ABNORMAL PSYCHOLOGY
PSYCHOMETRICIAN LICENSURE BOARD EXAMINATION
Jham White Perral
Introduction and Historical Overview
1. Stigma – refers to the destructive beliefs and attitudes held by a society that are ascribed to
groups considered different in some manner, such as people with mental illness. Four
characteristics:
 A distinguishing label is applied.
 The label is linked to undesirable attributes by the society.
 People with the label are seen as different.
 People with the label are discriminated against.
2. Mental Disorder – cannot be defined in one simple sentence but with multiple essential
characteristics:
 The disorder occurs within the individual.
 It causes personal distress or disability.
 It is not a culturally specific reaction to an event (e.g., death of a loved one).
 It is not primarily a result of social deviance or conflict with society.
Generally, it may cause:
 Personal Distress – (self-explanatory), but not all disorders cause distress (e.g., people
with antisocial disorders even enjoy violating laws), and not all distress cause disorders
(e.g., hunger due to religious fasting, or childbirth)
 Disability – impairment in some important part of life, but not all disorders cause disability
(e.g., bulimia nervosa which includes binge eating and compensatory vomiting), and not
all disability causes disorders (e.g., a blind person).
 Violation of Social Norms – (self-explanatory)
 Dysfunction – classified as a “harmful dysfunction” has two components, a “value
judgment component” that something is harmful and an “objective component” that the
harmful thing can cause dysfunction.
3. Early Demonology – a time before the age of scientific inquiry when all good and bad
manifestations of power beyond human control—eclipses, earthquakes, storms, fire, diseases,
the changing seasons—were regarded as supernatural; and that behavior seemingly outside
individual control was also ascribed to supernatural causes.
 Demonology – the doctrine that an evil being or spirit can dwell within a person and
control his or her mind and body.
 Exorcism – the ritualistic casting out of evil spirits.
4. Early Biological Explanations – a time where the explanation for mental disorders were based on
the workings on the biological body itself, not the demon or divine.
 Hippocrates – the father of modern medicine. Categorized mental disorders into three:
Mania, Melancholia, Phrenitis or Brain Fever.
 Humors or Fluids of the Body – needs to be balanced in order to maintain a healthy
mental life. Four Humors:
 Blood – too much of this leads to changeable temperament.
 Yellow Bile – imbalance leads to irritability and anxiousness.
 Black Bile – leads to melancholia.
 Phlegm – leads to being sluggish and dull.
5. The Dark Ages and Demonology – the return of the time of lack of scientific inquiry was made
possible because of the death of Galen and the decay of Greek and Roman civilizations.
 Galen – the second-century Greek who is regarded as the last great physician of the
classical era.
 The Persecution of Witches – people with mental disorders at that time were branded as
witches and were persecuted according to the orders of Pope Innocent VIII’s Malleus
Maleficarum (the witches hammer) – a textbook on witchcraft.
 Lunacy Trials – accusation of witches and persecution were prohibited in England, and as
such those who were mentally disturbed were allowed to be treated in hospitals. A lunacy
trial would determine if the person is really eligible for hospitalization because of a mental
disorder. Lunacy comes from the idea of Paracelsus who attributed the disorders on the
misalignments of the moon and stars (moon: luna). This explanation was more preferred
than being persecuted for being a witch.
6. The Development of Asylums – the excess of Leprosariums (treatment centers for leprosy)
brought about by the decrease of leprosy cases, made possible the conversion of the utilities for
treating mental disorders.
 Asylums – refuges for the confinement and care of people with mental illness.
 Priory of St. Mary of Bethlehem – an asylum founded in 1243 where the word
“bedlam” was derived, meaning that the place was deplorable, full of wild uproar
and confusion. The place became a tourist attraction for wealthy people to see
people with mental disorders, along with Lunatics Tower.
 Benjamin Rush – believed that mental disorders are caused by the excess of blood in the
brain, thus proposed the treatment of Blood Letting.
 Philippe Pinel – made reforms so that instead of chaining and confining patients, they may
be able to freely roam around the grounds.
 Moral Treatment – humane treatment; patients had close contact with attendants, who
talked and read to them and encouraged them to engage in purposeful activity; residents
led lives as close to normal as possible and in general took responsibility for themselves
within the constraints of their disorders. Most notable advocate is Dorothea Dix.
7. The Contemporary Thoughts – (review all of Theories of Personality)
8. The Mental Health Professions:
 Clinical Psychologists – education requires Ph.D or Psy.D degree (requires graduate
studies). If Ph.D, then there is heavy emphasis on research, but has an additional two skills:
assessment and diagnosis, and psychotherapy. If Psy.D, then there is lesser emphasis on
research and more on assessment and diagnosis.
 Psychiatrists – education requires M.D (Doctor of Medicine) and residency. Heavy
emphasis on pharmacotherapy, or the administering of psychoactive medications.
 Psychiatric Nurses – education requires either a bachelors or masters level. Further
training may allow them to do pharmacotherapy.
 Counseling Psychologists – education requires graduate studies. Less emphasis on mental
disorders and more on vocational issues such as on prevention, education, and lifeproblems.
 Social Workers – education requires a degree on M.S.W. (Masters on Social Work), which
is 2 years of graduate studies. More emphasis on psychotherapy but not on assessment and
diagnosis.
 Marriage and Family Therapists – education requires masters or doctoral degree. Treat
families or couples, focusing on the ways in which these relationships impact a variety of
mental health issues.
9. Paradigm – a conceptual framework or approach within which a scientist works—that is, a set of
basic assumptions, a general perspective, that defines how to conceptualize and study a subject,
how to gather and interpret relevant data, even how to think about a particular subject. Three
paradigms: Genetic, Neuroscience, and Cognitive.
10. The Genetic Paradigm – has risen from the knowledge that (1) almost all behavior is heritable
to some degree (i.e., involves genes) and (2) despite this, genes do not operate in isolation from
the environment. Instead, throughout the life span, the environment shapes how our genes are
expressed, and our genes also shape our environments.
 Genes – the carriers of the genetic information (DNA) passed from parents to child.
 Gene Expression – is the process when genes make proteins that in turn make the body
and brain work, and some of these proteins switch, or turn, on and off other genes.
 Polygenic – comes from the idea that no single gene contributes to vulnerability to mental
disorders; meaning several genes, perhaps operating at different times during the course
of development, turning themselves on and off as they interact with a person’s
environment is the essence of genetic vulnerability.
 Heritability – refers to the extent to which variability in a particular behavior (or
disorder) in a population can be accounted for by genetic factors. There are two
important points about heritability to keep in mind:
 Heritability estimates range from 0.0 to 1.0: the higher the number, the greater
the heritability.
 Heritability is relevant only for a large population of people, not a particular
individual.
 Environmental Factors:
 Shared Environment – factors include those things that members of a family
have in common, such as family income level, child-rearing practices, and
parents’ marital status and quality.
 Nonshared Environment – (sometimes referred to as unique environment)
factors are those things believed to be distinct among members of a family, such
as relationships with friends or specific events unique to a person (e.g., being in
a car accident or on the swim team), and these are believed to be important in
understanding why two siblings from the same family can be so different.
 Behavior Genetics – is the study of the degree to which genes and environmental factors
influence behavior.
 Genotype – is the total genetic makeup of an individual, consisting of inherited
genes.
 Phenotype – the totality of observable behavioral characteristics, such as level of
anxiety.
 Molecular Genetics – studies seek to identify particular genes and their functions.
 Alleles – different forms of the same gene.
 Genetics Polymorphism – refers to a difference in DNA sequence on a gene that
has occurred in a population.
 Single Nucleotide Polymorphisms – refers to differences between people in a
single nucleotide.
 Transcription – the process by which DNA is transcribed to RNA.
 Copy Number Variations (CNV) – refers to an abnormal copy of one or more
sections of DNA within the gene(s), can be present in a single gene or multiple
genes.
 Gene-Environment Interaction – means that a given person’s sensitivity to an
environmental event is influenced by genes.
 Epigenetics – “above or outside the gene”, is the study of how the environment can alter
gene expression or function
 Reciprocal Gene-Environment Interaction – genes may promote certain types of
environments. The basic idea is that genes may predispose us to seek out certain
environments that then increase our risk for developing a particular disorder.
11. The Neuroscience Paradigm – holds that mental disorders are linked to aberrant processes in
the brain.
 Study Parts of the Neuron
 Neurotransmitters: dopamine, serotonin, norepinephrine, and gamma-aminobutyric
acid (GABA).
 Corpus Callosum – the major connection between the two hemispheres of the brain; a
band of nerve fibers
 Frontal Lobe – lies in front of the central sulcus.
 Parietal Lobe – is behind the Frontal Lobe and above the lateral sulcus.
 Temporal Lobe – is located below the lateral sulcus.
 Occipital Lobe – lies behind the Parietal and Temporal Lobes.
 Thalamus – is a relay station for all sensory pathways except the olfactory. The nuclei
making up the thalamus receive nearly all impulses arriving from the different sensory
areas of the body before passing them on to the cortex, where they are interpreted as
conscious sensations.
 Brain Stem – comprised of the pons and the medulla oblongata, functions primarily as a
neural relay station.
 Pons – contains tracts that connect the cerebellum with the spinal cord and with motor
areas of the cerebrum.
 Medulla Oblongata – serves as the main line of traffic for tracts ascending from the spinal
cord and descending from the higher centers of the brain.
 Limbic System:
 Anterior Cingulate – which is an area just above the corpus callosum.
 Septal Area – which is anterior to the thalamus.
 Hippocampus – which stretches from the septal area into the temporal lobe.
 Hypothalamus – which regulates metabolism, temperature, perspiration, blood
pressure, sleeping, and appetite.
 Amygdala – which is embedded in the tip of the temporal lobe.
12. The Cognitive Behavioral Paradigm
 Behavioral Activation Therapy – an operant conditioning therapy for depression which
involves helping a person engage in tasks that provide an opportunity for positive
reinforcement.
 Systematic Desensitization – involves two components: (1) deep muscle relaxation and
(2) gradual exposure to a list of feared situations, starting with those that arouse minimal
anxiety and progressing to those that are the most frightening.
 Cognition – is a term that groups together the mental processes of perceiving,
recognizing, conceiving, judging, and reasoning.

Stroop Task – the participant sees a set of color names printed in inks of different colors
and must name the ink color of each word as rapidly as possible. A test for finding out the
person’s schema.
 Schema – an organized network of already-accumulated knowledge.
 Cognitive Behavior Therapy – incorporates theory and research on cognitive processes.
Cognitive behavior therapists pay attention to private events—thoughts, perceptions,
judgments, self-statements, and even tacit (unconscious) assumptions—and have studied
and manipulated these processes in their attempts to understand and modify overt and
covert disturbed behavior.
 Cognitive Restructuring – is a general term for changing a pattern of thought.
People with depression may not realize how often they think self-critically, and
those with anxiety disorders may not realize that they tend to be overly sensitive
to possible threats in the world.
13. Factors that Cut Across the Paradigms: Emotion, Socio-Cultural, Interpersonal
 Emotions – influence how we respond to problems and challenges in our environment;
they help us organize our thoughts and actions, both explicitly and implicitly, and they
guide our behavior.
 Socio-Cultural Factors – such as gender, race, culture, ethnicity, and socioeconomic
status, can contribute to different psychological disorders.
 Interpersonal Factors – the quality of relationships influences different disorders. Family
and marital relationships, social support, and even the amount of casual social contact all
play a role in influencing the course of disorders.
 Object Relations Theory – which stresses the importance of long-standing
patterns in close relationships, particularly within the family, that are shaped by
the ways in which people think and feel. The “object” refers to another person in
most versions of this theory. This theory goes beyond transference to emphasize
the way in which a person comes to understand, whether consciously, how the
self is situated in relation to other people. For example, a woman may come to
understand herself as a worthless person based on her cold and critical
relationship with her mother.
 Attachment Theory – essence of the theory is that the type or style of an infant’s
attachment to his or her caregivers can set the stage for psychological health or
problems later in life.
 Interpersonal Therapy – emphasizes the importance of current relationships in
a person’s life and how problems in these relationships can contribute to
psychological symptoms. Four Interpersonal Issues:
 Unresolved Grief – for example, experiencing delayed or incomplete
grieving following a loss.
 Role Transitions – for example, transitioning from child to parent or
from worker to retired person.
 Role Disputes – for example, resolving different relationship
expectations between romantic partners.
 Interpersonal or Social Deficits – for example, not being able to begin
a conversation with an unfamiliar person or finding it difficult to
negotiate with a boss at work.
14. Diathesis-Stress: An Integrative Paradigm
 Diathesis-Stress Paradigm – is an integrative paradigm that links genetic,
neurobiological, psychological, and environmental factors. It is not limited to one
particular school of thought, such as cognitive behavioral, genetic, or neurobiological. The
diathesis–stress concept was introduced in the 1970s as a way to account for the multiple
causes of schizophrenia.
 Diathesis – a predisposition toward disease.
 Stress – environmental, or life, disturbances.
15. Diagnosis and Assessment – are the critically important “first steps” in the study and treatment
of psychopathology. Diagnosis will allow the clinician to describe base rates, causes, and
treatment for Aaron and his family, all of which are important aspects of good clinical care.
