PSY 2414 Abnormal Psychology (GUARANTEED PASS) Notes | (Download To Score A)

Abnormal Psychology Chapter 1: Introduction and Methods of Research 4 Definitions (p. 4-6) 4 How Do We Define Abnormal Behavior? (p. 6-10) 4 Historical Perspectives on Abnormal Behavior (p. 10-19) 4 Research Methods in Abnormal Psychology (p. 19-32) 6 Chapter 2: Contemporary Perspectives on Abnormal Behavior 7 The Biological Perspective (p. 38-45) 7 The Psychological Perspective (p. 45-60) 10 The Sociocultural Perspective (p. 60-63) 13 The Biopsychosocial Perspective (p. 63-66) 14 Chapter 3: Classification and Assessment of Abnormal Behavior 14 How Are Abnormal Behavior Patterns Classified? (p. 70-77) 14 Standards of Assessment (p. 77-80) 16 Methods of Assessment (p. 80-99) 16 Sociocultural and Ethnic Factors in Assessment (p. 99-100) 21 Chapter 4: Methods of Treatment 21 Psychotherapy (p. 104-125) 22 Biomedical Therapies (p. 126-130) 25 Hospitalization and Community-Based Care 27 Chapter 5: Stress, Psychological Factors, and Health 28 Adjustment Disorders (p. 141-143) 28 Chapter 6: Anxiety Disorder 29 Overview of Anxiety Disorders (p. 171-172) 29 Panic Disorder (p. 172 - 179) 29 Phobic Disorders (p. 179-193) 31 Obsessive-Compulsive Disorder (p. 194-198) 32 Generalized Anxiety Disorder (p. 198-200) 33 Acute Stress Disorder and Posttraumatic Stress Disorder (p. 200-204)34 Ethnic Differences in Anxiety Disorders (p. 204-205) 35 Chapter 8: Mood Disorders and Suicide 35 Types of Mood Disorders (p. 248-259) 35 Causal Factors in Depressive Disorders (p. 259-269) 38 Causal Factors in Bipolar Disorders (p. 269-270) 40 Treatment of Mood Disorders (p. 270-278) 40 Suicide (p. 278-284) 41 Chapter 10: Eating Disorders 42 Eating Disorders (332-342) 42 Chapter 12: Schizophrenia and Other Psychotic Disorders 45 Schizophrenia (p. 397-426) 45 Subtypes of Schizophrenia 47 Theoretical Perspectives 48 Treatment Options 50 Other Psychotic Disorders (p. 426-429) 51 Chapter 13: Personality Disorders and Impulse Control Disorders 52 Types of Personality Disorders (p. 435-454) 52 Theoretical Perspectives (p. 454-463) 55 Treatment of Personality Disorders (p. 463-465) 57 Impulse Control Disorders (p. 465-469) 58 Chapter 14: Abnormal Behavior in Childhood and Adolescence58 Normal and Abnormal Behavior in Childhood and Adolescence (p. 475-478) 58 Pervasive Developmental Disorders (p. 478-485) 59 Mental Retardation (p. 485-489) 61 Learning Disorders (p. 489-492) 64 Communication Disorders (p. 492-493) 64 Attention-Deficit and Disruptive Behavior Disorders (p. 493-499) 65 Childhood Anxiety and Depression (p. 499-506) 67 Elimination Disorders (p. 506-509) 69 Appendix 71 Anxiety Disorders 71 Mood Disorders 73 Eating Disorders 74 Schizophrenia 75 Personality Disorders 76 Childhood and Adolescence 77 Chapter 1: Introduction and Methods of Research Definitions (p. 4-6) • Abnormal psychology is the branch of psychology that studies abnormal behavior, and how to help people affected by psychological disorders • A psychological disorder is an abnormal pattern which causes both emotional distress and impaired functionality • Itʼs noteworthy that the term psychological disorder is used, as opposed to the term mental illness, which is derived from the medical model perspective • The surgeon general points out a few things about mental health: • It is the complex interaction of brain and environment • Effective treatments exist for most mental disorders, which often involve different integrated therapies • Progress has been slow, because we are still working out underlying causes • Although 15% of Americans receive help, many more need • Mental health problems are better understood after context is taken into account How Do We Define Abnormal Behavior? (p. 6-10) • There are a few critera for determining abnormality: 1. This is an unusual occurrence 2. It deviates from the social norm • Itʼs worth remembering that differenct cultures have different definitions of mental health and illness 3. It involves a faulty perception of reality 4. It elicits significant personal distress 5. It involves maladaptive behavior 6. Itʼs potentially dangerous • Abnormal patterns express themselves differently in different cultures • Also, different cultures experience emotions differently Historical Perspectives on Abnormal Behavior (p. 10-19) • Demonological Model • Prehistoric ancestors seemed to think that abnormal behavior was caused by the inhabitation of evil spirits which would be removed through trephination • But at the same time, trephination may merely have been a surgery to remove shattered pieces of bone or blood clot from a head injury • This view remained prominent until the Age of Enlightenment • Origins of Medical Model in the “Ill Humor” concept • Philosopher/physicians like Hippocrates and Galen developed the humor model, which is like a predecessor for the medical model. It can be summarized as such: Humor Word for Excess Behavioral Results Phelgm Phlegmatic Lethargy Blood Sanguine Optimism Humor Word for Excess Behavioral Results Yellow bile Bilious/choleric Irritation Black bile Melancholy Depression • They also classified abnormal behavior: • Melancholia: excessive depression • Phrenitis: bizarre schizophrenic behavior • Mania: exceptional