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GENERAL PSYCHOLOGY
LECTURE 13
PSYCHOPATHOLOGY &TREATMENT
Visiting Assistant PROFESSOR YEE-SAN TEOH
Department of Psychology
National Taiwan University
Unless noted, the course materials are licensed
under Creative Commons AttributionNonCommercial-ShareAlike 3.0 Taiwan (CC
BY-NC-SA 3.0)
PSYCHOPATHOLOGY &
TREATMENT
Defining Mental Disorders
• Mental disorders are currently diagnosed using the
diagnostic manual of the American Psychiatric
Association.
• Diagnostic & Statistical Manual of Mental Disorders
(DSM-IV-TR).
Mental Disorders (DSM-IV-TR)
• Behavioral or psychological syndrome or pattern that
occurs in a person that is associated with present:
Distress (e.g. painful symptom), or
Disability – impairment in one or more important areas of
functioning, or
Significantly increased risk of harm (suffering, death,
pain, disability, or an important loss of freedom)
Mental Disorders (DSM-IV-TR)
• The syndrome or pattern must:
Not be merely an expectable and culturally sanctioned
response to a particular event.
Currently be considered a manifestation of the behavioral,
psychological, or biological dysfunction in the individual.
Prevalence of Mental Disorders
• Point prevalence – how many people in a given
population have a given disorder at a particular point in
time.
• Lifetime prevalence – how many people in a certain
population will have the disorder at any point in their lives.
i. 46% of the U.S. population will experience at least one
mental disorder during their lifetimes.
ii. Anxiety disorders are the most common disorders
(lifetime prevalence rate of 29%).
ASSESSING
MENTAL DISORDERS
Clinical Assessment
Clinical interviews
Self-report measures
Projective tests
Lab tests (e.g. neuroimaging,
blood)
Clinical Interview
• Clinician asks patient to describe her problems/concerns.
• Close attention is paid to the patient’s report, looking for
consistencies and discrepancies in:
(i) Symptoms: what is reported by the patient about his
physical or mental condition (e.g. hearing voices)
(ii) Signs: what is observed by the clinician about a
patient’s physical or mental condition (e.g. inattention)
Self-Report Measures
• Asking participants questions, e.g. questionnaire.
Beck Depression Inventory (BDI)
• Targets people’s feelings of depression.
Projective Tests
• Unstructured personality tests
• Use relatively ambiguous stimuli to elicit responses that
are unguarded and authentic.
• E.g. Unconscious wishes & conflicts that cannot be
revealed via direct testing.
Thematic Apperception Test (TAT)
• Person is shown a set of pictures and asked to make up a
story about each.
• Responses are seen as revealing implicit or otherwise
hidden motives.
The DSM-IV-TR
• Sets out specific criteria - particular duration for the
symptoms or a certain frequency for each disorder.
• Contains 5 dimensions of functioning.
• Includes disorders that seem to appear only in some
cultures, e.g.
i. Dhat (India): term used to refer to severe anxiety abt
the discharge of semen.
ii. Ghost sickness (Native Americans): preoccupation with
death
5 Axes of DSM-IV-TR
I
• Clinical syndromes, e.g. depression, eating
disorders, drug dependence
II
• 2 broad sets of difficulties – mental retardation &
personality disorder
III
• General medical conditions that may contribute to a
person’s psychological functioning
IV
V
• Social or environmental problems (e.g. family)
• Global assessment – how well person is coping with
her overall situation.
ANXIETY DISORDERS
Prevalence & Symptoms
• Lifetime prevalence is 29%
• More common in women than in men.
• Main symptom = feeling of intense anxiety.
• Person with anxiety disorder will often take steps (usually
disruptive to their lives & unsuccessful) to deal with
anxiety
Anxiety Disorder I: Phobias
• Intense & irrational fear.
• Coupled with great efforts to avoid the feared object or
situation.
• Specific & social phobias.
Specific phobias - Characteristics
• Intense & irrational fear directed at a particular object –
person probably knows it irrational but cannot help it.
• Lifetime prevalence of around 13%.
• Gender ratio of 2:1 (female:male)
• Some fears are more common than others (e.g. snakes vs
specific numbers).
Specific phobias - Examples
Acrophobia
(high places)
Claustrophobia
(enclosed places)
Ochlophobia
(crowds)
Mysophobia
(germs)
Triskaidekaphobia
(number 13)
Specific phobias – Avoidance strategies
• Developing strategies for avoiding the phobic object.
• Phobias often expand in scope so that the person may
avoid more and more objects or places.
Social Phobia - Characteristics
• Also referred to as social anxiety disorder.
• Fear of embarrassment or humiliation causes people to
avoid situations that might expose them to public scrutiny.
