Extended Chapter Outlines (Both 13 & 14)

I. The Nature of Psychological Disorders
The field of psychopathology studies the nature of psychological disorders.

A. Criteria for Psychological Disorders
The main criteria for determining that a person has a psychological disorder are abnormality, maladaptiveness, and personal distress.

1. The Criterion of Abnormality
Abnormal behavior deviates from the norm, either qualitatively or quantitatively.

2. The Criterion of Maladaptiveness
Maladaptive behavior is that which seriously disrupts one’s life.

3. The Criterion of Personal Distress
This criterion assumes that our subjective feelings of anxiety, depression, or other unpleasant emotion determine whether we have a psychological disorder.

B. Viewpoints on Psychological Disorders
Current viewpoints attribute disorders to natural causes, but they differ in the extent to which they attribute disorders to biological, mental, or environmental factors.

1. The Biopsychological Viewpoint
Biopsychological researchers are interested in the role of heredity, brain structure, brain activity, and brain chemistry in the development of psychological disorders.

2. The Psychoanalytic Viewpoint
This approach studies unconscious conflicts over impulses such as sex and aggression, which originate in childhood.

3. The Behavioral Viewpoint
This approach views disorders as stemming from positive reinforcement of inappropriate behaviors and punishment of appropriate behaviors.

4. The Cognitive Viewpoint
According to this approach, disorders are the result of irrational or maladaptive thinking about one’s self, life events, and the world in general.

5. The Humanistic Viewpoint
This approach views psychological disorders as the result of incongruence between one’s actual self and public self as a consequence of trying to live up to the demands of others.

6. The Social-Cultural Viewpoint
This approach notes that though some disorders are universal, others are unique to particular cultures.

C. Classification of Psychological Disorders
The first modern classification system for psychological disorders was created in 1883.

1. The DSM-IV
The DSM-IV provides a means of communication among mental health practitioners, offers a framework for research on the causes of disorders, and helps practitioners diagnose and choose the best treatment for particular disorders.

2. Criticisms of the Diagnosis of Psychological Disorders
Some professionals criticize the potential negative effects of the diagnosis of psychological disorders.

II. Anxiety Disorders
Though anxiety is a normal part of living, in anxiety disorders it becomes intense, chronic, and disruptive.

A. Generalized Anxiety Disorder
The person with a generalized anxiety disorder is in a continual state of anxiety that exists independent of any particular stressful situation.

1. The Nature of Generalized Anxiety Disorder
The central feature of this disorder is worry.

2. Causes of Generalized Anxiety Disorder
There appears to be a genetic basis to the disorder; however, each school of thought provides a different explanation.

B. Obsessive-Compulsive Disorder
Obsessions are persistent, recurring thoughts, while compulsions are repetitive actions that one feels compelled to perform.

1. The Nature of Obsessive-Compulsive Disorder
People whose obsessions and compulsions interfere with their daily functioning suffer from OCD.

2. Causes of Obsessive-Compulsive Disorder
Some people appear to have a hereditary predisposition to develop OCD; however, each school of thought provides a different explanation.

C. Panic Disorder
A panic attack is a symptom of this disorder.

1. The Nature of Panic Disorder
Panic disorder is marked by sudden attacks of overwhelming anxiety, accompanied by dizziness, trembling, cold sweats, heart palpitations, shortness of breath, fear of dying, and fear of going crazy.

2. Causes of Panic Disorder
There may be a genetic predisposition to developing this disorder; however, each school of thought provides a different explanation.

D. Phobias
This refers to the experience of excessive or inappropriate fear.

1. The Nature of Phobias
Phobias are among the most common psychological disorders.

a. Specific Phobias
A specific phobia is an intense, irrational fear of a specific object of situation.

b. Social Phobia
People with a social phobia fear public scrutiny.

c. Agoraphobia
Agoraphobia is the fear of being in public.

2. Causes of Phobias
Phobias have been the target of much scientific research.

a. Biopsychological Factors
Some people have a biological, possibly hereditary, predisposition to develop phobias.

b. Psychological Factors
Other schools of thought provide different explanations.

III. Somatoform Disorders

In somatoform disorders, individuals are preoccupied with physical symptoms or a physical characteristic.

A. Hypochondriasis

1. The Nature of Hypochondriasis

Hypochondriasis manifests as anxiety and fear as the possibility of having a

serious illness as a result of misinterpreting benign physical symptoms.

Assurances from physicians are mostly unhelpful.

2. Causes of Hypochondriasis

Each school of thought provides a different explanation.

B. Conversion Disorder

1. The Nature of Conversion Disorder

Conversion disorder is the manifestation of a neurological symptoms with no

organic cause. Stress is assumed to be the cause.

2. Causes of Conversion Disorder

Each school of thought provides a different explanation.

