Unit 8: Clinical Psychology

Definitions of Disorder
●​ The definition of disordered behavior is composed of four components.
○​ First, disordered behavior is unusual—it deviates statistically from typical
behavior.
○​ Second, disordered behavior is maladaptive: that is, it interferes with a
person’s ability to function in a particular situation.
○​ Third, disordered behavior is labeled as abnormal by the society in which
it occurs.
○​ Finally, disordered behavior is characterized by perceptual or cognitive
dysfunction.

Theories of Psychopathology
●​ Sigmund Freud engaged in careful observation and analysis of people with
varying degrees of behavioral abnormalities.
●​ Freud and the psychoanalytic school hypothesized that the interactions among
conscious and especially unconscious parts of the mind were responsible for a
great deal of disordered behavior.
●​ Humanistic school: of psychology suggests that disordered behavior is, in part,
a result of people being too sensitive to the criticisms and judgments of others.
●​ Cognitive perspective: views disordered behavior as the result of faulty or
illogical thoughts.
●​ Behavioral approach: to disordered behavior is based on the notion that all
behavior, including disordered behavior, is learned.
●​ Biological view: of disordered behavior, which is a popular one in the United
States at the present time, views disordered behavior as a manifestation of
abnormal brain function, due to either structural or chemical abnormalities in the
brain.
●​ Sociocultural approach: holds that society and culture help define what is
acceptable behavior.

Diagnosis of Psychopathology
●​ The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the
American Psychiatric Association’s handbook for the identification and
classification of behavioral disorders.
 ○​ The DSM-5 calls for the separate notation of important social factors and
physical disabilities, in addition to the diagnosis of mental disorders.

Neurodevelopmental Disorder
●​ The term neurodevelopmental refers to the developing brain.
●​ Related disorders manifest early in development, and may be due to genetic
issues, trauma in the womb, or brain damage acquired at birth or in the first years
of life.
●​ Intellectual disability: (formerly known as mental retardation) is characterized
by delayed development in general mental abilities (reasoning, problem-solving,
judgment, academic learning, etc.).
●​ Autism spectrum disorder: is a neurodevelopmental disorder that often
manifests early on in childhood development.
●​ Attention-deficit hyperactivity disorder (ADHD): is described as patterned
inattention and/or hyperactivity-impulsivity.
●​ Other neurodevelopmental disorders include communication disorders such as
language disorder, speech sound disorder, and fluency disorder (stuttering);
motor disorders such as developmental coordination disorder, stereotypic
movement disorder, and tics; and specific learning disorders.

Schizophrenia Spectrum and other Psychotic Disorders

●​ Although the term schizophrenia literally means “split brain,” these disorders
have nothing to do with what used to be called Multiple Personality Disorder.
●​ Delusions: are beliefs that are not based in reality, such as believing that one
can fly, that one is the president of a country, or that one is being pursued by the
CIA (assuming that these things are not true).
●​ Hallucinations: are perceptions that are not based in reality, such as seeing
things or hearing voices that are not there, or feeling spiders on one’s skin
(assuming they are not really there).
●​ Disorganized thinking and disorganized speech are typical.
●​ It is important to distinguish between positive symptoms and negative
symptoms.
○​ A positive symptom: of schizophrenic disorders refers to something that a
person has that typical people do not.
○​ A negative symptom: refers to something that typical people do have, but
that one does not have.

Bipolar and Related Disorders

 ●​ Bipolar disorders: as the name suggests, involves movement between two
poles: depressive states on the one hand, and manic states on the other hand.
●​ Because manic states often have psychotic features, the DSM-5 now regards
bipolar disorders as a bridge between the psychoses and the major depressive
disorders.

Depressive Disorders
●​ Unlike the everyday-language use of the term (“I’m so depressed about that
test”), depressive disorders involve the presence of a sad, empty, or irritable
mood, combined with changes in thinking and bodily functioning that significantly
impair one’s ability to function.