 Cornerstones of Diagnosis and Assessment: Reliability and Validity.
 Reliability – refers to consistency of measurement.
 Interrater Reliability – refers to the degree to which two independent observers
agree on what they have observed.
 Test-Retest Reliability – measures the extent to which people being observed
twice or taking the same test twice, perhaps several weeks or months apart,
receive similar scores.
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 Alternate-Form Reliability – the extent to which scores on the two forms of the
test are consistent. Sometimes psychologists use two forms of a test rather than
giving the same test twice, perhaps when there is concern that test takers will
remember their answers from the first round of taking the test and aim merely
to be consistent.
 Internal Consistency Reliability – assesses whether the items on a test are
related to one another. For example, one would expect the items on an anxiety
questionnaire to be interrelated, or to correlate with one another, if they truly
tap anxiety. A person who reports a dry mouth in a threatening situation would
be expected to report increases in muscle tension as well, since both are common
characteristics of anxiety.
 Validity – whether a measure measures what it is supposed to measure.
 Content Validity – refers to whether a measure adequately samples the domain
of interest.
 Criterion Validity – is evaluated by determining whether a measure is
associated in an expected way with some other measure (the criterion).
 Concurrent Validity – if both variables are measured at the same point
in time. People with depression today should score higher on a test about
depression today.
 Predictive Validity – the ability of the measure to predict some other
variable that is measured at some point in the future. IQ test can today
may predict successful people in the future; or that negative thinking of
children today may predict adults with depression in the future.
 Construct Validity – is a more complex concept. It is relevant when we want to
interpret a test as a measure of some characteristic or construct that is not
observed simply or overtly. A construct is an inferred attribute, such as
anxiousness or distorted cognition.
Diagnostic and Statistical Manual of Mental Disorders (DSM) – the official diagnostic system
used by mental health professionals. Published in 1952 by the American Psychiatric Association
History – *see latest DSM*
Multiaxial Classification System – *see latest DSM*
Latest DSM Chapters – *see latest DSM*
Disorder Diagnoses – *see latest DSM*
New Diagnoses – *see latest DSM*
Combined Diagnoses – *see latest DSM*
Ethnic and Cultural Considerations in Diagnoses
 Amok – the term is Malaysian and is defined by the dictionary as a murderous frenzy. A
dissociative episode in which there is a period of brooding followed by a violent and
sometimes homicidal outburst.
 Ghost Sickness – an extreme preoccupation with death and those who have died, found
among certain Native American tribes.
 Drat – a term used in India to refer to severe anxiety about the discharge of semen.
 Koru – reported in South and East Asia, an episode of intense anxiety about the
possibility that the penis or nipples will recede into the body, possibly leading to death.
 Shenjing Shuairuo – (neurasthenia) a common diagnosis in China, a syndrome
characterized by fatigue, dizziness, headaches, pain, poor concentration, sleep problems,
and memory loss.
 Taijin Kyofusho – common in Japan. The fear that one could offend others through
inappropriate eye contact, blushing, a perceived body deformation, or one’s own foul
body odor.
 Hikikomori – (withdrawal) This refers to a syndrome observed in Japan, Taiwan, and
South Korea in which an individual, most often an adolescent boy or young adult man,
shuts himself into a room (e.g., bedroom) for a period of 6 months or more and does not
socialize with anyone outside the room.
Comorbidity – which refers to the presence of a second diagnosis.
Clinical Interviews – is different from a casual conversation is the attention the interviewer pays
to how the respondent answers questions—or does not answer them.
 Structured Clinical Interview (SCID) – is a structured interview in which the questions are
set out in a prescribed fashion for the interviewer. Is a branching interview; that is, the
client’s response to one question determines the next question that is asked. It also
contains detailed instructions to the interviewer concerning when and how to probe in
detail and when to go on to questions about another diagnosis.
Assessment of Stress – can be conceptualized as the subjective experience of distress in response
to perceived environmental problems.

Hans Selye – physician, his pioneering work set the stage for our current
conceptualization of stress. Coined the term General Adaptation Syndrome (GAS) to
describe the biological response to sustained and high levels of stress.
 General Adaptation Syndrome, Selye’s Model – there are three phases of stress
response: Phase 1 “The Alarm Reaction”, Phase 2 “Resistance”, Phase 3 “Exhaustion”.
 Alarm Reaction Phase – the Autonomic Nervous System (ANS) is activated by the
stress.
 Resistance Phase – the organism tries to adapt to the stress through available
coping mechanisms.
 Exhaustion Phase – the organism dies or suffers irreversible damage.
 Bedford College Life Events and Difficulties Schedule (LEDS) – widely used to study lifestressors; semi-structured; was designed to address a number of problems in life stress
assessment, including the need to evaluate the importance of any given life event in the
context of a person’s life circumstances. The interviewer and the interviewee work
collaboratively to produce a calendar of each of the major events within a given time
period.
 Self-Report Stress Checklists: List of Threatening Experiences, and Epidemiological
Research Interview Life Events Scale – these checklists typically list different life events
(e.g., death of a spouse, serious physical illness, major financial crisis), and participants
are asked to indicate whether or not these events happened to them in a specified period
of time. Difficulty in these tests: Variability and Bias.
27. Psychological Tests – further structure the process of assessment. Two most common types:
Personality Tests and intelligence Tests.
 Personality Tests – two types: Self-report Personality Inventories and Projective
Personality Tests.
 Self-Report Personality Inventory – the person is asked to complete a self-report
questionnaire indicating whether statements assessing habitual tendencies apply
to him or her.
 Minnesota Multiphasic Personality Inventory (MMPI) – developed in
the early 1940s by Hathaway and McKinley (1943) and revised in 1989.
 Projective Personality Test – is a psychological assessment tool in which a set of standard
stimuli—inkblots or drawings—ambiguous enough to allow variation in responses is
presented to the person.
 Projective Hypothesis – The assumption is that because the stimulus materials
are unstructured and ambiguous, the person’s responses will be determined
primarily by unconscious processes and will reveal his or her true attitudes,
motivations, and modes of behavior.
 Thematic Apperception Test (TAT) – in this test a person is shown a series of
black-and-white pictures one-by-one and asked to tell a story related to each.
 Rorschach Inkblot Test – by Hermann Rorschach. in this test a person is
shown a series of black-and-white pictures one-by-one and asked to tell
a story related to each. Half the inkblots are in black, white, and shades
of gray; two also have red splotches; and three are in pastel colors.
 Exner – designed the most commonly used system for scoring the
Rorschach test.
 Intelligence Tests – often referred to as an IQ test, is a way of assessing a person’s current
mental ability. Pioneered by Alfred Binet: Wechsler Adult Intelligence Scale (WAIS),
Wechsler Intelligence Scale for Children (WISC), and the Wechsler Preschool and Primary
Scale of Intelligence (WPPSI).
 Uses of Intelligence Tests:
 Predicting school performances.
 Used in conjunction with Achievement Tests to identify strengths and
weaknesses.
 To determine whether the person has Intellectual Developmental
Disorder.
 To identify intellectually gifted children.
 To monitor people with dementia by using it in neuropsychological
evaluations.
 Stereotype Threat – suggests that the social stigma of poor intellectual
performance borne by some groups can affect the way that group will perform in
intelligence tests. Telling a group before a test that women normally perform
worse than men in mathematical tests would likely result to women actually
scoring low.
28. Behavioral and Cognitive Assessments – includes (1) Aspects of the environment that might
contribute to symptoms, (2) Characteristics of the person, (3) The frequency and form of
problematic behaviors, and (3) Consequences of problem behaviors. Methods in gathering
behavioral or cognitive assessments:
 Direct Observation of Behavior – more than just going out and observing, in formal
behavioral observation, the observer divides the sequence of behavior into various parts
that make sense within a learning framework, including such things as the antecedents
and consequences of particular behaviors. For laboratory settings, Artificial Situations are
used, usually observed through a one-way mirror.
 Self-Observation – observing and tracking one’s own behavior and responses through
self-monitoring.
 Ecological Momentary Assessment (EMA) – involves the collection of data in real
time as opposed to the more usual methods of having people reflect back over
some time period (retrospective) and report on recently experienced thoughts,
moods, or stressors (i.e., through a diary or device).
 Reactivity – is one possible downside of EMA, the phenomenon wherein behavior
changes because it is being observed. Under reactivity is the Hawthorne Effect.
 Cognitive-Style Questionnaires – tend to be used to help plan targets for treatment as
well as to determine whether clinical interventions are helping to change overly negative
thought patterns. In format, some of these questionnaires are similar to the personality
tests.
 Dysfunctional Attitude Scale (DAS) – developed based on Aaron Beck’s theory;
contains items such as “People will probably think less of me if I make a mistake”.
29. Neurobiological Assessment – assumes that some symptoms are likely to be due to or at least
reflected in malfunctions of the brain or other parts of the nervous system. Neurobiological
Assessment Methods include:
Brain Imagining, Neurotransmitter
Assessment,
Neuropsychological Assessment, and Psychophysiological Assessment.
 Brain Imaging – the use of devices that have become available through technological
advancements to allow clinicians and researchers a much more direct look at both the
structure and functioning of the brain.
 Computerized Axial Tomography Scan (CT Scan or CAT Scan) – helps to assess
structural brain abnormalities (and is able to image other parts of the body for
medical purposes). A moving beam of X-rays passes into a horizontal cross section
of the person’s brain, scanning it through 360 degrees; the moving X-ray detector
on the other side measures the amount of radioactivity that penetrates, thus
detecting subtle differences in tissue density.
 Magnetic Resonance Imaging (MRI) – superior to CT scan because it produces
higher quality pictures. Does not rely on radiation as opposed to CT scan. Uses a
large circular magnet to move hydrogen atoms in the body, and measures the
electromagnetic signals as these atoms return to their original positions after the
magnet has been turned off.
 Functional Magnetic Resonance Imaging (fMRI) – the more advanced version of
the MRI, which allows researchers to measure both brain structure and brain
function. It is quicker that it can measure brain function through measuring BOLD
signals (Blood Oxygenation Level Dependent).
 Blood Oxygenation Level Dependent Signals (BOLD Signals) – As
neurons fire, blood flow increases to that area. Therefore, blood flow in
a particular region of the brain is a reasonable proxy for neural activity in
that brain region.
 Positron Emission Tomography (PET Scan) – a more expensive and invasive
procedure, also allows measurement of both brain structure and brain function,
although the measurement of brain structure is not as precise as with MRI or
fMRI. A substance used by the brain is labeled with a short-lived radioactive
isotope and injected into the bloodstream. The radioactive molecules of the
substance emit a particle called a positron, which quickly collides with an
electron. A pair of high-energy light particles shoot out from the skull in opposite
directions and are detected by the scanner.
 Neurotransmitter Assessment – assessing the amount of a neurotransmitter.
 Postmortem Analysis – removing the brain of the deceased and counting the
neurotransmitters.
 Metabolite Analysis – A metabolite, typically an acid, is produced when a
neurotransmitter is deactivated. These by-products of the breakdown of
neurotransmitters, such as norepinephrine, dopamine, and serotonin, are found
in urine, blood serum, and cerebrospinal fluid (CSF; the fluid in the spinal column
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and in the brain’s ventricles). For example, a major metabolite of dopamine is
homovanillic acid; of serotonin, 5-hydroxyindoleacetic acid. A high level of a
particular metabolite presumably indicates a high level of a neurotransmitter,
and a low level indicates a low level of the transmitter.
 Neuropsychological Assessment – are based on the idea that different psychological
functions (e.g., motor speed, memory, language) rely on different areas of the brain and
impairments in specific areas of the internal structures of the brain may be manifested in
the ability and way that people can perform various tasks.
 Halstead-Reitan Neuropsychological Test Battery – three of the tests:
 Tactile Performance Test—Time – while blindfolded, the patient tries to
fit variously shaped blocks into spaces of a form board, first using the
preferred hand, then the other, and finally both.
 Tactile Performance Test—Memory – after completing the timed test,
the participant is asked to draw the form board from memory, showing
the blocks in their proper location. Both this and the timed test are
sensitive to damage in the right parietal lobe.
 Speech Sounds Perception Test – participants listen to a series of
nonsense words, each comprising two consonants with a long-e sound in
the middle. They then select the “word” they heard from a set of
alternatives. This test measures left-hemisphere function, especially
temporal and parietal areas.
 Luria–Nebraska Battery – based on the work of the Russian psychologist
Aleksandr Luria. The battery includes 269 items divided into 11 sections and can
be administered in 2 1 – 2 hours and can be scored in a highly reliable manner.
 Psychophysiological Assessment – is concerned with the bodily changes that are
associated with psychological events. Experimenters have used measures such as heart
rate, tension in the muscles, blood flow in various parts of the body, and electrical activity
in the brain (so-called brain waves) to study physiological changes when people are afraid,
depressed, asleep, imagining, solving problems, and so on.
 Heart Rate – is graphically depicted in an electrocardiogram (EKG), which may be
seen as waves on a computer screen or on a roll of graph paper each heartbeat
generates electrical changes, which can be recorded by electrodes placed on the
chest that convey signals to an electrocardiograph or a polygraph.
