I. Overview

1. Psychopathology is the study of the nature and development of mental disorders.
2. Mental Disorders are defined by the Diagnostic and Statistical Manual of Mental Disorders [DSM]
(current version is DSM-IV)
3. Only those things listed in the DSM are mental disorders.
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1. Definitions and Overview
2. Paradigms in the study of psychopathology
3. Overview of treatments for psychopathology
4. Classification [Diagnoses] of mental disorders and Assessment of the presence or the absence of mental
disorders and issues related to assessment.
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1. How much do we know? Very little.
2. Problem of remaining Objective (easy to bring subjectivity into approach)
3. Definitional Problems

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II. What is Abnormal?

1. Statistical Infrequency
a. Population Distributions
b. Normal Curve
c. Example: Mental Retardation (IQ < 70 -- 2 SDs below mean population IQ)
d. Works only for some types of infrequent behavior (e.g., low IQ, hallucinations, depression)
e. Other types of infrequent behavior/characteristics are not considered abnormal in the sense of
psychopathology (e.g., athletic ability, high IQ).
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2. Violation of Norms
a. Set of established social norms -- what behavior is expected of individual (and what behavior is
not expected)
b. Behavior that threatens or makes anxious those observing behavior typically represents a violation
of the social norms
c. Examples: psychopath's callousness, bizarre behavior of schizophrenics
d. Problem: Other things that fall in the domain of psychopathology do not fit this definition
(e.g., anxiety, depression)
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3. Personal Distress
a. Behavior is abnormal if it creates personal suffering (e.g., depression, anxiety)
b. But there is no suffering in some disorders (e.g., psychopathy, lack of insight)
c. Other things cause suffering but are not psychopathology (e.g., hunger, childbirth, physical illness,
teaching abnormal psychology, taking abnormal psychology)
d. Also problematic because of the subjectivity of definition -- what will be reported as suffering
varies from culture to culture and by individual within a culture.
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4. Disability or Dysfunction
a. Behavior is dysfunctional if it prevents individual from pursuing some goal (e.g., substance abuse,
anxiety, depression).
b. But things like fetishes are psychopathology but do not prevent goals.
c. Some have defined disability/dysfunction as a failure of some mechanism in the person that causes
that person harm.
i. anxiety is a dysfunction because people aren't supposed to be afraid of things that pose
no objective threat.
ii. This definition depends on agreement on what is "normal."
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5. Unexpectedness
a. Another way of looking at normality
b. For example: Hunger versus Phobias
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1. No single definition fits all things that are Mental Disorders
2. Each of the above are partial definitions
3. Abnormality defined as a combination of these definitions
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III. Understanding Causes of Abnormal Behavior