excitement • Medieval Times • This era went back to the “doctrine of posession” • The treatment of choice was exorcism • Witchcraft • The 15th to 17th centuries changed the focus from demonic possession to accusation of witchcraft • Its “diagnostic tests” were torture • Asylums • At the same time, there was a movement in England to look at physical causes of disorders • Asylums were built to care for the insane, but conditions were appalling • Some were even public spectacles • The Reform Movement/Moral Therapy • Jean-Baptiste Pussin and Philippe Pinel began the modern era of treatment in the late 18th century • They tried to treat mental disorder as an illness, not contain it like a threat to society • This sparked efforts of moral therapy where harsh practices ended and humane treatment began • In England and America, reformers such as William Tuke, Dorothea Dix and Benjamin Rush followed suit • Late 19th Century • This was a step backwards as mental institutions grew, but only covered custodial care • They aimed to restrain patients, not treat them • Outpatienting • In 1963, Congress established a nationwide system of community health centers to help patients leave the hospital • This, combined with new medications helped them return to society Contemporary Perspectives on Abnormal Behavior • Biological Perspective: • Wilhelm Griesinger argued that abnormal behavior comes from disease in the brain • Emil Kraepelin wrote an influential textbook fleshing out the medical model • He specified two main groups of mental disorders: • Dementia praecox (schizophrenia) - caused by a body chemical imbalance • Manic-depressive psychosis (bipolar disorder) - caused by an abnormality in the bodyʼs metabolism • According to the medical model, people behaving abnormally suffer from a mental illness which can be classified according to its distincitve causes and symptoms • Itʼs not necessarily biological • The medical model gained significant ground when syphilis was proven to lead to genral paresis • Thank goodness for syphilis • It is noteworthy that much of the terminology used now has been “medicalized” • Psychological Perspective: • Jean Martin Charcot used hypnosis to experiment with hysteria, showing that much of the disorder was not physical in nature • Joseph Breuer used hypnosis to treat a famous patient, Anna O. • Freud found similar uses in hypnosis, and further developed the psychodynamic model • At the time, emphasis was placed on catharsis, but the underlying point still stands • Sociocultural Perspective • Many problems come from environmental sources • Biopsychosocial Perspective • The integrative model that looks at interactions between the sources, as well as the sources themselves Research Methods in Abnormal Psychology (p. 19-32) • We try to perform research according to the scientific method, a systematic method of conducting research where theories are examined in light of evidence • A theory is a formulation of the relationships underlying observed events • We try and be as critical as possible by making our explanations as neutral as possible • Ideally, these theories also help predict future data, and control present behavior • The scientific method works as follows: 1. Formulate a research question 2. Frame the research question in the form of a hypothesis, or testable assumption 3. Test the hypotheses 4. Draw conclusions about the hypothesis Ethics • Ethical principles are “designed to promote the dignity of the individual, protect human welfare, and preserve scientific integrity” • In short, the psychologist may not inflict harm upon the subject/client • As such, experiments must be vetted through IRBs • They rely on two factors, among others: • Informed consent: people must be able to make a free, educated choice to participate in this study, and continue to participate in it • Confidentiality: the subjectʼs identity is secured Forms of Study: • Naturalistic observation • Correlational method • Longitudinal study • Experimental method • Iʼm assuming knowledge of this section. Here are the vocabulary words from the section: • Independent variables • Dependent variables • Experimental/control groups • Random assignment vs selection factors • Blind/double blind experiments • Placebo and placebo effects • Internal validity vs. confounds • External validity • Construct validity • We can never be absolutely certain about the construct validity of research, because weʼre never absolutely certain about the current theories • Epidemological studies • Examining the rates of occurrence of abnormal behavior in various settings and population groups • Survey method • Doing epidemological studyign through questionnaires • Incidence: the number of new cases • Prevalence: the overall number of cases • It relies on random sampling for its generalizability • Kinship studies • Genotype vs. phenotype • The first diagnosis is called an index case, or proband • This is relevant because the distribution of disorders in the family relative to the proband will help determine if it is genetically linked • A concordance rate refers to the percentage of cases in which both twins have the same trait or disorder • Adoptee studies • Case studies • Single-case experimental design • Often uses the reversal