 Skin Conductance – or electrodermal responding, measured by an electrodermal
activity meter (EDA meter). Anxiety, fear, anger, and other emotions increase
activity in the sympathetic nervous system, which then boosts sweat-gland
activity. Increased sweat-gland activity increases the electrical conductance of
the skin. Conductance is typically measured by determining the current that flows
through the skin as a small voltage is passed between two electrodes on the hand.
When the sweat glands are activated, this current shows a pronounced increase.
 Brain Activity – measured by an electroencephalogram (EEG). Electrodes placed
on the scalp record electrical activity in the underlying brain area. Abnormal
patterns of electrical activity can indicate seizure activity in the brain or help in
locating brain lesions or tumors. EEG indices are also used to measure attention
and alertness.
Research Methods in Psychopathology
Science – comes from the Latin word “scire” which means “to know”. Science is the systematic
pursuit of knowledge through observation.
Theory – is a set of propositions meant to explain a class of observations.
Hypotheses – expectations about what should occur if a theory is true.
Approaches to Research on Psychopathology: Case Study, Correlation, and Experiments
The Case Study – recording detailed information about one person at a time. A comprehensive
case study would cover developmental milestones, family history, medical history, educational
background, jobs held, marital history, social adjustment, personality, environment and
experiences in therapy across the life course. Characteristics of Case Studies:
 Excellent source of hypotheses that can be tested through controlled research
 Can provide information about novel cases or procedures
 Can disconfirm a relationship that was believed to be universal (can disprove but not
prove a hypothesis).
 Cannot provide causal evidence because cannot rule out alternative hypotheses
 May be biased by observer’s theoretical viewpoint (lacks control and objectivity)
The Correlational Method – study of the relationship between two or more variables; measured
as they exist in nature.

Correlation Coefficient – denoted by the symbol r. An r of either +1.00 or –1.00 indicates
the strongest possible, or perfect, relationship, whereas an r of .00 indicates that the
variables are unrelated. If the sign of r is positive, the two variables are said to be
positively related; in other words, as the values for variable X increase, those for variable
Y also tend to increase.
 Statistical Significance – p < 0.05, where p stands for probability. The higher the
correlational coefficient, the higher the statistical significance. The higher the number of
participants, the lower the correlational coefficient needed to get a high statistical
significance. Thus, the higher the number of participants, the easier it is to arrive at a
higher correlational coefficient, which ultimately leads to a higher statistical significance.
 Clinical Significance – is defined by whether a relationship between variables is large
enough to matter.
 Problems of Causality:
 Directionality Problem – correlation does not imply causation. This can be
partially overcome by using a Longitudinal Design or a Cross-Sectional Design or
through using a High-Risk Method.
 Third-Variable Problem – confounding variables.
 Epidemiology – is the study of the distribution of disorders in a population.
 Epidemiological Research – is one example of a correlational research. That is, data are
gathered about the rates of a disorder and its correlates in a large sample.
Epidemiological research focuses on three features of a disorder:
 Prevalence – the proportion of people with the disorder either currently or
during their lifetime.
 Incidence – the proportion of people who develop new cases of the disorder in
some period, usually a year.
 Risk Factors – variables that are related to the likelihood of developing the
disorder.
 Behavior and Molecular Genetics Research – is another example of a correlational
research; has relied on three basic methods to uncover whether a genetic predisposition
for psychopathology is inherited—comparison of members of a family, comparison of
pairs of twins, and investigation of adoptees.
 Family Method – can be used to study a genetic predisposition among members
of a family because the average number of genes shared by two blood relatives
is known. The starting point in such investigations is the collection of a sample of
persons with the diagnosis in question. These people are referred to as index
cases or probands. Then relatives are studied to determine the frequency with
which the same diagnosis might be applied to them. If a genetic predisposition to
the disorder being studied is present, first-degree relatives of the index cases
should have the disorder at a rate higher than that found in the general
population. Concordance (whether the relatives are matched on presence or
absence of a disorder) should be higher between first-degree relatives than other
degrees.
 Twin Method – where both monozygotic (MZ) twins and dizygotic (DZ) twins are
compared. Concordance should be higher between MZ than between DZ.
 Adoptees Method – studies children who were adopted and reared completely
apart from their biological parents.
 Cross-Fostering – children are adopted and reared completely apart from
their biological parents. In this case, however, the adoptive parent has a
particular disorder, not the biological parent.
 Association Studies – In these studies, researchers examine the
relationship between a specific allele (i.e., different forms of the same
gene) and a trait or behavior in the population. Because the researchers
are measuring a specific allele rather than the general chromosome
location, association studies can be precise.
o Genome-Wide Association Studies (GWAS) – a special type of
association research; examines the entire genome of a large
group to identify variation between people.
Characteristics of Correlational Method:
 Widely used because we cannot manipulate many risk variables (such as personality,
trauma, or genes) or diagnoses in psychopathology research with humans
 Often used by epidemiologists to study the incidence, prevalence, and risk factors of
disorders in a representative sample

Often used in behavioral genetics research to study the heritability of different mental
disorders
 Cannot determine causality because of the directionality and third-variable problems
37. The Experiment – is the most powerful tool for determining causal relationships. It involves the
random assignment of participants to conditions, the manipulation of an independent variable,
and the measurement of a dependent variable.
 Internal Validity – refers to the extent to which the experimental effect can be attributed
to the independent variable. For a study to have internal validity, the researchers must
include at least one control group.
 Control Group – does not receive the experimental treatment and is needed to
claim that the effects of an experiment are due to the independent variable.
 Placebo Control Group – in psychotherapy research, the placebo might
be a therapy that consists of support and encouragement (the
“attention” component) but not the active ingredient of therapy under
study (e.g., exposure to a feared stimulus in a behavioral treatment of a
phobia). In medication studies, a placebo might be a sugar pill that is
described to the patient as a proven treatment. A placebo condition
allows researchers to control for expectations of relief.
 Placebo Effect – refers to a physical or psychological improvement that
is due to a patient’s expectations of help rather than to any active
ingredient in a treatment.
 Double-blinded Procedure – That is, the psychiatrist and the patient are
not told whether the patient receives active medication or a placebo, so
as to reduce bias in evaluating outcomes
 Efficacy – whether a treatment works under the purest of conditions.
 Effectivity – how well the treatment works in the real world.
 Dissemination – is the process of facilitating adoption of efficacious treatments
in the community, most typically by offering clinicians guidelines about the best
available treatments along with training on how to conduct those treatments.
 External Validity – is defined as the extent to which results can be generalized beyond
the study.
 Treatment Outcome Research (TOR) – one example of an experimental research; is
designed to address a simple question: does treatment work? The clear answer is yes.
 Treatment Manuals – are detailed books on how to conduct a particular
psychological treatment; they provide specific procedures for the therapist to
follow at each stage of treatment; are designed to help therapists be more similar
in what they do.
 Randomized Controlled Trials (RCT) – another example of an experimental research; are
studies in which clients are randomly assigned to receive active treatment or a
comparison (either no treatment, a placebo, or another treatment).
 Analogue Experiments – another example of an experimental research. Investigators
attempt to create or observe a related phenomenon—that is, an analogue—in the
laboratory to allow more intensive study. Because a true experiment is conducted, results
with good internal validity can be obtained. The problem of external validity arises,
however, because the researchers are no longer studying the actual phenomenon of
interest.
 Single-Case Experiments – experiments do not always have to be conducted on groups;
the experimenter studies how one person responds to manipulations of the independent
variable. Unlike the traditional case studies described above, single-case experimental
designs can have high internal validity. Lack of external validity.
 Reversal Design or ABAB Design – a form of single-case design where the
participant’s behavior must be carefully measured in a specific sequence: (1) An
initial time period, the baseline (A); (2) A period when a treatment is introduced
(B); (3) A reinstatement of the conditions of the baseline period (A); (4) A
reintroduction of the treatment (B).
 Meta-Analysis – the first step in a meta-analysis is a thorough literature search, so that
all relevant studies are identified. Because these studies have typically used different
statistical tests, meta-analysis then puts all the results into a common scale, using a
statistic called an effect size. For example, in treatment studies, the effect size offers a
way of standardizing the differences in improvement between a therapy group and a
control group so that the results of many different studies can be averaged.
Characteristics/Features of the Experimental Method:
 The investigator manipulates an independent variable


Participants are assigned to the two conditions by random assignment
The researcher measures a dependent variable that is expected to vary with conditions
of the independent variable
 Differences between conditions on the dependent variable are called the experimental
effect
38. Mood Disorders – involve disabling disturbances in emotion—from the extreme sadness and
disengagement of depression to the extreme elation and irritability of mania.
39. DEPRESSIVE DISORDERS – is the presence of sad, empty, or irritable mood, accompanied by
related changes that significantly affect the individual’s capacity to function (e.g., somatic and
cognitive changes in major depressive disorder and persistent depressive disorder); studies found
that the lowering of the neurotransmitters themselves (norepinephrine, dopamine, and
serotonin) or the sensitivity of the receptors can lead to depression.
 Neurobiological Factors:
 Amygdala – helps a person to assess how emotionally important a stimulus is;
heightened during mood disorders.
 Subgenual Anterior Cingulate – heightened
 Dorsolateral Prefrontal Cortex – diminished
 Hippocampus – diminished; lessened emotional regulation
 Neuroendocrine System:
 Hypothalamic Pituitary Adrenocortical Axis (HPA Axis) – is overly activated in
depression. It overly secretes the stress hormone cortisol which leads to
Cushing’s Syndrome, the over-secretion of cortisol, which is linked to depression.
 Cognitive Theories:
 Beck’s Theory – argued that depression is associated with a negative triad:
negative views of the self, the world, and the future.
 Cognitive Bias – or tendencies to process information in certain negative
ways.
 Hopelessness Theory – the most important trigger of depression is hopelessness,
which is defined as an expectation that (1) desirable outcomes will not occur and
that (2) the person has no responses available to change this situation. Two key
dimensions of attributions:
 Stable versus Unstable – stable means one is aware of the deficiency and,
as a response to this awareness, can act to resolve it (e.g., I lack
intelligence, or I lack mathematical ability); unstable means one is not
aware of the reason behind the feelings and instead just surrenders to it
(e.g., I am exhausted, or I am fed up with math.)
 Global versus Specific – global means everyone of us can experience it
(e.g., exhaustion, intelligence, etc.), specific means it can be unique (e.g.,
mathematical abilities).
 Rumination Theory – is defined as a tendency to repetitively dwell on sad
experiences and thoughts, or to chew on material again and again. The
most detrimental form of rumination may be a tendency to brood or to
regretfully ponder why an episode happened.
 Treatments:
 Interpersonal Psychotherapy – builds on the idea that depression is closely tied
to interpersonal problems. The core of the therapy is to examine major
interpersonal problems, such as role transitions, interpersonal conflicts,
bereavement, and interpersonal isolation.
 Cognitive Therapy – a cognitive therapy (CT) aimed at altering maladaptive
thought patterns.
 Mindfulness-based Cognitive Therapy (MBCT) – focuses on relapse
prevention after successful treatment for recurrent episodes of major
depression.
 Behavioral Activation (BA) Therapy – was based on the idea that many of the risk
factors for depression can result in low levels of positive reinforcement; the goal
of BA is to increase participation in positively reinforcing activities so as to disrupt
the spiral of depression, withdrawal, and avoidance.
 Behavioral Couples Therapy – , researchers work with both members of a couple
to improve communication and relationship satisfaction.
 Psychoeducational Approaches – typically help people learn about the symptoms
of the disorder, the expected time course of symptoms, the biological and
psychological triggers for symptoms, and treatment strategies.
 Electroconvulsive Therapy for Depression – used to treat MDD that has not
responded to medication. ECT entails deliberately inducing a momentary seizure
and unconsciousness by passing a 70- to 130-volt current through the patient’s
brain. Formerly, electrodes were placed on each side of the forehead, a method
known as bilateral ECT.
 Medications Three Categories of Antidepressants: Monoamine Oxidase
Inhibitors (MAOI), Tricyclic Antidepressants, and Selective Serotonin Reuptake
Inhibitors (SSRIs)

Include:
 disruptive mood dysregulation disorder
 major depressive disorder (including major depressive episode)
 persistent depressive disorder
 premenstrual dysphoric disorder
 substance/medication-induced depressive disorder
 depressive disorder due to another medical condition
 other specified depressive disorder
 unspecified depressive disorder
40. Disruptive Mood Dysregulation Disorder – Diagnostic Criteria:
A. Temper outburst (severe and recurrent) are behaviorally or verbally manifested.
B. Temper outburst inconsistent with developmental level.
C. Temper outburst 3 or more times per week.
D. Temper outburst most of the day, nearly every day, observable (parents, teachers, peers.)
E. A-D need be present for 12 or more months, without being absent 3 consecutive months.
F. A-D need be present in at least two among these three settings: Home, School, Peers.
G. Diagnosis should not be made before 6 years old and after 18 years old.
H. Diagnosis should not go beyond 10 years old for diagnosing onset.
I. Manic or hypomanic episodes full criteria are not met for one day
J. Are not better explained by another mental disorder.
K. Is not a result of a substance or another medical or neurological condition.
Differential Diagnosis:
 Bipolar Disorders: Bipolar Disorders are episodic while DMDD are chronic; BD have
elevated or expansive mood contrary to DMDD’s disruptive mood; BD has grandiosity
while DMDD has not. A diagnosis of BD automatically nullifies a diagnosis of DMDD.