1. False dichotomy
2. Diathesis - Stress Model
3. Biopsychosocial Model
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1. Science and Scientific Methods
a. Testability and Falsifiability -- Statements, theories, hypotheses must be both testable and
falsifiable (regardless of how plausible they may seem) in order to satisfy a scientific
approach.
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b. Reliability -- events, observations, etc must be reproducible
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c. The Role of Theory
-- A Theory is set of propositions meant to explain a class of phenomena.
-- Goal of science is to advance theories that can explain what is observed (i.e., data) often in
terms of cause and effect relations.
-- Theories can help guide research (e.g., specify what variables should be related).
-- Theoretical constructs (e.g., anxiety) are unobservable entities that help simplify relations between
observable variables.
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2. Research Methods in Abnormal Psychology
a. Case Studies
i. Detailed Description -- Rare Phenomena/Disorders
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ii. Disconfirming Evidence iii. Confirming Evidence? iv. Hypothesis Generation
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b. Epidemiological Research
i. Epidemiology: study of frequency and distribution of disorder in a population
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ii. Terminology
a. Prevalence: proportion of population with disorder at given time point.
b. Incidence: number of new case in a given time period.
c. Risk Factor: condition or variable that increases likelihood of the presence of
disorder being studied if the condition or variable is present.
d. Lifetime Prevalence: proportion of population that have ever experienced the
disorder.
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iii. Epidemiological research may provide clues as to the cause(s) of a disorder and provide
information about the extent to which a disorder affects a given population.
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c. Correlational Method
i. Measures the association between two variables -- correlation coefficient can range
from -1.0 to 1.0
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ii. Examples
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iii. Statistical Significance (relation between number of cases, size of correlation, and the
p-level or level of false positives that are determined to be acceptable (usually 5 in 100).
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iv. Relevance to Psychopathology Research
-- Correlational research is implicit in cases where classificatory variables are used (i.e.,
comparing individuals with or without a diagnosis on some other variable).
-- Any research in which research participants are grouped by some pre-existing factor is
correlational (e.g., sex, education, race)
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v. Cause and Effect in Correlational Research
a. Directionality of influence (i.e., A-->B or B-->A?)
b. Third Variables (i.e., C-->A and C-->B)
c. Longitudinal Designs (eliminate some problems)
d. Standard "Mantra" -- correlation does not imply causation
BUT causation DOES imply correlation.
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d. Experiment
i. The Necessary Components
a. Random Assignment of Subjects
b. Manipulated Independent Variable
c. Measurement of Dependent Variable
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ii. Internal Validity -- refers to whether or not the observed effects are due to the manipulation
of independent variable
a. Control Groups
b. Confounds
c. Experimenter Bias
d. Double-Blind Procedures
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iii. External Validity -- refers to the generalizability of results
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iv. Analogue Experiments
a. Study of related phenomena or species
b. Reduced external validity -- when generalized to non-analogue context
c. Increased internal validity -- greater experimental control
d. Ethics of non-analogue studies -- when unable to conduct study with people
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IV. A Brief History of Psychopathology

1. Idea of an evil being dwelled within person & control mind and body
2. Exorcism - cast out the evil being to eliminate mental illness

1. Belief that something wrong with the body ("soma") caused mental illness
2. Three categories of disorder: Mania, Melancholia, Phrenetis (brain fever)
3. Balance of humors: Blood, Black Bile, Yellow Bile, and Phlegm

1. Decline of Leprosy (15 - 16th Century) -- space available
2. Treatments: bleeding, confinement, spinning
3. Bethlehem -- Bedlam (& entertainment)

1. Phillippe Pinel - treat mentally ill as sick
2. Unchain the patients, treat with contact, dignity, respect
3. Actually mostly for the upper class
4. Shift following the assumption of control of hospitals by physicians

1. Emil Kraepelin (1st textbook of Psychiatry)
2. 1883, Classification System
3. Syndromes (co-occuring symptoms)
a. Dementia Praecox (now known as schizophrenia)
b. Manic - Depressive Psychosis
4. General Paresis:
a. A condition that consisted of a steady deterioration of physical and mental health, delusions of grandeur,
and progressive paralysis.
b. Some general paresis patients had earlier had syphilis
c. Gave rise to the "Germ Theory of Disease:" general paresis patients did not develop syphilis when
inoculated by live matter from active sores.

1. Hysterical Symptoms (conversion disorder)
a. Mesmor -- distribution of magnetic fluid in body (1780)
b. Charcot -- students hypnotized woman (1850)
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Paradigm: a set of basic assumptions that outline the particular universe of scientific inquiry. A paradigm specifies the kinds of concepts regarded as legitimate and the methods that are used to collect and interpret data.

Reductionism:

I. Biological Paradigm (Disease Model)

1. Genes - carrier of genetic code (DNA)
2. Genotype - genetic makeup of individual, unobservable
3. Phenotype - observable genetic characteristics, product of genes and environment
4. Study Methods
a. Family Study - occurrence of disorder within individuals sharing known degree of genetic concordance
(i.e., sibs = 50%). Index Cases are the sample of individuals with diagnosis under study (proband)
b. Twin Studies (MZ-DZ concordance)
-- If concordance is greater for MZ twins (identical genetic makeup), than for DZ twins (same shared
genes as sibs) than predisposition for disorder is assumed to be genetic.
-- However, problem of shared environment: i.e., within families, does the similarity of MZ twins
result in them being treated more alike than DZ twins?
-- Attempts to eliminate this problems have used adoption studies: MZ and DZ twins reared apart.