IV. Dissociative Disorders
In dissociative disorders, the person’s conscious mind loses access to certain thoughts, feelings, and memories.

A. Dissociative Amnesia and Fugue
Dissociative amnesia is the inability to recall personally significant memories. Dissociative fugue is marked by memory loss characteristic of dissociative amnesia as well as the loss of one’s identity and fleeing from one’s prior life.

1. The Nature of Dissociative Amnesia and Fugue
Dissociative amnesia is related to trauma. In dissociative fugue the person may adopt a new identity, then emerge from the fugue state some time later.

2. Causes of Dissociative Amnesia and Fugue
Each school of thought provides a different explanation.

B. Dissociative Identity Disorder
In this disorder, a person has two or more distinct personalities that alternate with one another.

1. The Nature of Dissociative Identity Disorder
An individual’s alternate personalities might include men, women, and children, each with its own way of walking, writing, and speaking.

2. Causes of Dissociative Identity Disorder
People who develop this disorder almost always have had traumatic experiences in early childhood leading them to escape into their alternate personalities. Given the conflicting evidence regarding the reality of this disorder, the existence of it promises to remain a controversial issue for years to come.

V. Mood Disorders
People with mood disorders experience prolonged periods of extreme depression or elation, often unrelated to their current circumstances.

A. Major Depression
This disorder is marked by depression so intense and prolonged that the person may be unable to function in everyday life.

1. The Nature of Major Depression
People with this disorder experience extreme distress that disrupts their lives for weeks or months at a time.

2. Causes of Major Depression
Each of the major viewpoints offers an explanation.

a. The Biopsychological Viewpoint
Mood disorders have a biological basis, apparently influenced by heredity.

b. The Psychoanalytic Viewpoint
The classic psychoanalytic view holds that the loss of a parent of rejection by a parent early in childhood predisposes the person to experience depression whenever she or he suffers a personal loss later in life.

c. The Behavioral Viewpoint
One of the most influential behavioral explanations is reinforcement theory, which assumes that depressed people lack the social skills needed to gain reinforcement from others and might instead provoke negative reactions from them. An influential cognitive-behavioral theory is an attributional theory.

d. The Cognitive Viewpoint
The most influential cognitive view of depression is Beck’s cognitive theory. Another cognitive theory focuses on rumination.

e. The Humanistic Viewpoint
This viewpoint attributes depression to the frustration of self-actualization.

f. The Social-Cultural Viewpoint
There are some cross-cultural commonalities in the manifestation of depression, but also variability in depressive symptoms.

B. Seasonal Affective Disorder

1. The Nature of Seasonal Affective Disorder

2. Causes of Seasonal Affective Disorder

C. Bipolar Disorder

1. The Nature of Bipolar Disorder
This is characterized by periods of mania alternating with longer periods of major depression.

2. Causes of Bipolar Disorder
Heredity plays a role.

D. Suicide and Mood Disorders
Most suicides are associated with major depression.

VI. Schizophrenia
Schizophrenia is a severe psychological disorder characterized by impaired social, emotional, cognitive, and perceptual functioning.

A. The Nature of Schizophrenia
About 1% of the world’s population are victims of schizophrenia.

1. Characteristics of Schizophrenia
Schizophrenia is associated with sensory-perceptual, cognitive, social-emotional, and motor symptoms.

a. Sensory-Perceptual Symptoms
People with schizophrenia typically experience hallucinations.

b. Cognitive symptoms
Chief among the cognitive symptoms is difficulty with attention. Among the most distinctive cognitive disturbances are delusions.

c. Social-Emotional Symptoms
Schizophrenic people typically have flat or inappropriate emotionality.

d. Motor Symptoms
Schizophrenia is also associated with unusual motor behavior.

2. Kinds of Schizophrenia
Diagnosticians distinguish several kinds of schizophrenic disorders: disorganized, catatonic, and paranoid.

B. Causes of Schizophrenia
No single viewpoint can explain all cases.

1. The Biopsychological Viewpoint
Biopsychological theories of schizophrenia consider genetic, biochemical, and neurological factors.

a. Hereditary Factors
Though there is a strong hereditary basis for schizophrenia, it seems that schizophrenia is best explained by the diathesis-stress model.

b. Neurochemical Factors
There is evidence of a dopamine basis for schizophrenia.

c. Season-of-Birth Factors
A disproportionate number of victims are born in November, December, and January.

d. Neurological Factors
Brain-imaging studies have shown that schizophrenia is often associated with unusual brain activity.

2. The Psychoanalytic Viewpoint
According to this viewpoint, people who become schizophrenic fail to overcome their dependence on their mothers and, as a result, become fixated at the oral stage.