Anxiety Disorders
●​ Fear: is an emotional response to something present; anxiety is a related
emotional response, but to a future threat or a possibility of danger.
●​ Physical effects of anxiety may include but are not limited to muscle tension,
hyperalertness for danger signs, and avoidance behaviors.
●​ Panic disorder: is an anxiety disorder characterized by recurring panic attacks,
as well as the constant worry of another panic attack occurring.
●​ Generalized anxiety disorder (GAD): is an anxiety disorder characterized by an
almost constant state of autonomic nervous system arousal and feelings of dread
and worry.
●​ Phobias: or persistent, irrational fears of common events or objects, are also
anxiety disorders.
●​ Agoraphobia: for example, is the fear of being in open spaces, public places, or
other places from which escape is perceived to be difficult.

Obsessive-Compulsive and Related Disorders

●​ As the name suggests, these disorders involve obsessions and/or
compulsions.
○​ Obsessions: are intrusive (unwanted) thoughts, urges, or images that
plague the individual.
○​ Compulsions: are repetitive behaviors (or mental acts) that one feels
compelled to perform, often in relation to an obsession.
●​ OCD is characterized by involuntary, persistent thoughts or obsessions, as well
as compulsions, or repetitive behaviors that are time consuming and
maladaptive, that an individual believes will prevent a particular (usually
unrelated) outcome.
Trauma-and Stressor-Related Disorders
●​ By definition, these disorders follow a particularly disturbing event or set of
events (the trauma or the stressor), like war or violence.
●​ The best-known such disorder is post-traumatic stress disorder (PTSD), which
can involve intrusive thoughts or dreams related to the trauma, irritability,
avoidance of situations that might recall the traumatic event, sleep disturbances,
diminished interest in formerly pleasurable activities, and social withdrawal.
●​ Other disorders include reactive attachment disorder: which can occur in
seriously neglected children who are unable to form attachments to their adult
caregivers, and adjustment disorders, or maladaptive responses to particular
stressors.

Disassociative Disorders
●​ In many cases, these disorders appear following a trauma, and may be seen as
the mind’s attempt to protect itself by splitting itself into parts.
○​ Thus, one might experience derealization, the sense that “this is not
really happening,” or depersonalization, the sense that “this is not
happening to me.”
●​ Significant gaps in memory may be related to dissociative amnesia, an inability
to recall life events that goes far beyond normal forgetting.
○​ Perhaps the most extreme of these disorders is dissociative identity
disorder (formerly known as multiple personality disorder), in which one
may not only “lose time,” but also manifest a separate personality during
that lost time.

Somatic Symptom and Related Disorders

●​ Soma means “body.”
●​ Somatic symptom disorder: involves, as one might expect, bodily symptoms
combined with disordered thoughts, feelings, and/or behaviors connected to
these symptoms.
●​ Related worries appear in illness anxiety disorder, in which one worries
excessively about the possibility of falling ill.
●​ Conversion disorder: (formerly known as hysteria) involves bodily symptoms
like changed motor function or changed sensory function that are incompatible
with neurological explanations.
●​ Factitious disorder: in which an individual knowingly falsified symptoms in order
to get medical care, or sympathy or aid from others.
Feeding and Eating Disorders
●​ Anorexia nervosa: (commonly called anorexia) involves not only restriction of
food intake, but also intense fear of gaining weight and disturbances in
self-perception, such as thinking one looks fat, when one does not.
●​ Bulimia nervosa: (commonly called bulimia) involves recurrent episodes of
binge-eating: eating large amounts of food in short amounts of time, followed by
inappropriate behaviors to prevent weight gain, such as self-induced vomiting
(purging), using laxatives, or intense exercising.
●​ Binge-eating disorder:: might be thought of as bulimia without purging.
●​ Pica refers to regular consumption of non-nutritive substances (plastic, paper,
dirt, string, chalk, etc.).