1. Neurons -- four major parts (cell body, dendrites, axons, terminal buttons)
2. Synapse - gap between neurons, neurochemical transmission across
3. Neurotransmitters (e.g., norepinephrene, epinephrene, dopamine, serotonin, gamma-aminobutyric acid
[GABA]) - agents which act in synapse
4. Relation to Disorder: too much or too little neurotransmitter (e.g., synthesis, breakdown, receptor sites)

1. PKU (phenylketonuria) unable to metabolize phenylaline because of a lack of appropriate enzyme. Causes
mental retardation. Solution is to identify near birth, alter diet.
2. ECT
3. Psychoactive Drugs: e.g., lithium, tricyclic antidepressants, SSRIs, neuroleptics.

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II. Psychodynamic Paradigm (Freud)

1. Two Basic Instincts: Eros and Thanatos (libido, death / aggression)
2. Id: present from birth, pleasure principle, employs primary process (fantasy of what is desired if not
satisfied in order to reduce tension)
3. Ego: primary conscious - second six months of life, deals with reality, employs secondary process (planning
and decision making), reality principle (mediate between real world - Id), derives all energy from Id
4. Superego: society's moral standards as interpreted by parents and internalized
5. The interplay between the three is psychdynamics of the personality
a. Defense Mechanisms (see below) reflect the unconscious component of ego
b. Unconscious: functions of Id, Superego, and some Ego (most important)

1. Oral (0-2)
2. Anal (2-3)
3. Phallic (3-5/6)
4. Latency (6-12) not sexual stage, dormant, id impulses suppressed
5. Genital (12 - adult)
6. Arrested development -- fixation, e.g., anal. retentive if unable to resolve conflicts between id and
reality. Example: Oedipus/Electra Complex
7. Defensive Mechanisms -- used to protect the ego from anxiety
a. Repression - push all unacceptable impulses and thoughts to unconscious
b. Projection - attribute own undesirable characteristics to others
c. Displacement - redirecting of emotional responses to other things
d. Reaction Formation - conversion of emotion into the opposite
e. Regression - retreat to behavior of earlier stage
f. Rationalization - invent a good reason for behavior

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III. Learning Paradigm - abnormal behavior learned in same way was as "typical" behavior

1. Classical Conditioning (Pavlov): US, CS, UR, CR
2. Operant Conditioning (Skinner): reinforcement, discriminative stimulus, shaping
3. Modeling (Bandura)
4. Mediational Learning: discriminative stimulus does not have a direct effect on behavior (e.g., 2-factor theory)

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IV. Cognitive Paradigm

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V. Diathesis-Stress: a biopsychosocial approach

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I. Biological Approaches

1. Psychosurgery
2. Electroconvulsive Therapy
3. Psychopharmacology

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II. Psychodynamic Psychotherapies

1. Ego-analysis
2. Attachment
3. Short-term Dynamic Therapy

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III. Behavioral & Cognitive Behavioral Approaches

1. Systematic desensitization
2. Exposure
3. Aversion Therapies

1. Contingency Management
2. Skills Training
a. Assertiveness Training
b. Social Skills Training
c. Problem Solving

1. Attributional Theory and Application
2. Self Instruction Training
3. Cognitive Therapy
4. Rational Emotive Therapy

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IV. Psychotherapy Research

1. Standard Outcome Study
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2. Issues in Treatment Outcome Research Design
a. Appropriate Control Groups
b. Placebo Control
c. Double-Blind Placebo
d. Measurement of Outcome
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2. Meta-analysis
a. Why?
b. Definition
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3. Effectiveness of Psychotherapy
a. Effective
b. Spontaneous Remission -- about 1/3 improve without treatment
c. About 2/3 of psychotherapy clients improve significantly
d. Differential Efficacy between Treatments
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4. Common Factors
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5. Predictors of Outcome

1. Examines factors that are part of the "process" of therapy as they relate to outcome.
a. Therapist Characteristics
b. Client Characteristics
c. Relationship Variables
d. Specific Therapeutic Acts (e.g., transference interpretations)
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