3. The Behavioral Viewpoint
Behavioral theories assume that schizophrenics are rewarded for behaving in bizarre ways.

4. The Cognitive Viewpoint
Proponents of the cognitive viewpoint point to disturbances of attention and thinking as the main factors in schizophrenia.

5. The Humanistic Viewpoint
According to the humanistic viewpoint, schizophrenia reflects extreme incongruence between the public self and the actual self.

6. The Social-Cultural Viewpoint
Cultural factors can affect the precise pattern of symptoms in schizophrenia, but there is some cross-cultural universality in schizophrenic symptoms.

VII. Personality Disorders
Personality disorders are long-standing, inflexible, maladaptive patterns of behavior.

A. Borderline Personality Disorder
BPD has been of growing interest because it has become more prevalent, devastates the lives of its victims and their loved ones, and presents one of the greatest challenges to therapists.

1. The Nature of Borderline Personality Disorder
The hallmark symptoms include impulsivity, unstable moods, and inconsistent sense of identity, and difficulty maintaining fulfilling intimate relationships.

2. Causes of Borderline Personality Disorder
There is a strong relationship between BPD and sexual abuse.

B. The Antisocial Personality Disorder
This disorder has been of particular interest, perhaps because it has been implicated in many notorious criminal cases.

1. The Nature of Antisocial Personality Disorder
This disorder is marked by impulsive, manipulative, often criminal behavior, without any feelings of guilt in the perpetrator.

2. Causes of the Antisocial Personality Disorder
Research has suggested a genetic basis; people with antisocial personalities have unusually low levels of reactivity to stress.

PART 2

Extended Chapter Outline

I. The History of Therapy
Treatment practices have been influenced by their cultural, religious, and scientific contexts.

A. Ancient Practices

B. Medieval and Renaissance Approaches

C. 18th- and 19th-Century Reforms

D. The Mental Health Movement

II. The Psychoanalytic Orientation
Psychoanalysis grew out of Breuer’s case study of Anna O. through Freud’s efforts.

A. The Nature of Psychoanalysis
Traditional psychoanalysis takes place with the client reclining on a couch and the therapist sitting nearby, just out of sight.

B. Techniques in Psychoanalysis
The main procedures in psychoanalysis are the analysis of free associations, resistances, dreams, and transferences.

1. Analysis of Free Associations
In free association, the client is urged to report any thoughts or feelings that come to mind.

2. Analysis of Resistances
In the analysis of resistance, the psychoanalyst notes behaviors that interfere with therapeutic progress.

3. Analysis of Dreams
Freud claimed that dreams symbolize unconscious sexual and aggressive conflicts.

4. Analysis of Transference
Transference is the client’s tendency to act toward the therapist in the way she or he acts toward important people in everyday life.

C. Offshoots of Psychoanalysis
Psychodynamic therapists rely more on discussions of past and present social relationships than on trying to uncover unconscious emotional conflicts.

III. The Behavioral Orientation
The behavioral orientation emphasizes changing maladaptive behaviors rather than providing insight into unconscious conflicts.

A. Classical-Conditioning Therapies
Therapies based on classical conditioning stress the importance of stimuli in controlling behavior.

1. Counterconditioning
This technique applies the principles of classical conditioning to replace unpleasant emotional responses to stimuli with more pleasant ones.

2. Systematic Desensitization
This form of counterconditioning trains the client to maintain a state of relaxation in the presence of imagined anxiety-inducing stimuli.

3. Aversion Therapy
This form of behavior therapy inhibits maladaptive behavior by pairing a stimulus that normally elicits a maladaptive response with an unpleasant stimulus.

B. Operant-Conditioning Therapies
Treatments based on operant conditioning change maladaptive behaviors by controlling their consequences.

1. Positive Reinforcement
One of the most important uses of positive reinforcement is the token economy, used often in institutional settings.

2. Punishment
The therapist provides aversive consequences for maladaptive behavior.

3. Extinction
Both imaginal flooding and in vivo flooding are techniques used to extinguish maladaptive behavior.

C. Social-Learning Therapies
Social-learning theory has contributed participant modeling as a way to overcome phobias.

IV. The Cognitive Orientation
The cognitive orientation assumes that our interpretation of events, rather than events themselves, cause psychological problems.

A. Rational-Emotive Behavior Therapy
In Ellis’s rational-emotive behavior therapy, psychological disorders are treated by forcing the client to give up irrational beliefs.

B. Cognitive Therapy
The goal of Beck’s cognitive therapy is to change exaggerated beliefs in treating psychological disorders, most notably depression.

V. The Humanistic Orientation
The humanistic orientation stresses the present, the conscious, subjective mental experience, and expression of emotion.

A. Person-Centered Therapy
This type of humanistic therapy, developed by Carl Rogers, helps clients find their own answers to their problems.

B. Gestalt Therapy
This type of humanistic therapy, developed by Fritz Perls, encourages clients to become aware of their true feelings and to take responsibility for their own actions.