design, where A-B-A-B phases are enacted Chapter 2: Contemporary Perspectives on Abnormal Behavior The Biological Perspective (p. 38-45) • The best thing to do here is to memorize the diagram on p 39. Parts of the cell include: • Neurons, the messenger cells of the body • Dendrites, the short projections from the body which receive the messages • Axons, the trunklike projections which send messages • Most axons have a myelin sheath to insulate it and speed up the connection • Axon terminals, which connect to the dendrite • Neurotransmitters, the chemical substances which purvey the message • Receptor site, the area where the receiving neuron collects the neurotransmitters • Usually, only the correct neurotransmitter is able to activate any given receptor • Psychiatric drugs work by affecting the availability of neurotransmitters • Synapses, the space between the two neurons where the neurotransmitters travel • Neurotransmitters which arenʼt accepted are either metabolized and removed by enzymes, or reabsorbed back to the axon terminal (reuptake) to prevent more firing • Key neurotransmitters inclule: • Acetylcholine (ACh) which controls muscle contractions and memory formation • Dopamine, which regulates muscle contractions, learning, memory and emotions • Norepinephrine, which involves learning and memory • Serotonin, which regulates mood, satiety and sleep Nervous System • There are two parts of the nervous system: • Central Nervous System (CNS): the spinal chord and brain • Peripheral Nervous System (PNS): everything else The Brain • See the diagrams on p. 42 • Here are the parts of the brain: • Hindbrain: • Medulla - life-support functions, like breathing and heartbeat • Pons - information about body movement, attention, sleep and respiration • Cerebellum - balance and motor coordination • Midbrain: • Reticular formation - the cluster of neurons that carry information from the hindbrain to the forebrain • Reticular activating system (RAS) - a network of neurons that carry information, that also plays a role in regulating states of arousal, from sleep to attention • Depressant drugs like alcohol dampen RAS activity • Forebrain: • Limbic system - critical to emotional processing and memory • Thalamus - the tip of the RAS that also does its jobs • Hypothalamus - higher bodily functions, like body temperature, reproductive processes, emotional and motivational states • Basal ganglia - important for postural movements and coordination • Cerebrum - higher mental functions, like thinking and problem solving • Has ridges to give it more surface area. This areaʼs called the cerebral cortex • Cerebral Cortex: • Divided into hemispheres • Occipital lobe is involved in processing visual stimuli • Temporal lobe is involved in processing auditory stimuli • Parietal lobe is involved in processing touch, temperature and pain • Sensory area is involved in processing sensation from the skin • The motor area/motor cortex of the frontal lobe is involved in controlling muscular responses • The prefrontal cortex is involved in regulating higher mental functions Peripheral Nervous System • Broken down into two subsystems: • Somatic nervous system - transmits messages from sensory organs to the brain for processing, and from the brain to the muscles for action • Autonomic nervous system - used for emotional processing, involuntary processes, and states of arousal • Sympathetic nervous system - activity leads to heightened arousal • Parasympathetic nervous system - activity leads to declining arousal • These systems work against each other, affecting heart rate, breathing rate, digestion, etc • For some disorders, like Alzheimerʼs, this method works wonders • On the other hand, most disorders involve environmental factors as well • But in the end, we can at least have these four things to say about genetics: 1. Genes do not dictate behavioral outcomes 2. Genetic factors create predisposition - not certainty 3. Multigenic determinism affects psychological disorders 4. Genetic factors and environmental influence interact with each other in shaping our personalities and determining our vulnerability to a range of psychological disorders The Psychological Perspective (p. 45-60) Psychodynamic Theory • Freudʼs psychoanalytic theory views personality as being influenced by the interplay of conflicting forces within the individual • Abnormal behavior or psychosis represents “symptoms” of these dynamic struggles - which often stem from childhood - taking place within the unconscious mind which interfere with reality • He emphasizes the conscious, preconscious and unconscious as well as the place that the id, ego and superego take place within it (see diagram) • The unconscious is where the illogical and socially unacceptable parts of the mind stay hidden, while still influencing our behavior • The id begins at birth and operates according to the pleasure principle of instant gratification • During the first year of life, delay of gratification becomes apparent, and the ego develops to organize reasonable coping mechanisms • As such, the ego operates along the reality principle • Its main job is to be rational, negotiating and capable of making decisions • The superego develops as moral standards are internalized • When the id and superego conflict, the ego activates different defense mechanisms to relieve the psychic tension which ensues • When even they donʼt help, or they become maladaptive, behavioral problems result • Major defense mechanisms include: • Repression - expulsion from awareness of unacceptable ideas or motives • Regression - the return of behavior that is typical of earlier stages of development • Displacement - the transfer of unacceptable impulses away from their original objects to safer/less threatening objects • Denial - refusal to recognize a threatening impulse or desire • Reaction formation - behaving in a way that is the opposite of oneʼs true wishes to keep these repressed • Rationalization - the use of self-justification to explain away unacceptable behavior • Projection - imposing oneʼs own impulses onto another person • Sublimation - the channeling of unacceptable impulses into socially constructive pursuits • In order to ease the psychic tension, Freud would aim to uncover the source of the tension in order to resolve it • Children develop through psychosexual phases which are: • Oral • Anal • Phallic • Latent • Genital • During these stages, the libido or sexual energy focuses on certain erogenous zones, or areas of growth • If there is an area where people fail, they become fixated on it and cannot move on • See slides for details • There were other theorists as well • Carl Jung made a spin-off called analytical psychology which focused on the need for self-awareness and self-direction • He believed in a “collective unconscious” which spawns certain archetypes which we use to reflect on the history of our species • Alfred Adler focused on the inferiority complex in his individual psychology • He also spoke of the creative self, where each person has their own unique concept of how to fulfill their potential • Karen Horney stressed the importance of parent-child relationships • They could end in developing a basic anxiety or basic hostility towards the world • More recently, there is a greater emphasis on the conscious self, and less on sexual instinct • Heinz Hartmann even termed the new movement ego psychology • Erik Erikson focused on psychosocial development in the light of facing challenges at different stages in life • Margaret Mahler brought about object-relations theory which suggested that we introject our parents into own personalities and that by dissecting this introjection, we learn about how we approach the world • According to Freud, mental health is the result of psychodynamic balance • Psychological disorders originate in childhood and are buried in the depths of the unconscious • When the urges of the id spill forth, psychosis results • Mental health is the abilities to love and be productive • Others also emphasized the importance of developing a differentiated self • Psychodynamic models are useful for introducing the fact that our knowledge of ourself is limited • On the other hand, his notion of childhood sexualityʼs controversial and overstated • Also, his theory does not work according to the scientific method • While the theory had major impact in the field of psychology, its influence is waning Learning Models • After the inexactitude of psychoanalysis and the subconscious, the field swung in the total opposite direction, with behaviorism, which defines psychology as the study of only observable behavior • From the behaviorist perspective, abnormal behavior is the acquisition of maladaptive behaviors • Meaning, whereas psychodynamics and the medical model consider abnormal behavior symptomatic of an underlying issue, behaviorism considers the abnormal behavior itself the issue • Major names are Ivan Pavlov, John B Watson and B F Skinner • Pavlov did the dog salivating experiment and invented classical conditioning • Watson tested it on humans with the “little Albert” experiment • Skinner did the operant conditioning experiment • Vocabulary words include: • Positive vs. Negative reinforcers • Primary vs. Secondary reinforcers • Punishment • Social-cognitive theory is a learning-based theory which emphasizes modeling, or observational learning, and also incorporates roles for cognitive variables in determining behavior • Major names are Albert Bandura, Julian Rotter and Walter Mischel • It also emphasizes the fact that people impact their environment the same way their environment impacts them • They also discuss that expectancies, beliefs about expected outcomes, should be taken into account as well • Learning theory led to behavior modification therapy where principles of learning are used to affect behavior • Itʼs very useful in improving childrenʼs behavior • At the same time, behaviorism is criticized for being too mechanistic, not looking into the human experience enough, which should be taken into account because it ultimately affects behavior Humanistic Models • Carl Rogers and Abraham Maslow believed that people have an internal, subjective experience of the world that must be discovered • Abnormal behavior comes from distorted views of the self • Maslow proposed the hierarchy of needs • Psychologists should show unconditional positive regard if parents have not • Conditional positive regard leads to children developing