 Oppositional Defiant Disorder: ODD do not have disruptions and dysregulations of
DMDD, but DMDD may have the oppositional defiance of ODD. A diagnosis of DMDD
automatically nullifies a diagnosis of ODD.
 Attention Deficit/Hyperactivity Disorder, Major Depressive Disorder, Anxiety Disorders,
and Autism Spectrum Disorder: If the outburst in DMDD is only secondary, a product of,
or one of the criterium under ADHD, MDD, AD, and ASD, this automatically nullifies a
diagnosis of DMDD. However, it is possible that AD is diagnosed alongside with DMDD.
 Intermittent Explosive Disorder: very similar but in IED, the individual does not have to
be persistently angry or irritable in-between outbursts, unlike in DMDD; IED diagnosis can
be made after 3 months while DMDD after 12 months. Thus, though similar, the two
cannot be diagnosed alongside each other.
41. Major Depressive Disorder – prevalent in ages 18-29 but may occur at any age, and more in
females. Is an episodic disorder.
Diagnostic Criteria:
A. 5 or more symptoms are present during a 2-week period, and one of the symptoms should be
1 or 2:
1. Depressed mood most of the day and nearly every day.
2. Diminished interest or pleasure most of the day and nearly every day.
3. Significant weight loss.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or inappropriate guilt.
8. Diminished ability to think or indecisiveness nearly every day.
9. Recurrent thoughts of death, suicidal ideation, or suicidal attempts.
B. Symptoms cause clinically significant distress and impairment.
C. Not attributable to physiological effects of a substance or another medical condition. (A-C is
enough for a diagnosis of MDD).
D. Should not be better explained by any of the disorders under schizophrenia spectrum.
E. There has never been a manic or a hypomanic episode.
Differential Diagnosis: *To be filled-in*
42. Persistent Depressive Disorder (PDD) – consolidation of the Chronic Major Depressive Disorder
and Dysthymia. Can be diagnosed alongside MDD.
Diagnostic Criteria: (only A is shown here because the rest is similar to Major Depressive Disorder.
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective
account or observation by others, for at least 2 years.
43. Premenstrual Dysphoric Disorder
44. (PROCEED TO DSM KAY DAGHAN KAAYY JUSQ)
45. BIPOLAR DISORDERS
 Mania – is a state of intense elation or irritability accompanied by other symptoms shown
in the diagnostic criteria.
1. Bipolar I Disorder – include a single episode of mania during the course of a person’s life.
2. Bipolar II Disorder – a person must have experienced at least one major depressive episode and
at least one episode of hypomania.
3. Cyclothymic Disorder – chronic; the person has frequent but mild symptoms of depression,
alternating with mild symptoms of mania.
1. ANXIETY DISORDERS
2. Anxiety – is defined as apprehension over an anticipated problem.
3. Fear – is defined as a reaction to immediate danger.
4. Kayak-Angst – a disorder that is similar to panic disorder, occurs among the Inuit people of
western Greenland; seal hunters who are alone at sea may experience intense fear,
disorientation, and concerns about drowning.
5. Koro – a sudden fear that one’s genitals will recede into the body—reported in southern and
eastern Asia.
6. Shenkui – intense anxiety and somatic symptoms attributed to the loss of semen, as through
masturbation or excessive sexual activity—reported in China and similar to other syndromes
reported in India and Sri Lanka.
7. Susto – fright-illness, the belief that a severe fright has caused the soul to leave the body—
reported in Latin America and among Latinos in the United States.
8. Specific Phobia – is a disproportionate fear caused by a specific object or situation, such as fear
of flying, fear of snakes, and fear of heights.
9. Agoraphobia – s a persistent, unrealistically intense fear of social situations that might involve
being scrutinized by, or even just exposed to, unfamiliar people.
10. Panic Disorder – is characterized by frequent panic attacks that are unrelated to specific
situations and by worry about having more panic attacks.
 Panic Attack – is a sudden attack of intense apprehension, terror, and feelings of
impending doom, accompanied by at least four other symptoms. Physical symptoms can
include labored breathing, heart palpitations, nausea, upset stomach, chest pain, feelings
of choking and smothering, dizziness, lightheadedness, sweating, chills, heat sensations,
and trembling; and fears of losing control, of going crazy, and even of dying.
 Depersonalization – a feeling of being outside one’s body.
 Derealization – a feeling of the world’s not being real.
 Locus Coeruleus – a part of the fear circuit that has been particularly important in panic
disorder. Fear and anxiety would lead to high activity in this area.
 Interoceptive Conditioning – classical conditioning of panic attacks in response to bodily
sensations; a person experiences somatic signs of anxiety, which are followed by the
person’s first panic attack; panic attacks then become a conditioned response to the
somatic changes.
 Anxiety Sensitivity Index – which measures the extent to which people respond
fearfully to their bodily sensations.
4. Agoraphobia – (from the Greek agora, meaning “marketplace”) is defined by anxiety about
situations in which it would be embarrassing or difficult to escape if anxiety symptoms occurred.
Commonly feared situations include crowds and crowded places such as grocery stores, malls,
and churches.
 Fear-of-Fear Hypothesis – which suggests that agoraphobia is driven by negative
thoughts about the consequences of experiencing anxiety in public
5. Generalized Anxiety Disorder – the central feature of GAD is “worry”; people with GAD are
persistently worried, often about minor things. The term worry refers to the cognitive tendency
to chew on a problem and to be unable to let go of it. Often, worry continues because a person
cannot settle on a solution to the problem.
6. Mower’s Two-Factor Model – explains the risk factor for developing anxiety and fear; suggests
two steps in the development of an anxiety disorder: Classical Conditioning and Operant
Conditioning.
7. Fear Circuit – such as the amygdala, shows elevation during fear and anxiety.
8. Medial Prefrontal Cortex – appears to be important in helping to regulate amygdala activity—it
is involved in extinguishing fears as well as using emotion regulation strategies to control
emotions.
9. Behavioral Inhibition – a tendency to become agitated and cry when faced with novel toys,
people, or other stimuli.
10. Dot Probe Task – measures the degree of selective attention to threatening stimuli.
11. Prepared Learning – the type of learning that states that our fear circuit may have been
“prepared” by evolution to learn fear of certain stimuli.
12. Treatments:
 In Vivo Exposure of Feared Objects – exposure
 Panic Control Therapy (PCT) – is based on the tendency of people with panic disorder to
overreact to the bodily sensations; uses exposure technique.
 Sedatives – are drugs that reduce anxiety; including benzodiazepines (Valium and Xanax)
and antidepressants (tricyclic antidepressants, Selective Serotonin Reuptake inhibitors,
and Serotonin-Norepinephrine Reuptake Inhibitors).
 D-cycloserine (DCS) – a drug that enhances learning but can bolster exposure
treatments.
1. Obsessive-Compulsive Disorders and Trauma-Related Disorders – (1) is based on the tendency
of people with panic disorder to overreact to the bodily sensations; and (2) include posttraumatic
stress disorder and acute stress disorder, two conditions that are triggered by exposure to
severely traumatic events.
2. Obsessive-Compulsive Disorder – is characterized by obsessions or compulsions.
 Obsessions – are intrusive and recurring thoughts, images, or impulses that are persistent
and uncontrollable (i.e., the person cannot stop the thoughts) and that usually appear
irrational to the person experiencing them.
 Compulsions – are repetitive, clearly excessive behaviors or mental acts that the person
feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent
some calamity from occurring.
 Yedasentience – is the subjective feeling of knowing; is an intuitive signal that you have
thought enough, cleaned enough, or in other ways done what you should to prevent
chaos and danger. One theory suggests that people with OCD suffer from a deficit in
yedasentience.
 Thought Suppression – people with OCD attempts to over suppress their thoughts that
they end up giving-in to the temptation. Trying to suppress a thought may have the
paradoxical effect of inducing preoccupation with it.
3. Body Dysmorphic Disorder (BDD) – preoccupation with an imagined or exaggerated defect in
their appearance. Although people with BDD may appear attractive to others, they perceive
themselves as ugly or even “monstrous” in their appearance. BDD and OCD activates these three
areas of the brain: orbitofrontal cortex (an area of the medial prefrontal cortex located just above
the eyes), the caudate nucleus (part of the basal ganglia), and the anterior cingulate.
4. Hoarding Disorder – the need to acquire is only part of the problem. The bigger problem is that
they abhor parting with their objects, even when others cannot see any potential value in them.
5. Treatment:
 Serotonin Reuptake Inhibitors (SRI)
 Exposure and Response Prevention (ERP)
6. Posttraumatic Stress Disorder (PTSD) – entails an extreme response to a severe stressor,
including increased anxiety, avoidance of stimuli associated with the trauma, and symptoms of
increased arousal. Acute Stress Disorder is a shorter-lived version of the PTSD.
 Intrusively Reexperiencing the Traumatic Event – repetitive memories or nightmares of
the event.
 Avoidance – avoid all reminders of the event.
 Other Signs of Mood and Cognitive Change after the Trauma
 Symptoms of Increased Arousal and Reactivity
7. Treatment:
 Imaginal Exposure – the person deliberately remembers the event
1. Dissociative Disorders and Somatic Symptom Disorders
2. Dissociative Disorders – includes three major disorders: Dissociative Amnesia,
Depersonalization/Derealization Disorder, and Dissociative Identity Disorder (formerly known as
Multiple Personality Disorder).
3. Dissociative Amnesia – lack of conscious access to memory, typically of a stressful experience.
involve deficits in explicit memory but not implicit memory.
 Explicit Memory – involves the conscious recall of experiences—for example, explicit
memory would be involved in describing a bicycle you had as a child.
 Implicit Memory – involves the conscious recall of experiences—for example, explicit
memory would be involved in describing a bicycle you had as a child.
The fugue subtype involves loss of memory for one’s entire past or identity.
 Fugue – Latin fugere “to flee”. The memory loss is more extensive. As in the Clinical Case
of Burt/Gene below, the person not only becomes totally amnesic but suddenly leaves
home and work and assumes a new identity. Sometimes the person takes on a new name,
a new home, a new job, and even a new set of personality characteristics.
4. Depersonalization/Derealization Disorder – alteration in the experience of the self and reality.
The person’s perception of the self or surroundings is disconcertingly and disruptively altered. The
altered perceptions are usually triggered by stress; it involves no disturbance of memory; people
rather suddenly lose their sense of self; and, people may have the impression that they are outside
their bodies, viewing themselves from a distance. Sometimes they feel mechanical, as though
they and others are robots.
 Derealization – refers to the sensation that the world has become unreal.
5. Dissociative Identity Disorder – at least two distinct personalities that act independently of each
other. Requires that a person have at least two separate personalities, or alters—different modes
of being, thinking, feeling, and acting that exist independently of one another and that emerge at
different times.
 Posttraumatic Model – proposes that some people are particularly likely to use
dissociation to cope with trauma, and this is seen as a key factor in causing people to
develop alters after trauma.
 Sociocognitive Model – considers DID to be the result of learning to enact social roles.
According to this model, alters appear in response to suggestions by therapists, exposure
to media reports of DID, or other cultural influences.
6. Treatment:
 Hypnosis through Age Regression – a technique where the person is hypnotized and
encouraged to go back in his or her mind to traumatic events in childhood.
7. Somatic Symptom Disorders – are defined by excessive concerns about physical symptoms or
health.
8. Complex Somatic Symptom Disorder – have somatic symptom; and, excessive thoughts, feelings,
and behaviors related to somatic symptoms. (1) one or more somatic symptoms that are
distressing or result in significant disruption in daily life, (2) excessive anxiety, concern, or time
and energy devoted to the somatic concern, and (3) duration of at least 6 months. To an outside
observer, it may seem that the person is using the somatic symptom to avoid some unpleasant
activity or to get attention and sympathy, but people with complex somatic symptom disorder
have no sense of this—they experience their symptoms as completely physical. Sigmund Freud
once called this as Conversion Disorder, he thought that anxiety and psychological conflict were
converted into physical symptom. Parts of the brain implicated in this disorder are: Anterior
Cingulate Context, Anterior Insula, Somatosensory Cortex.
9. Illness Anxiety Disorder – unwarranted fears about a serious illness despite absence of any
significant somatic symptoms. Different from hypochondriasis in a way that hypochondriasis
involves somatic symptoms, thus the diagnosis should be complex somatic symptom disorder
instead of hypochondriasis.
10. Functional Neurological Disorder – neurological symptom(s) that cannot be explained by medical
disease or culturally sanctioned behavior. The person suddenly develops neurological symptoms,
such as blindness or paralysis. The symptoms suggest an illness related to neurological damage,
but medical tests indicate that the bodily organs and nervous system are fine. Hysteria was the
term originally used to describe this disorder.
