would do well in school

Neuropsychological Testing

- Neuropsychological tests measure abilities in areas such as receptive and expressive language,
attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction in
such a way that the clinician can make educated guesses about the person’s performance and the
possible existence of brain impairment.

Neuroimaging: Pictures of the Brain

- Neuroimaging can be divided into two categories. One category includes procedures that examine any
damage. The other category includes procedures that examine the actual functioning of the brain by
mapping blood flow and other metabolic activity

Images of Brain Structure

-x-ray, the degree of blockage is picked up by detectors in the opposite side of the head. A computer
then reconstructs pictures of various slices of the brain. This procedure, which takes about 15 minutes,
is called a computerized axial tomography (CAT) scan or CT scan.

- Several more recently developed procedures give greater resolution (specificity and accuracy) than a
CT scan without the inherent risks of X-ray tests. A now commonly used scanning technique is called
nuclear magnetic resonance imaging (MRI)

Images of Brain Functioning

- PET scans display areas of high and low neurological activity, as in these scans of a brain affected by
HIV

- A second procedure used to assess brain functioning is called single photon emission computed
tomography (SPECT)

Psychophysiological Assessment
- Yet another method for assessing brain structure and function specifically and nervous system activity
generally is called this

- Psychophysiological assessment of other bodily responses may also play a role in assessment. These
responses include heart rate, respiration, and electrodermal responding, formerly referred to as galvanic
skin response (GSR), which is a measure of sweat gland activity controlled by the peripheral nervous
system.

Diagnosing Psychological Disorders

-If we want to determine what is unique about an individual’s personality, cultural background, or
circumstances, we use what is known as an idiographic strategy. This information lets us tailor our
treatment to the person.

-But to take advantage of the information already accumulated on a particular problem or disorder, we
must be able to determine a general class of problems to which the presenting problem belongs. This is
known as a nomothetic strategy. In other words, we are attempting to name or classify the problem.

-The term classification itself is broad, referring simply to any effort to construct groups or categories
and to assign objects or people to these categories on the basis of their shared attributes or relations—a
nomothetic strategy. If the classification is in a scientific context, it is most often called taxonomy, which
is the classification of entities for scientific purposes, such as insects, rocks, or—if the subject is
psychology—behaviors.

-If you apply a taxonomic system to psychological or medical phenomena or other clinical areas, you use
the word nosology. All diagnostic systems used in healthcare settings, such as those for infectious
diseases, are nosological systems. The term nomenclature describes the names or labels of the
disorders that make up the nosology (for example, anxiety or mood disorders)

Classification Issues

Categorical and Dimensional Approaches

-Classical categorical approaches are quite useful in medicine. It is extremely important for a physician
to make accurate diagnoses.

-second strategy is a dimensional approach, in which we note the variety of cognitions, moods, and
behaviors with which the patient presents and quantify them on a scale

-A third strategy for organizing and classifying behavioral disorders has found increasing support in
recent years as an alternative to classical categorical or dimensional approaches. It is a categorical
approach but with the twist that it basically combines some features of each of the former approaches.
Called a prototypical approach, this alternative identifies certain essential characteristics of an entity so
that you (and others) can classify it, but it also allows certain nonessential variations that do not
necessarily change the classification.

-Reliability

Validity
 - Types: predictive validity, criterion validity, content validity

Diagnosis before 1980

-. Kraepelin first identified what we now know as the disorder of schizophrenia. His term for the disorder
at the time was dementia praecox

-Dementia praecox refers to deterioration of the brain that sometimes occurs with advancing age
(dementia) and develops earlier than it is supposed to, or “prematurely” (praecox).

-the first Diagnostic and Statistical Manual (DSM-I), published in 1952 by the American Psychiatric
Association.

-Only in the late 1960s did systems of nosology begin to have some real influence on mental health
professionals.

-In 1968, the American Psychiatric Association published a second edition of its Diagnostic and Statistical
Manual (DSM-II),

-and in 1969, WHO published the eighth edition of the ICD, which was all but identical to DSM-II, since
leaders in mental health began to realize the importance of at least trying to develop a uniform system
of classification.

DSM-III and DSM-III-R

-The year 1980 brought a landmark in the history of nosology: the third edition of the Diagnostic and
Statistical Manual (DSM-III) (American Psychiatric Association, 1980)

-First, DSM-III attempted to take an atheoretical approach to diagnosis, relying on precise descriptions of
the disorders as they presented to clinicians rather than on psychoanalytic or biological theories of
etiology

-The second major change in DSM-III was that the specificity and detail with which the criteria for
identifying a disorder were listed made it possible to study their reliability and validity

DSM-IV and DSM-IV-TR

-The 10th edition of the International Classification of Diseases (ICD-10) (World Health Organization,
1992) was published in 1992, and the United States is required by treaty obligations to use the ICD-10
codes in all matters related to health.