conditions of worth, leading to anxiety • They should aim for a process of self-discovery and acceptance • Self-actualization is the tendency to strive to become all one is capable of being • Often, a distorted self-concept leads to anxiety in facing an insurmountable task • This will bridle the authentic self • People hurt others when they feel they must choose between what the others want and their authentic selves • This theory led to client-centered therapy or person-centered therapy • Strengths: • Focus on conscious experience, self-discovery and self-acceptance • Brought about concepts of free choice, inherent goodness, personal responsibility and authenticity • Weaknesses: • Not scientific • Often yields circular explanations for behavior Cognitive Models • Cognitive theory studies the thoughts, beliefs, expectations and attitudes that accompany/underlie behavior • Major names include Albert Ellis and Aaron Beck • It often uses computer-related metaphors for information processing: • Storage • Memory • Manipulation • Retrieval • Output • Abnormal behavior is a result of a glitch in the information processing called a cognitive distortion • Similar to what was said above, social-cognitive theorists focus on the way social information is encoded • Ellis emphasized that troubling events themselves do not lead to being disturbed, but rather how they are perceived and interpreted. He called it the ABC approach: • Activating event = Belief = Consequences • Ellis used Rational Emotive Behavior Therapy (REBT) to help his clients • It would dissect peopleʼs beliefs and allow them to realize which ones are maladaptive, or incorrect • Beck believed there were four basic types of cognitive distortions: • Selective abstraction - focusing exclusively on the negative parts of an experience • Overgeneralization - taking a few isolated experiences as indications of a greater rule • Magnification - blowing an event out of proportion • Absolutist thinking - looking at the world in black and white • Beckʼs model of therapy is called cognitive therapy • Eventually it merged with learning therapy to make the popular therapy of today, cognitive-behavioral therapy (CBT) • Itʼs especially effective against emotional disorders, like anxiety and depression The Sociocultural Perspective (p. 60-63) • This perspective takes society into account • Some, like Thomas Szasz, take it to such an extreme, they argue that there is no such thing as abnormal behavior, and rather itʼs just a societal condemnation of deviating from the norm • Everyone agrees that SES should be taken into account • Along these lines, traditionally disadvantaged groups (blacks and Hispanics) have as many incidents of psychological disorder as whites, but they usually last much longer because they go improperly treated • Native Americans have the highest rate of mental disorder • Asians show lower rates • People from lower incomes tend to be institutionalized more. But this is a controversial fact. There are two explanations: • Social causation model: social stressors like poverty bring about more severe psychological disorders • Downward drift hypothesis: psychological disorders lead to SES plummeting • Some data lean in favor of the social causation model The Biopsychosocial Perspective (p. 63-66) • The diathesis-stress model combines all the other perspectives • People have diatheses, or vulnerabilities, which activate once stressors reach a certain threshold • A diathesis can be biological, like genetics, or psychological, like personality or cognitive beliefs • The complexity of this model is both its strength and weakness Chapter 3: Classification and Assessment of Abnormal Behavior How Are Abnormal Behavior Patterns Classified? (p. 70-77) • In the 19th century, Emil Kraepelin began developing a comprehensive model of classification • In 1952, the American Psychiatric Association continued his work with the Diagnostic and Statistical Manual of Mental Disorders (DSM) • By now itʼs up to the DSM IV-TR (text revision) • The World Health Organization has its own version called the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) which is mainly used for compiling statistics • But itʼs made to be compatible with the DSM • Because itʼs based off of the medical model, abnormal behavior is classified as “mental disorders”, involving: • Emotional distress • Significantly impaired functioning • Behavior that places people at risk • The DSM is descriptive, not explanatory. Itʼs used only to diagnose • It is comprised of five axes: • Axis I: clinical disorders and other conditions that may be a focus of clinical attention • These are the clinical syndromes which are not permanent, and therefore treatable • Ex. Mood disorders, anxiety disorders, etc. • It also includes other conditions that may be a focus of clinical attention • Ex. Academic, vocational or social problems, psychological factors which will affect medical conditions • Axis II: personality disorders and mental retardation • These are enduring and rigid patterns of maladaptive behavior that are generally considered beyond treatment • They can undergo therapy to minimize their effects, however • Axis III: general medical conditions • Only the ones useful for the understanding/treatment