Carpal Tunnel Syndrome – a recognized medical condition, can produce symptoms similar to
those of glove anesthesia. Nerves in the wrist run through a tunnel formed by the wrist bones and
membranes. The tunnel can become swollen and may pinch the nerves, leading to tingling,
numbness, and pain in the hand. P
 Anesthesia – the loss of sensation.
 Tunnel Vision – in which the visual field is constricted as it would be if the person were
peering through a tube.
 Aphonia – loss of the voice other than whispered speech.
 Anosmia – loss of the sense of smell.
11. Malingering – intentionally faking psychological or somatic symptoms to gain from those
symptoms.
12. Factitious Disorder – intentionally faking psychological or somatic symptoms to gain from those
symptoms.
1. Schizophrenia – is a disorder characterized by disturbances in thought, emotion, and behavior—
disordered thinking, in which ideas are not logically related; faulty perception and attention; a
lack of emotional expressiveness or, at times, inappropriate expressions; and disturbances in
movement and behavior, such as a disheveled appearance. Historically, it was divided into three:
Positive Symptoms, Negative Symptoms, and Disorganized Symptoms. Initially called Dementia
Praecox by Emil Kraepelin, and changed by Eugene Bleuler to Schizophrenia from the words
schizein (“to split) and phren (“mind”).
Neurotransmitters behind Schizophrenia:
 Dopamine Theory – that schizophrenia is related to excess activity of the
neurotransmitter dopamine.
 Glutamate – low levels of glutamate have been found in the cerebrospinal fluid of people
with schizophrenia; and postmortem studies have revealed low levels of the enzyme
needed to produce glutamate.
 Homocysteine – elevated levels of this amino acid has been found in people with
schizophrenia and in pregnant women in their third trimester of pregnancy whose child
would go on to be a person with schizophrenia.
 Enlarged Ventricles
 Prefrontal Cortex – is known to play a role in behaviors such as speech, decision making,
emotion, and goal-directed behavior, which are disrupted in schizophrenia.
 Temporal Cortex and Surrounding Regions – additional research has found that people
with schizophrenia have structural and functional abnormalities in the temporal cortex,
including areas such as the temporal gyrus, hippocampus, amygdala, and anterior
cingulate.
 Schizophrenic Mother
 Expressed Emotions (EE) – expression of critical comments towards a person with
schizophrenia; an environment with high EE would increased the chance of relapse.
Molecular genetics research:
 COMT Gene – is associated with executive functions that rely on the prefrontal cortex.
Deficiency in executive functioning was found in people with Schizophrenia.
 BDNF Gene – gene has been studied and linked with cognitive function in people with
and without schizophrenia. People with the Met allele reduced their verbal memory.
2. Positive Symptoms – comprise excesses and distortions, such as hallucinations and delusions.
 Delusions – which are beliefs contrary to reality and firmly held in spite of disconfirming
evidence, are common positive symptoms of schizophrenia. Types of Delusions:
 Thought Insertion – a person may believe that thoughts that are not his or her
own have been placed in his or her mind by an external source.
 Thought Broadcasting – a person may believe that his or her thoughts are
broadcast or transmitted, so that others know what he or she is thinking.
 Belief that an external force controls the person’s behavior.
 Grandiose Delusions – an exaggerated sense of his or her own importance,
power, knowledge, or identity.
 Ideas of Reference – incorporating unimportant events within a delusional
framework and reading personal significance into the trivial activities of others.
 Hallucinations – sensory experiences in the absence of any relevant stimulation from the
environment. More auditory than visual.
3. Negative Symptoms – of schizophrenia consist of behavioral deficits; they include avolition,
asociality, anhedonia, blunted affect, and alogia. These symptoms tend to endure beyond an
acute episode and have profound effects on the lives of people with schizophrenia. The first
domain, involving motivation, emotional experience, and sociality, is sometimes referred to as
the experience domain. The second domain, involving outward expression of emotion and
vocalization, is referred to as the expression domain.
 Avolition – refers to a lack of motivation and a seeming absence of interest in or an
inability to persist in what are usually routine activities, including work or school, hobbies,
or social activities.
 Asociality – severe impairments in social relationships.
 Anhedonia – a loss of interest in or a reported lessening of the experience of pleasure.
People with schizophrenia appear to have a deficit in anticipatory pleasure but not
consummatory pleasure.
 Consummatory Pleasure – refers to the amount of pleasure experienced in-themoment or in the presence of something pleasurable (e.g., food).
 Anticipatory Pleasure – refers to the amount of expected or anticipated pleasure
from future events or activities (e.g., success after graduating).
 Blunted Affect – refers to a lack of outward expression of emotion. A person with this
symptom may stare vacantly, the muscles of the face motionless, the eyes lifeless. When
spoken to, the person may answer in a flat and toneless voice and not look at his or her
conversational partner.
 Alogia – refers to a significant reduction in the amount of speech. Simply put, people with
this symptom do not talk much. A person may answer a question with one or two words
and will not be likely to elaborate on an answer with additional detail.
4. Disorganized Symptoms – include disorganized speech and disorganized behavior.
 Disorganized Speech – also known as Formal Thought Disorder. Refers to problems in
organizing ideas and in speaking so that a listener can understand.
 Loose Associations – or derailment, which case the person may be more
successful in communicating with a listener but has difficulty sticking to one topic.
A lesser form of Disorganized Speech.
 Disorganized Behavior – takes many forms. People with this symptom may go into
inexplicable bouts of agitation, dress in unusual clothes, act in a childlike or silly manner,
hoard food, or collect garbage.
 Catatonia – grossly abnormal psychomotor behavior refers to disturbances in
movement behavior. People with this symptom may gesture repeatedly, using
peculiar and sometimes complex sequences of finger, hand, and arm movements,
which often seem to be purposeful. Some people manifest an unusual increase in
their overall level of activity, including much excitement, wild flailing of the limbs,
and great expenditure of energy similar to that seen in mania
 Catatonic Immobility – people adopt unusual postures and maintain them for
very long periods of time. Catatonia can also involve waxy flexibility—another
person can move the patient’s limbs into positions that the patient will then
maintain for long periods of time.
5. Other Psychotic Disorders in the Schizophrenia Spectrum:
 Schizophreniform Disorder – symptoms are the same as that of schizophrenia but last
only from 1 to 6 months.
 Brief Psychotic Disorder – lasts from 1 day to 1 month and is often brought on by extreme
stress, such as bereavement.
 Schizoaffective Disorder – comprises a mixture of symptoms of schizophrenia and mood
disorders.
 Delusional Disorder – is troubled by persistent delusions of persecution or by delusional
jealousy, the unfounded conviction that a spouse or lover is unfaithful. Other delusions
seen in this disorder include delusions of being followed, delusions of erotomania
(believing that one is loved by some other person, usually a complete stranger with a
higher social status), and delusions of having a general medical condition (e.g., having
cancer).
 Attenuated Psychosis Syndrome – a new diagnosis. The idea for such a new category
came from research over the past two decades that has sought to identify young people
who are at risk for developing schizophrenia.
6. Treatment:
 Antipsychotic Drugs – or neuroleptics, were found to help with some of the symptoms of
schizophrenia. Includes phenothiazines (Thorazine), butyrophenones (Haloperidol
Haldol), and thioxanthenes (Thiothixene Navane). Side effects include:
 Parkinson’s Disease
 Tardive Dyskinesia – the mouth muscles involuntarily make sucking, lipsmacking, and chin-wagging motions. In more severe cases, the whole body can
be subject to involuntary motor movements.
 Neuroleptic Malignant Syndrome – occurs in about 1 percent of cases. In this
condition, which can sometimes be fatal, severe muscular rigidity develops,
accompanied by fever. The heart races, blood pressure increases, and the person
may lapse into a coma.
 Second-Generation Antipsychotic Drugs – including olanzapine (trade name Zyprexa) and
risperidone (trade name Risperdal); their mechanism of action is not like that of the
typical or first-generation antipsychotic medications.
 Social Skills Training – is designed to teach people with schizophrenia how to successfully
manage a wide variety of interpersonal situations—discussing their medications with
their psychiatrist, ordering meals in a restaurant, filling out job applications, interviewing
for jobs, saying no to drug dealers on the street, and reading bus schedules.
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Family Therapy and Cognitive Behavioral Therapy
Cognitive Remediation Therapies – such as cognitive remediation training or cognitive
enhancement therapy (CET); are treatments that seek to enhance basic cognitive
functions such as verbal learning ability.
 Psychoeducation, Case Management, and Residential Treatment
SUBSTANCE USE DISORDERS
Addiction – typically refers to a more severe substance use disorder that is characterized by
having more symptoms, tolerance, and withdrawal, by using more of the substance than
intended, by trying unsuccessfully to stop, by having physical or psychological problems made
worse by the drug, and by experiencing problems at work or with friends.
Tolerance – is indicated by either (1) larger doses of the substance being needed to produce the
desired effect or (2) the effects of the drug becoming markedly less if the usual amount is taken.
Withdrawal – refers to the negative physical and psychological effects that develop when a
person stops taking the substance or reduces the amount.
Alcohol Use Disorder
Delirium Tremens (DTs) – occurs rarely when the level of alcohol in the blood drops suddenly.
The person becomes delirious as well as tremulous and has hallucinations that are primarily visual
but may be tactile as well.
Short Term Effects:
 Small Intestine – where most of the alcohol goes, and from there is absorbed into the
blood.
 Liver – where alcohol is primarily broken down.
 Blood-Alcohol Concentration – depends on: amount ingested, food-presence, weight and
body fat, the efficiency of the liver, and the alcohol content of the drink.
 Anterior Cingulate and Orbitofrontal – areas associated with monitoring errors and
making decisions; areas of the brain that are affected by alcohol.
Long Term Effects:
 Malnutrition – provides the calories that do not have nutrition.
 B-Complex Vitamin Deficiency – leads to memory loss and amnestic syndrome, which
eventually leads them to confabulation (reporting imaginary events just to fill in memory
gaps).
 Liver Cirrhosis – a disease in which some liver cells become engorged with fat and protein,
impeding their function; some cells die, triggering an inflammatory process, and when
scar tissue develops, blood flow is obstructed.
 Multiple Organ Damage – damage to the endocrine glands and pancreas, heart failure,
erectile dysfunction, hypertension, stroke, and capillary hemorrhages, which are
responsible for the swelling and redness in the face, especially the nose, of people who
chronically abuse alcohol.
 Fetal Alcohol Syndrome (FAS) – a condition where growth of the fetus is slowed, and
cranial, facial, and limb anomalies can be produced.
Tobacco Use Disorder
Nicotine – is the addicting agent of tobacco.
Secondhand Smoke – or environmental tobacco smoke (ETS); the smoke coming from the burning
end of a cigarette; contains higher concentrations of ammonia, carbon monoxide, nicotine, and
tar than does the smoke actually inhaled by the smoker.
Marijuana – consists of the dried and crushed leaves and flowering tops of the hemp plant,
Cannabis sativa. It is most often smoked, but it may be chewed, prepared as a tea, or eaten in
baked goods.
 Delta-9-tetrahydrocannabinol (THC) – the major active chemical in marijuana.
 CB1 and CB2 Cannabinoid Brain Receptors – the two receptors identified through
research that caters marijuana effects. Short-term memory is caused by the marijuana’s
effects on the hippocampus where most of the concentration of these receptors are
found.
 Hashish – much stronger than marijuana, is produced by removing and drying the resin
exudate of the tops of cannabis plants. In DSM-5, cannabis use disorder will likely be the
category name that includes marijuana.
Opiates – include opium and its derivatives morphine, heroin, and codeine. They are considered
sedatives.
Opium – originally the principal drug of illegal international traffic; it was known to the people of
the Sumerian civilization, dating as far back as 7000 B.C. They gave the poppy that supplied this
drug the name opium, meaning “the plant of joy.”
 Morphine – named after Morpheus, the Greek god of dreams, was separated from raw
opium. This bitter-tasting powder proved to be a powerful sedative and pain reliever.
15.
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Before its addictive properties were noted, it was commonly used in medicines. In the
middle of the nineteenth century, when the hypodermic needle was introduced in the
United States, morphine began to be injected directly into the veins to relieve pain.
 Heroin – Used initially as a cure for morphine addiction, heroin was substituted for
morphine in cough syrups and other patent medicines. So many maladies were treated
with heroin that it came to be known as G.O.M., or “God’s own medicine”. However,
heroin proved to be even more addictive and more potent than morphine.
 Hydrocodone and Oxycodone – opiates legally prescribed as pain medications.
Hydrocodone is most often combined with other drugs, such as acetaminophen (the
active agent in Tylenol), to create prescription pain medicines such as Vicodin, Zydone, or
Lortab. Oxycodone is found in medicines such as Percodan, Tylox, and OxyContin.
 Vicodin – is one of the most commonly abused drugs containing hydrocodone.
 OxyContin – is one of the most commonly abused drugs containing oxycodone.
Stimulants – act on the brain and the sympathetic nervous system to increase alertness and motor
activity. Amphetamines are synthetic stimulants; cocaine is a natural stimulant extracted from the
coca leaf.
 Amphetamines – produce their effects by causing the release of norepinephrine and
dopamine and blocking the reuptake of these neurotransmitters. Wakefulness is
heightened, intestinal functions are inhibited, and appetite is reduced—hence their use
in dieting.