• Intensely afraid of being watched and judged by others.
• Concerned about negative evaluations as well as positive
ones.
Social Phobia - Characteristics
• Lifetime prevalence of around 13%.
• Equal prevalence for men & women.
• Typically emerges in childhood or adolescence.
• May be accompanied by other anxiety disorders or
depression.
Social Phobia - Examples
• Fears may be limited to one type of situation:
- Speaking in front of others
- Writing in front of others
- Eating in front of others
• Fears can also be generalized to many different
situations.
Social Phobia – Avoidance Strategies
• Avoid situations in which they must expose themselves to
public scrutiny.
E.g. Avoid public speaking or performing because they think others
will think they are stupid.
• When forced into unwanted situations – may use alcohol
or drugs – substance abuse or dependence a real risk.
STRESS DISORDERS
Stress Disorders
• A category of anxiety disorders triggered abruptly by an
identifiable or horrific event.
• E.g. 911 incident, war, 921 earthquake, Japan Tsunami
• E.g. child abuse, witnessing a violent crime, rape,
physical assault.
Posttraumatic Stress Disorder (PTSD)
• Lifetime prevalence of 7%, more likely in women.
5 core components (DSM-IV-TR):
1. Must experience a traumatic event that qualifies as a
serious traumatic stressor, possibly one that was either
objectively or subjectively related to threats of life or
physical integrity.
2-4. Three symptoms clusters of reexperiencing,
avoidance/numbing, and hyperarousal.
- Person must have at least:
i. 1 reexperiencing symptom (e.g. recurrent &
distressing memories or thoughts of the event,
physiological reactivity to trauma reminders)
ii. 3 avoidance symptoms (e.g. efforts to avoid
thoughts, feelings, or talking about the traumatic event;
avoiding activities, places, people, or situations that
serve as trauma reminders)
iii. 2 hyperarousal symptoms (e.g. difficulty falling or
staying asleep, irritability, temper outbursts)
5. Symptoms cluster must be present for at
least a month and must cause functional
impairment in social, school, family, health, or
another important area of daily living.
ROOTS OF
ANXIETY DISORDERS
Comorbidity
• Having one of the anxiety disorders increases the
likelihood of having another anxiety disorder as well.
• More than ½ the people with one anxiety disorder will at
some point also have some other anxiety disorder..
Genetic risk factors
• The probability that one member of a twin pair will have
an anxiety disorder if the other twin has it is much higher
for identical than fraternal twins.
• Genes do not directly ‘cause’ the anxiety disorder.
• Disorder will emerge only if the person with the genetic
vulnerability is exposed to some sort of stressor.
Brain Bases
• Phobias – brain regions involved in fear learning
especially active.
• PTSD – less brain activation in prefrontal regions assoc
with emotional regulation.
Psychological Risk Factors
• Psychological maltreatment of a child.
• Experiences that condition a person to the phobic object.
• Learning through observation of fear demonstrated by
someone else.
• Development of PTSD is affected by:
i. Severity of trauma
ii. Level of social support available to person.
iii. Person’s genetic pattern (x5 more likely if parent has
had it).
MOOD DISORDERS
Mood Disorders
• Also called affective disorders.
• Changes in mood (disturbance in positive & negative
mood) and motivation.
• Emotional and energetic extremes.
• 2 Types:
a. Depression
b. Bipolar disorder
Depression
• Unipolar – at one extreme – depressed.
• Depressed mood and/or loss of pleasure.
• Lifetime prevalence of 7-12% for men; 20-25% for women
• Higher prevalence in women – repetitively turning
emotional difficulties over and over in their minds.
Symptoms of Depression
Centers on feelings of sadness, hopelessness, & broad
apathy about life.
Loses interests in eating, hobbies, sex, almost
everything.
Depressed feelings lasting at least 2 weeks &
accompanied by other symptoms, such as insomnia &
feelings of worthlessness.
Many also experience anxiety
Symptoms of Depression
20% of people have psychotic delusions – unshakable
beliefs. E.g. hearing voices aboutt punishment.
Cognitive Deficits – disrupted attention & working
memory.
Physical Manifestations – loss of appetite, weight loss,
weakness, fatigue, poor bowel functioning, sleep
disorders, loss of interest in sex.
Age of Onset of Depression
• Most commonly begins in adolescence & continues
through middle adulthood.
• But can emerge in the elderly & children.
• Some symptoms of depression in adolescents are
expressed in teenage form:
- Despair – substance abuse
- Apathy aboutt life – number of classes missed
- Irritability – aggression & defiance
ROOTS OF MOOD DISORDERS
Genetic Factors
• Concordance rate is roughly 2 times higher in identical
twins than in fraternal twins.