VI. The Social-Relations Orientation
The social-relations orientation assumes that because many psychological problems involve interpersonal relationships, additional people must be brought into the therapeutic process.

A. Group Therapy

1. Transactional Analysis
This is a form of psychoanalytic group therapy, developed by Eric Berne, that helps clients change their immature or inappropriate ways of relating to other people.

2. Social-Skills Training
This is a form of behavioral group therapy that improves the client’s social relationships by improving her or his interpersonal skills. Assertiveness training is a form of social skills training that teaches clients to express their feelings directly, instead of passively or aggressively.

3. Self-Help Groups
Self-help groups are conducted by people who have experienced those problems.

B. Family Therapy
This form of group therapy encourages the constructive expression of feelings and the establishment of rules that family members agree to follow.

VII. The Biopsychological Orientation
The biopsychological approach is based on the assumption that psychological disorders are associated with brain dysfunctions and consequently will respond to treatments that alter brain activity.

A. Psychosurgery
Although psychosurgery, the treatment of psychological disorders by destroying brain tissue, was once considered a humane alternative to locking agitated patients in rooms, its contemporary use has declined markedly.

B. Electroconvulsive Therapy
While ECT, a biomedical therapy that uses brief electric currents to induce brain seizures, was originally used for treating agitated patients, it proved more successful in elevating the mood of severely depressed patients who failed to respond to drug therapy.

C. Drug Therapy
Since its introduction in the 1950s, drug therapy has become the most widely used form of medical therapy.

1. Antianxiety Drugs
Today, the most widely prescribed antianxiety drugs are the benzodiazepines, such as Xanax and Valium.

2. Antidepressant Drugs
The MAO inhibitors work by blocking enzymes that normally breakdown the neurotransmitters serotonin and norepinephrine. The tricyclic anti depressants increase serotonin and norepinephrine levels by preventing their re-uptake by neurons that release them. More recently, drugs known as serotonin-re-uptake inhibitors, such as Prozac, Zoloft, and Paxil, have become widely used.

3. Antimania Drugs
The drug lithium carbonate is frequently prescribed to prevent the extreme mood swings of bipolar disorder.

4. Antipsychotic Drugs
Commonly used antipsychotic drugs, the phenothiazines, work by blocking brain receptor sites for the neurotransmitter dopamine. A newer drug, clozapine, produces fewer side effects than traditionally prescribed antipsychotic drugs.

VIII. Community Mental Health
Psychologists involved in community psychology have been involved in deinstitutionalization and the prevention of psychological disorders.

A. Deinstitutionalization
This is the movement toward treating people with psychological disorders in community settings instead of mental hospitals.

B. Prevention of Psychological Disorders
Community mental-health centers have three main goals in the prevention of psychological disorders: primary prevention, secondary prevention, and tertiary prevention.

IX. The Rights of the Therapy Client

A. The Rights of Hospitalized Patients

1. The Right to Receive Treatment

In recent years reforms have improved treatment and provided protection through

emphasizing the right of individuals receiving treatment.

2. The Right to Refuse Treatment

B. The Right to Confidentiality

The balance between protecting the patient and protecting the public is

highlighted by the Tarasoff case.

X. Finding the Proper Therapy
You could receive therapy from a psychologist, a psychiatrist, or a variety of other kinds of therapists. You may choose to read self-help books, called bibliotherapy.

A. Selecting the Right Therapist
The therapist should be warm, open, concerned, and empathetic.

B. Bibliotherapy as an Alternative
If you choose high-quality books written by credible authors, bibliotherapy can be effective.

XI. The Effectiveness of Psychotherapy

In 1952, Hans Eysenck challenged psychotherapists by claiming that people who received psychotherapy improved no more than those who did not receive therapy.

A. Evaluation of Psychotherapy
One of the basic issues concerns what criteria to use in evaluating the success of psychotherapy.

1. Criteria of Success
Overall, psychotherapy is more effective than placebo treatment, which in turn is more effective than no-treatment control conditions.

2. Major Research Studies
Psychotherapy works, but no single kind stands out as clearly more effective than the others. One study found that many of the participants relapsed, indicating that 16 weeks of therapy might be insufficient to produce lasting relief from depression.

B. Factors in the Effectiveness of Psychotherapy
Researchers study the characteristics of therapies, clients, and therapists.

1. Therapy Characteristics

Research suggests that the only important therapy characteristic is the number of therapy sessions—the more sessions, the greater the improvement.

2. Client Characteristics

According to research conducted by Luborsky, clients were more likely to improve if they had more education, higher intelligence, and higher socioeconomic status.

3. Therapist Characteristics
The client’s perception of therapist empathy has been consistently identified as an important factor in the effectiveness of psychotherapy.