 Benzedrine – the first amphetamine, was synthesized in 1927.
 Methamphetamine – a derivative of Amphetamine.
 Cocaine – The alkaloid cocaine was first extracted from the leaves of the coca shrub in
the mid-1800s and has been used since then as a local anesthetic. Reduces pain. Is a
vasoconstrictor. Blocks reuptake of dopamine
 Crack – a new form of cocaine; comes in a rock-crystal form that is then heated,
melted, and smoked. The name crack comes from the crackling sound the rock
makes when being heated.
Hallucinogens – which refers to the main effects of such drugs, hallucinations; is the current term
used from d-lysergic acid diethylamide (LSD). The term psychedelic, from the Greek words for
“soul” and “to make manifest,” was applied to emphasize the subjectively experienced expansion
of consciousness reported by users of LSD and often referred to by them as a “trip.” Unlike the
hallucinations in schizophrenia, however, these are usually recognized by the person as being
caused by the drug
 Flashbacks – (also referred to as hallucinogen persisting perception disorder, or HPPD)
are visual recurrences of psychedelic experiences after the physiological effects of the
drug have worn off.
 Mescaline – a type of hallucinogen, an alkaloid and the active ingredient of peyote, was
isolated in 1896 from small, disklike growths of the top of the peyote cactus. The drug has
been used for centuries in the religious rites of Native American people living in the U.S.
Southwest and northern Mexico.
 Psilocybin – a type of hallucinogen, is a crystalline powder that Hofmann isolated from
the mushroom Psilocybe mexicana in 1958.
Ecstasy
–
a
hallucinogen-like
substance;
is
made
from
MDMA
(methylenedioxymethamphetamine). Acts primarily by contributing to both the release and the
subsequent reuptake of serotonin.
 Methylenedioxymethamphetamine – was first synthesized in the early 1900s, and it was
used as an appetite suppressant for World War I soldiers. Chemical precursors to MDMA
are found in several commonly used spices, such as nutmeg, dill, saffron, and sassafras.
PCP – phencyclidine, often called angel dust, is another drug that is not easy to classify. Developed
as a tranquilizer for horses and other large animals, it generally causes serious negative reactions,
including severe paranoia and violence. Coma and death are also possible.
Treatment for Alcohol Addiction:
 Inpatient Hospital Treatment
 Detoxification – is the first step in treating substance-use disorder.
 Alcohol Anonymous (AA) – founded in 1935, is the largest and the most widely-known
self-help group in the world. The AA program tries to instill in each member the belief
that alcohol dependence is a disease that can never be cured and that continuing vigilance
is necessary to resist taking even a single drink, lest uncontrollable drinking begin all over
again. They rely on a higher power, a religious power.
 Rational Recovery – a divergent of AA because they do not rely on a higher
power, they rely on social support, reassurance, encouragement, and suggestions
for leading a life without alcohol.
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Couples Therapy
Contingency Management Therapy – is a cognitive behavior treatment for alcohol and
drug use disorders that involves teaching people and those close to them to reinforce
behaviors inconsistent with drinking—for example, taking the drug Antabuse (discussed
later in the chapter) and avoiding situations that were associated with drinking in the past.
 Relapse Prevention – a type of cognitive behavioral treatment where the goal is
to help people avoid relapsing back into drinking or drug use once they have
stopped.
 Motivational Intervention – a brief motivational treatment that included individualized
feedback about a person’s drinking in relation to community and national averages,
education about the effects of alcohol, and tips for reducing harm and moderating
drinking.
 Controlled Drinking – was introduced into the domain of alcohol treatment by Mark and
Linda Sobell. A pattern of alcohol consumption that is moderate, avoiding the extremes
of total abstinence and inebriation.
 Guided Self-Change – is the approach used by Moderate Drinking. The basic
assumption is that people have more potential control over their immoderate
drinking than they typically believe and that heightened awareness of the costs
of drinking to excess as well as of the benefits of abstaining or cutting down can
be of material help.
 Medications:
 Antabuse – a drug that discourages drinking by causing violent vomiting if alcohol
is ingested.
 Naltrexone – drug blocks the activity of endorphins that are stimulated by
alcohol, thus reducing the craving for it.
 Acamprosate – common in Europe; it impacts the glutamate and GABA
neurotransmitter systems and thereby reduces the cravings associated with
withdrawal.
Treatment for Smoking:
 Physician’s Advice
 Scheduled Smoking – the strategy is to reduce nicotine intake gradually over a period of
a few weeks by getting smokers to agree to increase the time between cigarettes.
 Nicotine Replacement Treatments – the goal is reducing a smoker’s craving for nicotine
by providing it in a different way; may be supplied in gum, patches, inhalers, or electronic
cigarettes.
Treatment for Drug Use:
 CBT
 Motivational Interviewing or Enhancement Therapy – this treatment involves a
combination of CBT techniques and techniques associated with helping clients generate
solutions that work for themselves.
 Self-Help Residential Homes – separation of people from previous social contacts, an
environment where drugs are not available, charismatic role-models, direct
confrontations in group therapy, and a setting where people are respected as human
beings.
 Medications:
 Methadone, Levomethadyl acetate, and Bupreophine – synthetic narcotics
designed to take the place of heroin.
 Buprenorphine (Suboxone) – is a medication that actually contains two agents:
buprenorphine and naloxone. Buprenorphine is a partial opiate agonist, which
means it does not have the same powerfully addicting properties as heroin, which
is a full agonist. A substitute for methadone which had sever side-effects.
 Naltrexone – is an opiate antagonist.
Prevention of Substance-Use Disorder:
 Peer-pressure resistance training
 Correction of beliefs and expectations
 Inoculation against mass media messages
 Peer Leadership
EATING DISORDERS
Anorexia Nervosa – the term anorexia refers to loss of appetite, and nervosa indicates that the
loss is due to emotional reasons. (1) Restriction of behaviors that promote healthy body weight.
(2) Intense fear of gaining weight and being fat. (3) Distorted body image or sense of body shape.
(4) amenorrhea (loss of menstrual period) (likely removed in DSM 5).
3. Bulimia Nervosa – Bulimia is from a Greek word meaning “ox hunger.” This disorder involves
episodes of rapid consumption of a large amount of food, followed by compensatory behavior,
such as vomiting, fasting, or excessive exercise, to prevent weight gain. Two subtypes of bulimia:
purging type and non-purging type.
 Binge – it involves eating an excessive amount of food, that is, much more than most
people would eat, within a short period of time (e.g., 2 hours). Second, it involves a feeling
of losing control over eating—as if one cannot stop.
4. Binge Eating Disorder – includes recurrent binges (one time per week for at least 3 months), lack
of control during the bingeing episode, and distress about bingeing, as well as other
characteristics, such as rapid eating and eating alone. It is distinguished from anorexia nervosa by
the absence of weight loss and from bulimia nervosa by the absence of compensatory behaviors
(purging, fasting, or excessive exercise). Most often, people with binge eating disorder are obese.
A BMI more than 30 is considered obese.
5. Treatment:
 Medications:
 Fluoxetine (Prozac) – an anti-depressant that is effective in treating bulimia
nervosa because these two disorders are often comorbid. No successful
treatment for anorexia and binge eating.
 Family Therapy – is the principal form of psychological treatment for anorexia, based on
the notion that interactions among members of the patient’s family can play a role in
treating the disorder.
 Changing the patient role of the person with anorexia
 Redefining the eating problem as an interpersonal problem
 Preventing the parents from using their child’s anorexia as a means of avoiding
conflict
 Family-Based Therapy – developed in England, the focus is on helping parents
work on restoring their daughter to a healthy weight while at the same time
building up family functioning in the context of adolescent development.
 CBT
6. Preventive Interventions:
 Psychoeducational Approaches – the focus is on educating children and adolescents
about eating disorders in order to prevent them from developing the symptoms.
 Deemphasizing Sociocultural Influences – the focus here is on helping children and
adolescents resist or reject sociocultural pressures to be thin.
 Risk Factor Approach – the focus here is on identifying people with known risk factors for
developing eating disorders (e.g., weight and body-image concern, dietary restraint) and
intervening to alter these factors.
1. SEXUAL DISORDERS
2. Sexual Response Cycle:
 Desire Phase – a concept introduced by Kaplan (1974), this stage refers to sexual interest
or desire, often associated with sexually arousing fantasies or thoughts.
 Excitement Phase – during this phase, men and women experience pleasure and
increased blood flow to the genitalia. In men, this flow of blood into tissues produces an
erection of the penis. In women, blood flow creates enlargement of the breasts and
changes in the vagina, such as increased lubrication.
 Orgasm Phase – in this phase, sexual pleasure peaks in ways that have fascinated poets
and the rest of us ordinary people for thousands of years. In men, ejaculation feels
inevitable and indeed almost always occurs (in rare instances, men have an orgasm
without ejaculating, and vice versa). In women, the outer walls of the vagina contract. In
both sexes, there is general muscle tension.
 Resolution Phase – this last stage refers to the relaxation and sense of well-being that
usually follow an orgasm. In men there is an associated refractory period during which
further erection is not possible. The duration of the refractory period varies across men
and even in the same man across occasions. Women are often able to respond again with
sexual excitement almost immediately, a capability that permits multiple orgasms.
3. Vaginal Plethysmograph – a device that measures a women’s physiological arousal.
4. Sexual Dysfunctions – have three categories: those involving sexual desire, arousal, and interest;
orgasmic disorders; and sexual pain disorders.
5. Disorders Involving Sexual Interest, Desire, and Arousal
 Sexual Interest/Arousal Disorder in Women – refers to persistent deficits in sexual
interest (sexual fantasies or urges), biological arousal, or subjective arousal.
 Hypoactive Sexual Desire Disorder – in men refers to deficient or absent sexual fantasies
and urges.
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Erectile Disorder – refers to failure to attain or maintain an erection through completion
of the sexual activity.
Orgasmic Disorder
 Female Orgasmic Disorder – refers to the persistent absence of orgasm after sexual
excitement.
 Early Ejaculation Disorder – defined by ejaculation that occurs too quickly.
 Delayed Ejaculation Disorder – defined by persistent difficulty in ejaculating.
Sexual Pain Disorder
 Genito-Pelvic Pain/Penetration Disorder – is defined by persistent or recurrent pain
during intercourse.
Human Sexual Inadequacy – posits that the immediate cause of sexual inadequacy comes from:
(1) Fears about performance, (2) and the adoption of the Spectator Role.
Treatment:
 Systematic Desensitization
 In-Vivo Desensitization
 Directed Masturbation – was devised by LoPiccolo and Lobitz (1972) to enhance women’s
comfort with and enjoyment of their sexuality.
 First Step: woman to carefully examine her nude body, including her genitals, and
to identify various areas with the aid of diagrams.
 Second Step: she is instructed to touch her genitals and to find areas that produce
pleasure.
 Third Step: she increases the intensity of masturbation using erotic fantasies. If
orgasm is not achieved, she is to use a vibrator in her masturbation.
 Final Step: her partner enters the picture, first watching her masturbate, then
doing for her what she has been doing for herself, and finally having intercourse
in a position that allows him to stimulate the woman’s genitals manually or with
a vibrator.
 Sensate-Focus Exercise – is a cognitive procedure to change attitudes and thoughts;
clients are encouraged to focus on the pleasant sensations that accompany even incipient
sexual arousal in sex; are a way of helping the person be more aware of and comfortable
with sexual feelings. The focus on physical sensations may counter the destructive
tendency to think about one’s performance or attractiveness during sex.
 Skills and Communications Training – therapists assign written materials and show
clients explicit videos demonstrating sexual techniques. Encouraging partners to
communicate their likes and dislikes to each other has been shown to be helpful for a
range of sexual dysfunctions.
 Couples Therapy – designed to address complex networks of relationship factors; to
address tensions that go beyond the sexual relationship.
 Squeeze Technique – for the treatment of Early Ejaculation; a partner is trained to
squeeze the penis in the area where the head and shaft meet to rapidly reduce arousal.
 Medications:
 Phosphodiesterase Type 5 Inhibitor (PDE-5) – the most common intervention for
Erectile Disorder; such as sildenafil (Viagra), tadafil (Cialis), or vardenafil (Levitra);
taken 1 hour before sex, and the effects last for about 4 hours.
The Paraphilias
Paraphilias – are a group of disorders defined by recurrent sexual attraction to unusual objects
or sexual activities lasting at least 6 months. In other words, there is a deviation (para) in what
the person is attracted to (philia).
Fetishistic Disorder – is defined by a reliance on an inanimate object or a non-genital part of the
body for sexual arousal. The person with fetishistic disorder feels a compulsive attraction to the
object; the attraction is experienced as involuntary and irresistible. It is the degree of the erotic
focus—the exclusive and very special status the object occupies as a sexual stimulant—that
distinguishes fetishistic disorder from the ordinary attraction.
Transvestic Fetishism – compulsive attraction to cross-dressing.
Pedohebephilic Disorder – (pedes is Greek for “child”, hebe is Greek for “pubescence,” and philia
is Greek for “attraction”) is diagnosed when adults derive sexual gratification through sexual
contact with prepubertal or pubescent children, or when they experience recurrent, intense, and
distressing desires for sexual contact with prepubertal or pubescent children. DSM-5 requires that
the offender be at least 18 years old and at least 5 years older than the child.