• Separate inheritance pathways for unipolar & bipolar
depression.
Brain Bases
• 3 neurotransmitters seem critical for mood disorders.
Norepinephrine
ii. Dopamine
iii. Serotonin
i.
• Many antidepressant medications work by altering the
availability of these chemicals at the synapse.
• Symptom improvements do not usually appear until a few
weeks later.
Brain Bases
• Brain imaging have shown that…
• Severe depression is associated with increased brain
activation in a limbic system region.
- Inducing sadness in healthy participants leads to
increased activation in this brain region.
- When depression is successfully treated, brain activity
returns to normal levels.
Psychological Risk Factors
• Identifiable life crisis (marital breakdown, death in family).
• Living environment (e.g. bad neighborhood)
• Additional stresses associated with low socio-economic
status.
The Diasthesis-Stress Model
Person who has gene variant +
no significant stresses in life
Low Risk
Person who doesn’t have gene variant +
many stresses in life
Low Risk
Person who has gene variant + stressors
High Risk
The Cognitive Schema
• Intensely negative & irrational beliefs:
Worthless
Future is bleak
Whatever happens, its
going to get worse
The Cognitive Schema
Beck
• Depressed patients are more negative in their thinking
overall and in their thinking about themselves.
• Negative beliefs can be detected in someone years
before the depression begins.
Peterson & Seligman
• Depressed persons usually present with a pessimistic
explanatory style.
Depression in other contexts
• Far more common in war-torn countries.
• Less commonly diagnosed in Asian countries like China,
Taiwan, and Japan than in the West.
• People in Asian countries may differ in how they
understand, display and perhaps even experience their
own symptoms.
TREATMENT OF MENTAL
DISORDERS
Different treatments target different causes
Psychological Treatments
Biomedical Treatments
• Alter psychological and
• Alter underlying biological
environmental processes.
• Changing perception and
beliefs.
• “Talk therapy”
processes directly.
• Administering medication
or doing neurosurgery.
PSYCHOLOGICAL
TREATMENTS
Cognitive Behavioral Therapy (CBT)
Cognitive Therapy (developed by Beck)
• Dysfunctional cognitions play a key role in the
development of mental disorders.
• Depressed people have negative beliefs about
themselves, the world and the future, and distorted
thought processes.
Negative beliefs…
World
Self
It’s a cruel
world out there
I am unlovable
Future
Things are only
going to get worse
Distorted Thought Processes
All-or-nothing
Overgeneralization
• Now that I’ve lost the election, I
am worthless
• I lost my car keys – that’s just
like me, I lose everything
Disqualifying the
positive
• My doing well on the test today
was just a fluke
Emotional
reasoning
• I feel it, therefore I know it’s true
Cognitive Restructuring
- Some form of mental health counseling
- Helps client become aware of inaccurate or negative
thinking.
- Focuses on patterns of thinking that are maladaptive.
- Teach strategies for keeping certain thoughts readily
available.
• Challenging someone’s beliefs or habits of interpreting the
world.
- Outright efforts of persuasion
- Confronting maladaptive beliefs
Cognitive-Behavioral Approach
• Present-focused.
• Concerned with identifying and solving problems the
patient wishes to address.
• Highly structured sessions.
• Patient expected to do homework – practice new skills or
new ways of thinking learnt during therapy.
• Group therapy is common
BIOMEDICAL
TREATMENTS
Biomedical Treatment
• Pharmacological – medications that alter information
flow at the synapse; influences thoughts, feelings,
behaviors.
• Nonpharmacological – direct manipulation of the
nervous system via surgery or electrical or magnetic
pulses.
Pharmacological Example
Antidepressants
• Medications designed to counteract depression.
• Selective serotonin reuptake inhibitors (SSRIs) – e.g.
Prozac, Zoloft, Paxil.
• Increase serotonin turnover in the brain
Pharmacological Example
Antidepressants
• Beneficial effects emerge only after drug is taken for a
month or so.
• Side effects include weight gain, nausea, diarrhea,
insomnia, loss of sexual desire/response.
• Overprescribed, possible risk of addiction.
Nonpharmacological Example
Electroconvulsive Therapy (ECT)
• Used mostly for severe depression.
• Brief, moderately intense electric current is passed
through the brain to produce a convulsive seizure.
• Patients are given short-acting anesthetics & muscle
relaxants.
• Works well for patients who have not responded well to
medications.
• Effects are quicker.
Nonpharmacological Example
Electroconvulsive Therapy (ECT)
• May produce memory impairment.
• But cognitive side effects are diminished if the ECT is
delivered to just one side of the brain during therapy.
• Use of ECT is controversial – generally reserved for use
only after medication has failed or when there seems to
be a serious chance of suicide.
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