Personality Disorders
●​ A personality disorder refers to a stable (and inflexible) way of experiencing and
acting in the world, one that is at variance with the person’s culture, that starts in
adolescence or adulthood, and leads to either personal distress or impairment of
social functioning.
●​ Cluster A: includes paranoid, schizoid, and schizotypal personality disorders.
○​ Schizoid personality disorder is marked by disturbances in feeling
(detachment from social relationships, flat affect, does not enjoy close
relationships with people), whereas schizotypal personality disorder is
marked by disturbances in thought (odd beliefs that do not quite qualify as
delusions, such as superstitions, belief in a “sixth sense,” etc.; odd
speech; eccentric behavior or appearance).
●​ Cluster B: includes antisocial, borderline, histrionic, and narcissistic personality
disorders.
○​ Terms like psychopath or sociopath have been used to describe people
with antisocial personality disorder, which is characterized by a
persistent pattern of disregard for, and violation of, the rights of others.
○​ Borderline personality disorder: involves a very stormy relationship with
the world, with others, and with one’s own feelings.
○​ Histrionic personality disorder: involves a pattern of excessive
emotionality and attention-seeking, beyond what might be considered
normal (even in a “culture of selfies”).
○​ Narcissistic personality disorder: involves an overinflated sense of
self-importance, fantasies of success, beliefs that one is special, a sense
of entitlement, a lack of empathy for others, and a display of arrogant
behaviors or attitudes.
 ●​ Cluster C: includes avoidant, dependent, and obsessive-compulsive personality
disorders.
○​ Avoidant personality disorder: involves an enduring pattern of social
inhibition, feelings of inadequacy, and hypersensitivity to real or perceived
criticism, which lead to avoidance behavior in relation to social, personal,
and intimate relationships.
○​ Dependent personality disorder: is marked by an excessive need to be
cared for, leading to clingy and submissive behavior and fears of
separation.
○​ Obsessive-compulsive personality disorder (OCPD): is marked by a
rigid concern with order, perfectionism, control, and work, at the expense
of flexibility, spontaneity, openness, and play.

Psychoanalysis
●​ Psychoanalysis: or psychoanalytic therapy, as it is sometimes called, was first
developed by Freud and focuses on probing past defense mechanisms of
repression and rationalization to understand the unconscious cause of a
problem.
●​ Countertransference: may occur if the therapist transfers his or her own
feelings onto the patient.

Humanistic Therapy
●​ The humanistic school of psychology takes a related, yet different approach to
the treatment of disordered behavior.
●​ Client-centered therapy: was invented by Carl Rogers and involves the
assumption that clients can be understood only in terms of their own realities.
○​ The client-centered therapist approaches this differently from the
Freudian.
●​ The therapist is honest, open, and emotional with the client (an active listener).
○​ Rogers called this client-relationship genuineness.
●​ The next key for successful client-centered therapy, according to Rogers, is
unconditional positive regard.
○​ Unconditional positive regard: is a term used in psychology to refer to an
attitude of acceptance and warmth towards another person, regardless of
their behavior or beliefs.
○​ The therapist provides this unconditional positive regard to help the client
reach a state of unconditional self-worth.
●​ The final key to successful therapy is accurate empathic understanding.
 ○​ Accurate empathic understanding: is the ability to accurately understand
and identify what someone else is feeling.
●​ Rogers used this term to describe the therapist’s ability to view the world from the
eyes of the client.
●​ This empathy is critical to successful communication between the therapist and
client.
●​ A different type of approach toward treatment is Gestalt therapy, which
combines both physical and mental therapies.
●​ Fritz Perls: developed this approach to blend an awareness of unconscious
tensions with the belief that one must become aware of and deal with those
tensions by taking personal responsibility.