 Incest – a subtype of pedohebephilic behavior; refers to sexual relations between close
relatives for whom marriage is forbidden.
Voyeuristic Disorder – involves an intense and recurrent desire to obtain sexual gratification by
watching unsuspecting others in a state of undress or having sexual relations.
16. Exhibitionistic Disorder – is a recurrent, intense desire to obtain sexual gratification by exposing
one’s genitals to an unwilling stranger, sometimes a child. It typically begins in adolescence.
17. Frotteuristic Disorder – involves the sexually oriented touching of an unsuspecting person.
18. Sexual Sadism Disorder – is defined by an intense and recurrent desire to obtain or increase
sexual gratification by inflicting pain or psychological suffering (such as humiliation) on another.
19. Sexual Masochism Disorder – is defined by an intense and recurrent desire to obtain or increase
sexual gratification through being subjected to pain or humiliation.
 Sadomasochism – combination of both
 Asphyxiophilia – a form of masochism that can result in death or brain damage; it involves
sexual arousal by restricting breathing, which can be achieved using a noose, a plastic bag,
or chest compression.
20. Cognitive Distortions/Justifications: p 387.
 Misattributing Blame
 Denying Sexual Intent
 Debasing the Victim
 Minimizing Consequences
 Deflecting Censure
 Justifying the Cause
21. Treatment:
 Motivation Enhancing Strategies – empathizing with the offender, point out treatment,
emphasize negative consequences, and explain that the psychophysiological assessment
of the patient’s sexual arousal will make it harder to deny sexual proclivities to the
authorities.
 CBT
 Castration – or removal of the testes.
 Megan-s Law – prevents recidivism, or preventing the return of the sex offenders to their
locale from where they were arrested; allows the offenders to be publicize so that their
identity may be known.
1. DISORDERS OF CHILD
2. Developmental Psychology – focuses on the disorders of childhood within the context of life-span
development, enabling us to identify behaviors that are considered appropriate at one stage but
disturbed at another.
3. Two Broad Domains of Childhood Disorder: Externalizing Disorders and Internalizing Disorders
 Externalizing Disorders – are characterized by more outward-directed behaviors, such as
aggressiveness, noncompliance, overactivity, and impulsiveness; the category includes
attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant
disorder.
 Internalizing Disorders – are characterized by more inward-focused experiences and
behaviors, such as depression, social withdrawal, and anxiety; the category includes
childhood anxiety and mood disorders.
4. Attention-Deficit/Hyperactivity Disorder (ADHD) – The child who is constantly in motion—
tapping fingers, jiggling legs, poking others for no apparent reason, talking out of turn, and
fidgeting—is often called hyperactive. Often, these children also have difficulty concentrating on
the task at hand for an appropriate period of time. When such problems are severe and persistent
enough, these children may meet the criteria for diagnosis of attention-deficit/hyperactivity
disorder (ADHD). Can be inattentive, hyperactive, or both combined.
5. Treatment of ADHD:
 Ritalin, Adderall, Concerta, and Strattera
 Multimodal Treatment of Children with ADHD (MTA) – is a study that yielded that
medication combined with intensive behavioral treatment is effective than both
medication alone and behavioral treatment alone. However, medication alone is superior
than behavioral treatment.
 Point Systems and Daily Report Cards (DRCs) – Children earn points or stars for behaving
in certain ways; the children can then spend their earnings for rewards. The DRC also
allows parents to see how their child is doing in school. The focus of these programs is on
improving academic work, completing household tasks, or learning specific social skills,
rather than on reducing signs of hyperactivity, such as running around and jiggling
6. Conduct Disorder – The DSM-5 criteria for conduct disorder focus on behaviors that violate the
basic rights of others and violate major societal norms. Nearly all such behavior is also illegal. The
symptoms of conduct disorder must be frequent and severe enough to go beyond the mischief
and pranks common among children and adolescents. These behaviors include aggression and
cruelty toward people or animals, damaging property, lying, and stealing. Often the behavior is
marked by callousness, viciousness, and lack of remorse.
7. Oppositional Defiant Disorder (ODD) – is diagnosed if a child does not meet the criteria for
conduct disorder—most especially, extreme physical aggressiveness—but exhibits such behaviors
as losing his or her temper, arguing with adults, repeatedly refusing to comply with requests from
adults, deliberately doing things to annoy others, and being angry, spiteful, touchy, or vindictive.
8. Treatment:
 Parent Management Training (PMT) – in which parents are taught to modify their
responses to their children so that prosocial rather than antisocial behavior is consistently
rewarded. Parents are taught to use techniques such as positive reinforcement when the
child exhibits positive behaviors and time-out and loss of privileges for aggressive or
antisocial behaviors.
 Multisystemic Treatment (MST) – MST involves delivering intensive and comprehensive
therapy services in the community, targeting the adolescent, the family, the school, and,
in some cases, the peer group (Figure 13.6). The treatment is based on the view that
conduct problems are influenced by multiple factors within the family as well as between
the family and other social systems.
9. LEARNING DISABILITIES of CHILDHOOD DISORDERS
10. Learning Disability – is a condition in which a person shows a problem in a specific area of
academic, language, speech, or motor skills that is not due to intellectual developmental disorder
or deficient educational opportunities; is not used by DSM but is used by most mental health
professionals to group together three categories of disorders that do appear in DSM: learning
disorders, communication disorders, and motor disorders.
11. Learning Disorders – include Dyslexia and Dyscalculia
 Dyslexia – (formerly called reading disorder) involves significant difficulty with word
recognition, reading comprehension, and typically written spelling as well. Brain areas
affected are temporoparietal and occipitotemporal areas.
 Dyscalculia – (formerly called mathematics disorder) involves difficulty in producing or
understanding numbers, quantities, or basic arithmetic operations. Brain area affected is
the intraparietal sulcus.
12. Communication Disorders – include Speech Sounds Disorder and Childhood Onset Fluency
Disorder
 Speech Sounds Disorder – (formerly called phonological disorder) involves correct
comprehension and sufficient vocabulary use, but unclear speech and improper
articulation. For example, blue comes out “bu”, and rabbit sounds like wabbit.
 Childhood Onset Fluency Disorder – (formerly called stuttering) is a disturbance in verbal
fluency that is characterized by one or more of the following speech patterns: frequent
repetitions or prolongations of sounds, long pauses between words, substituting easy
words for those that are difficult to articulate (e.g., words beginning with certain
consonants), and repeating whole words (e.g., saying “go-go-go-go” instead of just a
single “go”).
13. Motor Disorders – include Tourette’s Disorder and Developmental Coordination Disorder
 Tourette’s Disorder – involves one or more vocal and multiple motor tics (sudden, rapid
movement or vocalization) that start before the age of 18.
 Developmental Coordination Disorder – (formerly called motor skills disorder) involves
marked impairment in the development of motor coordination that is not explainable by
intellectual developmental disorder or a disorder such as cerebral palsy.
14. INETELLECTUAL DEVELOPMENTAL DISORDER of CHILDHOOD DISORDERS
15. Intellectual Developmental Disorders – (1) significantly below average intellectual functioning,
(2) deficits in adaptive behavior, and (3) an onset prior to age 18.
16. Down Syndrome – a product of chromosomal abnormality that is caused by the crhomsome called
trisomy 21, which refers to having an extra copy (i.e., three instead of two) of chromosome 21
17. Fragile X Syndrome – a product of chromosomal abnormality which involves a mutation in the
fMR1 gene on the X chromosome. Physical symptoms associated with fragile X include large,
underdeveloped ears and a long, thin face.
18. Phenylketonuria (PKU) – a product of a recessive gene disease where the infant, born without
obvious signs of difficulty, soon begins to suffer from a deficiency of a liver enzyme, phenylalanine
hydroxylase. This enzyme is needed to convert phenylalanine, an amino acid contained in protein,
to tyrosine, an amino acid that is essential for the production of certain hormones, such as
epinephrine. Because of this enzyme deficiency, phenylalanine and its derivative, phenylpyruvic
acid, are not broken down and instead build up in the body’s fluids. This buildup eventually
damages the brain because the unmetabolized amino acid interferes with the process of
myelination, the sheathing of neuron axons, which is essential for neuronal function.
19. IDD as a result of Infectious Disease – maternal infectious diseases may include Rubella (German
Measles), Cytomegalovirus, toxoplasmosis, herpes simplex, HIV, syphilis, encephalitis, and
meningococcal meningitis.
20. IDD as a result of Environmental Hazards – caused by mercury and lead.
21. Treatment:
 Residential Training – adults with intellectual developmental disorder live in small to
mediumsized residences that are integrated into the community. Medical care is
provided, and trained, live-in supervisors and aides help with residents’ special needs
around the clock. Residents are encouraged to participate in household routines to the
best of their abilities.
 Applied Behavior Analysis – is an operant approach; to teach a child a particular routine,
the therapist usually begins by dividing the targeted behavior, such as eating, into smaller
components: pick up spoon, scoop food from plate onto spoon, bring spoon to mouth,
remove food with lips, chew, and swallow food. Operant conditioning principles are then
applied to teach the child these components of eating.
 Self-Instructional Training – teaches children to guide their problem-solving efforts
through speech. For example, when the toaster was presented upside down, the person
would be taught to first state the problem (“Won’t go in”), then to state the response
(“Turn it”), self-evaluate (“Fixed it”), and self-reinforce (“Good”). They were rewarded
with praise and high-fives when they verbalized and solved the problem correctly.
 Computer-Assisted Behavior – the visual and auditory components of computers can
help to maintain the attention of distractible students; the level of the material can be
geared to the individual, ensuring successful experiences; and the computer can meet the
need for numerous repetitions of material without becoming bored or impatient, as a
human teacher might.
22. AUTISM SPECTRUM DISORDER
23. Autism Spectrum Disorder (ASD) – is comprised by autistic disorder, Asperger’s disorder,
pervasive developmental disorder not otherwise specified, and childhood disintegrative disorder.
Have problems in their “joint attention” and in their “theory of the mind”.
 Deficit in Joint Attention – typically, children gaze to gain someone’s attention or to direct
the other person’s attention to an object; children with ASD generally do not. That is,
interactions that require two people to pay attention to each other, whether speaking or
communicating emotion nonverbally, are impaired in children with autism.
 Lack of “Theory of the Mind’ – is believed to be the core deficit of children with ASD. This
refers to a person’s understanding that other people have desires, beliefs, intentions, and
emotions that may be different from one’s own. This ability is crucial for understanding
and successfully engaging in social interactions. Theory of mind typically develops
between 21 – 2 and 5 years of age. Children with ASD seem not to undergo this
developmental milestone and thus seem unable to understand others’ perspectives and
emotional reactions.
 Echolalia – in which the child echoes, usually with remarkable fidelity, what he or she has
heard another person say. The teacher may ask a child with ASD, “Do you want a cookie?”
The child’s response may be, “Do you want a cookie?” This is immediate echolalia. In
delayed echolalia, the child may be in a room with the television on and appear to be
completely uninterested. Several hours later or even the next day, the child may echo a
word or phrase from the television program.
 Pronoun Reversal – in which children refer to themselves as “he,” “she,” or “you” (or
even by their own name).
 Literal Use of Words – if a father provided positive reinforcement by putting his daughter
on his shoulders when she learned to say the word yes, then the child might say yes to
mean she wants to be lifted onto her father’s shoulders. Or a child may say “do not drop
the cat” to mean “no,” because a parent had used these emphatic words when the child
was about to drop the family feline.
 Repetitive and Ritualistic Acts
24. Treatment:
 Intensive Operant Conditioning
 Pivotal Response Treatment – a term based on the notion that intervening in a key, or
pivotal, area may lead to changes in other areas.
 Medication:
 Haloperidol (Haldol) – an antipsychotic medication used in the treatment of
schizophrenia; is most commonly used medication for treating problem behaviors
in children with ASD.
 Fenfluramine – known to lower serotonin levels in rats and monkeys, was
associated with dramatic improvement in the behavior and thought processes of
children with ASD.
 Naltrexone – an opioid receptor antagonist, and found that this drug reduces
hyperactivity in children with ASD and produces a moderate improvement in the
initiation of social interactions.
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1. LATE LIFE AND NEUROCGNITIVE DISORDERS
2. Social Selectivity – apparent in older people. As we age, our interests shift away from seeking
new social interactions to cultivating a few social relationships that really matter to us, such as
those with family and close friends.
3. Effects that Contribute to Differences among Age Groups:
 Age Effects – are the consequences of being a certain chronological age;
 Cohort Effects – are the consequences of growing up during a particular time period with
its unique challenges and opportunities. For example, experiences like the Great
Depression, a world war, or 9/11 each shape experiences and attitudes. Similarly, the
expectations for marriage have changed drastically in the past century, at least in Western
societies, from a focus on stability to a focus on happiness and personal fulfillment.
 Time-of-measurement Effects – are confounds that arise because events at a particular
point in time can have a specific effect on a variable that is being studied (Schaie &
Hertzog, 1982). For example, people tested right after Hurricane Katrina in New Orleans
might demonstrate elevated levels of anxiety.