-To make the ICD-10 and DSM as compatible as possible, work proceeded more or less simultaneously
on both the ICD-10 and the fourth edition of the DSM (DSM-IV), published in 1994.

DSM-5 and DSM-5-TR

-In the almost 20 years since the publication of DSM-IV, our knowledge had advanced considerably, and,
after over 10 years of concerted effort, DSM-5 was published in the spring of 2013

-David Kupfer was the chair of the task force for the 5th edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM), which was published in 2013
Criticisms of DSM-5

-. As a consequence, individuals are often diagnosed with more than one psychological disorder at the
same time, which is called comorbidity.

A Caution about Labeling and Stigma

-A related problem that occurs any time we categorize people is labeling

Creating and Abandoning Diagnoses

-As discussed in Chapter 1, disorders are always influenced by societal factors. For example,
homosexuality used to be considered a psychiatric disease. It was removed from the DSM only in 1973
and does not appear in DSM III.

CHAPTER 4

RESEARCH METHOD

Examining Psychopathology

-Important Concepts

-Basic Components of a Research Study

-Internal validity is the extent to which you can be confident that the independent variable is causing
the dependent variable to change.

-External validity refers to how well the results relate to things outside your study—in other words, how
well your findings describe similar individuals who were not among the study participants.

Epidemiological Research

-Scientists often think of themselves as detectives, searching for the truth by studying clues. One type of
correlational research that is much like the efforts of detectives is called epidemiology, the study of the
incidence, distribution, and consequences of a particular problem or set of problems in one or more
populations.

-One of the more important strategies used in single-case experimental design is repeated
measurement

-Genetic researchers examine phenotypes, the observable characteristics or behavior of the individual,
and genotypes, the unique genetic makeup of individual people.

-Genome means “all the genes of an organism

-Endophenotypes are the genetic mechanisms that ultimately contribute to the underlying problems
causing the symptoms and difficulties experienced by people with psychological disorders

Family Studies
-The family member with the trait singled out for study is called the proband

Adoption Studies

CHAPTER 5

Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders

Anxiety is a future-oriented negative mood state characterized by bodily symptoms of physical tension
and by apprehension about the future

Biological Contributions

-genetic vulnerability does not cause anxiety and/or panic directly. That is, stress or other factors in the
environment can “turn on” or “turn off “, certain genes

-activation of a network that involves the prefrontal cortex and the amygdala while performing certain
tasks can predict response to Cognitive Behavioral Therapy

Psychological Contributions

AN INTEGRATED MODEL

COMORBILITY OF ANXIETY AND RELATED DISORDERS

Generalized Anxiety Disorder

-anxiety sensitivity, which is the tendency to become distressed in response to arousal-related

sensations, arising from beliefs that these anxiety-related sensations have harmful consequences

-treatments, both drug and psychological, are reasonably effective. Benzodiazepines are most often
prescribed for generalized anxiety, and the evidence indicates that they give some relief, at least in the
short term.

Panic Disorder and Agoraphobia

-Agoraphobia, which is fear and avoidance of situations in which a person feels unsafe or unable to
escape to get home or to a hospital in the event of a developing panic, panic-like symptoms, or other
physical symptoms, such as loss of bladder control.

Nocturnal Panic

-Nocturnal attacks are studied in a sleep laboratory

-Some therapists assume that patients with nocturnal panic might have a breathing disorder called sleep
apnea, an interruption of breathing during sleep that may feel like suffocation.

-A related phenomenon occurring in children is called sleep terrors

-Panic control treatment (PCT) developed at one of our clinics concentrates on exposing patients with
panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic
attacks.
-specific phobia is an irrational fear of a specific object or situation that markedly interferes with an
individual’s ability to function. In earlier versions of the DSM, this category was called “simple” phobia to
distinguish it from the more complex agoraphobia condition, but we now recognize there is nothing
simple about it.

-7 YEARS OF AGE ARE THE ONSET OF THIS PHOBIA

Blood–Injection–Injury Phobia

-blood–injection– injury phobia runs in families more strongly than any phobic disorder we know.

-The average age of onset for this phobia is approximately 9 years

Situational Phobia

-Phobias characterized by fear of public transportation or enclosed places are called situational phobias

Natural Environment Phobia

-Sometimes very young people develop fears of situations or events occurring in nature. These fears are
called natural environment phobias

Animal Phobia

-Fears of animals and insects are called animal phobias.

Separation Anxiety Disorder

-Separation anxiety disorder is characterized by children’s unrealistic and persistent worry that
something will happen to their parents or other important people in their life or that something will
happen to the children themselves that will separate them from their parents

Selective Mutism