Behavioral Therapy
●​ Behavioral therapy: stands in dramatic contrast to the insight therapies.
●​ Counterconditioning: is a technique in which a response to a given stimulus is
replaced by a different response.
●​ Counterconditioning can be accomplished in a few ways.
○​ One is to use aversion therapy, in which an aversive stimulus is
repeatedly paired with the behavior that the client wishes to stop.
○​ Another method used for counterconditioning is systematic
desensitization.
○​ This technique involves replacing one response, such as anxiety, with
another response, such as relaxation.
●​ Other forms of behavioral therapy involve extinction procedures, which are
designed to weaken maladaptive responses.
○​ One way of trying to extinguish a behavior is called flooding.
○​ Flooding involves exposing a client to the stimulus that causes the
undesirable response.
●​ Implosion: is a similar technique, in which the client imagines the disruptive
stimuli rather than actually confronting them.
●​ Operant conditioning: is a behavior-control technique that we discussed in the
chapter on learning.
○​ A related approach is behavioral contracting, in which the therapist and
the client draw up a contract by which they both agree to abide.
●​ Modeling: is a therapeutic approach based on Bandura’s social learning theory.
○​ This technique is based on the principle of vicarious learning.

Cognitive Therapy
 ●​ Cognitive approaches to the treatment of disordered behavior rely on changing
cognitions, or the ways people think about situations, in order to change
behavior.
●​ One such approach is rational-emotive behavior therapy (REBT) (sometimes
called simply RET, for rational-emotive therapy), formulated by Albert Ellis.
●​ Another cognitive approach is cognitive therapy, formulated by Aaron Beck, in
which the focus is on maladaptive schemas.
●​ Maladaptive schemas: include arbitrary inference, in which a person draws
conclusions without evidence, and dichotomous thinking, which involves
all-or-none conceptions of situations.

Biological Therapies
●​ Biological therapies are medical approaches to behavioral problems.
●​ Biological therapies are typically used in conjunction with one of the previously
mentioned forms of treatment.
●​ Electroconvulsive therapy (ECT): is a form of treatment in which fairly high
voltages of electricity are passed across a patient’s head.
○​ This treatment causes temporary amnesia and can result in seizures.
●​ Another form of biological treatment is psychosurgery.
○​ Perhaps the most well-known form of psychosurgery is the prefrontal
lobotomy, in which parts of the frontal lobes are cut off from the rest of the
brain.
●​ Psychopharmacology: is the treatment of psychological and behavioral
maladaptations with drugs.
○​ There are four broad classes of psychotropic, or psychologically active
drugs: antipsychotics, antidepressants, anxiolytics, and lithium salts.
●​ Antipsychotics: like Clozapine, Thorazine, and Haldol reduce the symptoms of
schizophrenia by blocking the neural receptors for dopamine.
●​ Antidepressants: can be grouped into three types: monoamine oxidase (MAO)
inhibitors, tricyclics, and selective reuptake inhibitors.
●​ MAO inhibitors: like Eutron, work by increasing the amount of serotonin and
norepinephrine in the synaptic cleft.
●​ Tricyclics: like Norpramin, Amitriptyline, and Imipramine increase the amount of
serotonin and norepinephrine.
●​ The third class of antidepressants, selective reuptake inhibitors (often called
the selective serotonin reuptake inhibitors, or SSRIs, for the neurotransmitter
most affected by them) also work by increasing the amount of neurotransmitter at
the synaptic cleft, in this case by blocking the reuptake mechanism of the cell
that released the neurotransmitters.
 ●​ Anxiolytics depress the central nervous system and reduce anxiety while
increasing feelings of well-being and reducing insomnia.
●​ Benzodiazepines: which also include Valium (Diazepam) and Librium
(Chlordiazepoxide), cause muscle relaxation and a feeling of tranquility.
●​ Lithium carbonate:a salt, is effective in the treatment of bipolar disorder.

Modes Of Therapy
●​ Group therapy: in which clients meet together with a therapist as an interactive
group, has some advantages over individual therapy.
●​ Twelve-step programs: are one form of group therapy, although they are usually
not moderated by professional psychotherapists.
●​ Another form of therapy in which there is more than a single client is couples or
family therapy.
○​ This type of treatment arose out of the simple observation that some
dysfunctional behavior affects the afflicted person’s loved ones.