4. Selective Mortality – when people are no longer available for follow-up because of death.
5. NEUROCOGNITIVE DISORDERS
6. Dementia – is a descriptive term for the deterioration of cognitive abilities to the point that
functioning becomes impaired.
 Alzheimer’s Disease – initially described by the German neurologist Alois Alzheimer in 1906,
the brain tissue irreversibly deteriorates, and death usually occurs within 12 years after the
onset of symptoms. People with Alzheimer’s disease have more plaques (small, round betaamyloid protein deposits that are outside the neurons) and neurofibrillary tangles (twisted
protein filaments composed largely of the protein tau in the axons of neurons) than would be
expected for the person’s age. Some cases of Alzheimer’s disease exhibit a particular form of
a gene on chromosome 19, called the apolipoprotein e4 or ApoE-4 allele.
 Frontotemporal Dementia – is caused by a loss of neurons in frontal and temporal regions of
the brain. Unlike Alzheimer’s disease, memory is not severely impaired in FTD. The disorder
strikes emotional processes in a more profound manner than Alzheimer’s disease does, and
in doing so, it can damage social relationships. Particular deficits seem to emerge in the ability
to regulate emotions. This can be caused by Pick’s Disease.
 Pick’s Disease – characterized by the presence of Pick bodies (spherical inclusions)
within neurons.
 Vascular Dementia – a is diagnosed when dementia is a consequence of cerebrovascular
disease. Most commonly, the person had a series of strokes in which a clot formed, impairing
circulation and causing cell death.
 Dementia with Lewy bodies (DLB) – can be divided into two subtypes, depending on whether
or not it occurs in the context of Parkinson’s disease; distinct symptom of DLB is that people
often experience intense dreams accompanied by levels of movement and vocalizing that may
make them seem as though they are “acting out their dreams”.
 Dementias Caused by Disease and Injury:
 Encephalitis – a generic term for any inflammation of brain tissue, is caused by viruses
that enter the brain.
 Meningitis – an inflammation of the membranes covering the outer brain, is usually
caused by a bacterial infection.
 Syphilis – a venereal disease produced by the organism Treponema pallidum that can
invade the brain and cause dementia.
 HIV, head traumas, brain tumors, nutritional deficiencies (especially of B-complex
vitamins), kidney or liver failure, and endocrine problems such as hyperthyroidism
 Toxins – mercury and lead.
 Chronic Substance Use
7. Cognitive Reserve – or the idea that some people may be able to compensate for the disease by
using alternative brain networks or cognitive strategies such that cognitive symptoms are less
pronounced.
8. Treatment:
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Medications:
 Cholinesterase Inhibitors – including donepezil (Aricept) and rivastigmine
(Exelon); the most commonly used medications for dementia; drugs that interfere
with the breakdown of acetylcholine and slows down the effects of dementia.
 Memantine (Namenda) – a drug that affects glutamate receptors believed to be
involved in memory, has shown small effects in placebo-controlled trials for
Alzheimer’s disease.
Delirium – is derived from the Latin words de, meaning “out of,” and lira, meaning “track.” The
term implies being off-track or deviating from the usual state; typically described as a clouded
state of consciousness. The two most common symptoms are extreme trouble focusing attention
and profound disturbances in the sleep/wake cycle. Have a rapid onset, does not necessarily
involve memory deficits, usually reversible, and secondary to another medical condition as
compared to dementia.
PERSONALITY AND PERSONALITY DISORDERS
Personality Disorders – a heterogeneous group of disorders defined by problems with forming a
stably positive sense of self and with sustaining close and constructive relationships. People with
this experience difficulties with their identity and their relationships in multiple domains of life,
and these problems are sustained for years. Includes: Obsessive-Compulsive, Narcissistic,
Schizotypal, Avoidant, Antisocial, Borderline, Paranoid, Schizoid, Histrionic, and Dependent.
Obsessive-Compulsive PD – preoccupation with order, perfection, and control. More females
than males.
Narcissistic PD – grandiosity, need for admiration, and lack of empathy. More males than females.
Have two models for its etiology:
 Self-Psychology Model – Heinz Kohut established a variant of psychoanalysis known as
self-psychology, which he described in his two books, The Analysis of the Self (1971) and
The Restoration of the Self (1977). Kohut noted that the person with narcissistic
personality disorder projects remarkable self-importance, self-absorption, and fantasies
of limitless success on the surface. But Kohut theorized that these characteristics mask a
very fragile self-esteem. People with narcissistic personality disorder strive to bolster
their sense of self-worth through unending quests for respect from others.
 Social-Cognitive Model – A model of narcissistic personality disorder developed by
Carolyn Morf and Frederick Rhodewalt (2001) is built around two basic ideas: (1) people
with this disorder have fragile self-esteem, in part because they are trying to maintain the
belief that they are special, and (2) interpersonal interactions are important to them for
bolstering self-esteem, rather than for gaining closeness or warmth.
Schizotypal PD – is defined by unusual and eccentric thoughts and behavior (psychoticism),
interpersonal detachment, and suspiciousness. People with this disorder might have odd beliefs
or magical thinking—for instance, the belief that they can read other people’s minds and see into
the future; cognitive distortions, disorganized and eccentric behavior, and lack of capacity for
close relationships. More males than females.
Avoidant PD – are so fearful of criticism, rejection, and disapproval that they will avoid jobs or
relationships to protect themselves from negative feedback; social inhibition, feelings of
inadequacy, and hypersensitivity to negative evaluation. More females than males.
Borderline PD – the core features of BPD are impulsivity and instability in relationships and mood.
For example, attitudes and feelings toward other people might change drastically, inexplicably,
and very quickly, particularly from passionate idealization to contemptuous anger; characterized
by more abrupt, large, and unexpected changes in negative moods than was major depressive
disorder; instability of interpersonal relationships, self-image, and affect, as well as marked
impulsivity. More females than males.
 Treatment: Dialectical behavior Therapy of Borderline Personality Disorder – combining
client-centered empathy and acceptance with cognitive behavioral problem solving,
emotionregulation techniques, and social skills training. The concept of dialectics comes
from the work of German philosopher Georg Wilhelm Friedrich Hegel (1770–1831). It
refers to a constant tension between any phenomenon (any idea, event, etc., called the
thesis) and its opposite (the antithesis), which is resolved by the creation of a new
phenomenon (the synthesis). In DBT, the term dialectical is used in two main ways.
 Treatment: Mentalization-Based Therapy of Borderline Personality Disorder – is a form
of psychodynamic treatment that was developed for BPD. The theory behind this
treatment emphasizes that people with BPD fail to engage in mentalization—thinking
about their own and others’ feelings. It is argued that early insecurity in relationships,
coupled with intense trauma, leads the person to defensively avoid thinking about
feelings and relationships. Because the person does not carefully consider these issues,
expectations for relationships based on early experiences continue to pervade current
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relationships. The therapist’s goal is to foster a more active, thoughtful approach to
relationships and feelings.
 Treatment: Schema-Focused Cognitive Therapy of Borderline Personality Disorder –
enriches traditional cognitive therapy with a broader focus on how early childhood
antecedents and parenting shape current cognitive patterns. In schema-focused therapy,
the therapist and the patient work to identify the maladaptive assumptions (schema) that
a client holds about relationships from his or her early experiences. It is assumed that the
person also has a schema for healthy relationships, and the goal of therapy is to increase
the use of this healthy schema, rather than automatic behaviors reflecting the
problematic relationship schema.
Paranoid PD – distrust and suspiciousness of others.
Schizoid PD – detachment from social relationships and restricted range of emotional expression.
Histrionic PD – excessive emotionality and attention seeking.
Dependent PD – submissive behavior, fears of separation, and excessive need to be taken care
of.
Antisocial PD – involves a pervasive pattern of disregard for the rights of others. The person with
APD is distinguished by aggressive, impulsive, and callous traits. Informally called “sociopathy or
psychopathy”. More males than females.
LEGAL AND ETHICAL ISSUES
Criminal Commitment – a procedure that confines a person in a mental hospital either for
determination of competency to stand trial or after acquittal by reason of insanity.
Civil Commitment – is a set of procedures by which a person who is deemed mentally ill and
dangerous but who has not broken a law can be deprived of liberty and placed in a psychiatric
hospital.
Insanity Defense – e is the legal argument that a defendant should not be held responsible for an
illegal act if it is attributable to mental illness or intellectual disability that interferes with
rationality or that results from some other excusing circumstance, such as not knowing right from
wrong.
Landmark Cases and Laws:
 Irresistible Impulse – this concept was formulated in 1834 in a case in Ohio. According to
this concept, if a pathological impulse or uncontrollable drive compelled the person to
commit the criminal act, an insanity defense is legitimate. The irresistible-impulse test
was confirmed in two subsequent court cases, Parsons v. State and Davis v. United States.
 The M’Naghten Rule – was formulated in the aftermath of a murder trial in England in
1843. The defendant, Daniel M’Naghten, had set out to kill the British prime minister, Sir
Robert Peel, but had mistaken Peel’s secretary for Peel. M’Naghten claimed that he had
been instructed to kill Lord Peel by the “voice of God.”
 American Law Institute (ALI) Guidelines:
 A person is not responsible for criminal conduct if at the time of such conduct as
a result of mental disease or defect he lacks substantial capacity either to
appreciate the criminality (wrongfulness) of his conduct or conform his conduct
to the requirements of law.
 As used in the article, the terms “mental disease or defect” do not include an
abnormality manifested only by repeated criminal or otherwise antisocial
conduct.
 Insanity Defense Reform Act of 1984: John Hinckley Jr. was found not guilty by reason of
insanity (NGRI)
 The person’s criminal act is a result of severe mental illness or defect that
prevents the person from understanding the nature of his or her crime.
 The burden of proof is shifted from the prosecution to the defense. The defense
has to prove that the person is insane.
 The person is released from the forensic or prison hospital only after being judged
to be no longer dangerous and to have recovered from mental illness. This could
be longer than he or she would have been imprisoned if convicted.
 Guilty But Mentally Ill (GBMI) – the person can be found legally guilty of a crime—thus
maximizing the chances of incarceration—and the person’s mental illness plays a role in
how he or she is dealt with. Thus, even a seriously ill person can be held morally and
legally responsible but can then be committed to a prison hospital or other suitable facility
for psychiatric treatment rather than to a regular prison for punishment
 Not Guilty by Reason of Insanity (NGRI) – there is no dispute over whether the person
actually committed the crime—both sides agree that the person committed the crime.
However, due to the person’s insanity at the time of the crime, the defense attorney
argues that the person should not be held responsible for and thus should be acquitted
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of the crime. A successful NGRI plea means the person is not held responsible for the
crime due to his or her mental illness
Competency to Stand Trial – must be decided before it can be determined whether a person is
responsible for the crime of which he or she is accused. It is possible for a person to be judged
competent to stand trial and then be judged not guilty by reason of insanity. Another reason for
this is to avoid “in absentia” (“not present”), which is a centuries-old principle of English common
law that refers here to the person’s mental state, not his or her physical presence.
Parens Patriae or “the power of the state” – which is ourselves, to whom the government should
serve their protection.
Police Power of the Sate – others, to whom the government should also serve to protects
ourselves from.
Outpatient Commitment – is one way of increasing medication compliance. It is an arrangement
whereby a patient is allowed to leave the hospital but must live in a halfway house or other
supervised setting and report to a mental health agency frequently.
Least Restrictive Alternative – to freedom is to be provided when treating people with mental
disorders and protecting them from harming themselves and others
The Tarasoff Case – became the basis for “the duty to warn and protect”. The case of the Indian
Porsenjit Poddar versus Tatiana Tarasoff.
ETHICAL DILEMMAS IN THERAPY AND RESEARCH
Informed Consent – the investigator must provide enough information to enable people to decide
whether they want to be in a study. Researchers must describe the study clearly, including any
risks involved. Researchers should disclose even minor risks that could occur from a study,
including emotional distress from answering personal questions or side effects from drugs.
Confidentiality – means that nothing will be revealed to a third party except for other
professionals and those intimately involved in the treatment, such as a nurse or medical secretary.
Privileged Communication – it is communication between parties in a confidential relationship
that is protected by law. The recipient of such a communication cannot legally be compelled to
disclose it as a witness. The right of privileged communication is a major exception to the access
courts have to evidence in judicial proceeding. Has exceptions for disclosure:
 The client has accused the therapist of malpractice. In such a case, the therapist can
divulge information about the therapy in order to defend himself or herself in any legal
action initiated by the client.
 The client is less than 16 years old and the therapist has reason to believe that the child
has been a victim of a crime such as child abuse. In fact, the psychologist is required to
report to the police or to a child welfare agency within 36 hours any suspicion he or she
has that the child client has been physically abused, including any suspicion of sexual
molestation.
 The client initiated therapy in hopes of evading the law for having committed a crime or
for planning to do so.
 The therapist judges that the client is a danger to self or others and disclosure of
information is necessary to ward off such danger (recall Focus on Discovery 16.3 on
Tarasoff).
_______________________________________END__________________________________________
God has made everything beautiful in its time. Ecclesiastes 3:11
Praise be to God.
JHAM WHITE G. PERRAL