of the mental disorder • Axis IV: psychosocial and environmental problems • These are potential stressors • Ex. Problems with primary support group, social environment, education, occupation, housing, economic status, access to services, etc. • Axis V: Global Assessment of Functioning (GAF) • This is a subjective rating of the current level of independent functioning • Some clinicians also take the potential GAF to set a goal to aim for • Thereʼs also a childrenʼs GAF (CGAF) • Culture-bound syndromes occur in some cultures, but are rare in others. For example: • TKS: an Asian excessive fear of offending others • Anorexia and dissociative identity disorder • See table 3.6 on page 76 for other examples • Strengths: • Classification is the core of science • It makes a shorthand to allow professionals to communicate more efficiently • It organizes research • Allows multiple diagnoses • Insurances use it as a reference guide • It helps identify populations with similar patterns of abnormal behavior • It is both very reliable and valid • It even usually has predictive validity • Its greatest advantage is its designation of specific diagnostic criteria, and ways to identify them • The multiaxal system integrates many different spheres of information and paints a full picture of the patient • Weaknesses: • It relies very strongly on the medical model • The validity of axes II and V have been questioned • Some feel it should be more sensitive to diversity • But the latest edition has placed a greater emphasis • Despite the way itʼs used as the bible of defining mental health, itʼs still in need of tweaking • Itʼs too focused on the binary of “disorder” and not the many shades of gray which may exist • For example, anxiety and depression are normal emotions taken to an extreme, yet the medicalized DSM gives off the impression of a disease to be totally abolished • It may promote sanism Standards of Assessment (p. 77-80) • Reliability: the extent to which a test yields consistent results • Internal consistency - the different parts of the test yield consistent results • Test-retest reliability - if the test is administered again to the same person, it will yield the same results • Interrater reliability - different raters yield similar results • Validity: the extent to which the test is identifying what itʼs aiming to • Content validity - the test represents the behaviors associated with what itʼs testing for • Ex. A depression test asks “how often are you sad?” • Criterion validity - the test correlates with other criteria and standards which identify what itʼs testing for • Ex. A depression test is verified by other tests which test for it • Predictive validity - the test predicts what will happen in terms of what itʼs testing for • Ex. A positive on a depression test can be treated with regular therapies for depression • Construct validity - the test corresponds to the theoretical models • Ex. Depression is tested according to accepted methods like self-report and physiological detection • Sensitivity vs. Specificity • A test should be sensitive enough to detect what itʼs testing for, so as not to produce false negatives • It should also be specific enough that it wonʼt over-diagnose, producing false positives Methods of Assessment (p. 80-99) Clinical Interview • Most cover these topics: • Identifying data • Description of presenting problems • Psychosocial history • Medical/psychiatric history • Medical problems/medication • They take a range of formats, which could be unstructured, semi-structured and structured • The more structured, the more exact and reliable the diagnosis • The more unstructured, the more room for personalizing the interview to expand on relevant issues • There is a shift towards computerizing the initial interview because it covers the same points, and people will reveal more about themselves to a non-judgemental screen • But at the same time, they may be too structured, and lack the human touch • And sometimes, they yield misleading findings Psychological tests • These are usually standardized on large numbers of subjects • They are on par with many medical tests in their predictive ability • Intelligence tests • They began with Binet in the early 20th century to help identify children who needed special help • Eventually it was co-opted by Stanford to make the Stanford-Binet Intelligence Scale, a scale still widely used • It yields an IQ score which is standardized at 100, with a standard deviation of 15 • This means that 68% fall within 1 SD, 95% within 2 and 99% within 3 • Thereʼs also the Weschler scales • Theyʼre divided into the Weschler Adult Intelligence Scale (WAIS), the Weschler Intelligence Scale for Children (WISC) and the Weschler Preschool Primary Scale of Intelligence (WPPSI) • Itʼs most used because it divides its results into subscales as well (see diagram) Objective Tests • These are self-report personality tests that can be scored objectively and are based on research and immense standardization • Theyʼre objective in the sense that they limit the range of possible responses and can therefore be scored objectively • Minnesota Multiphasic Personality Inventory (MMPI-2) • Consists of 500 T-F statements • Widely used personality test • Its success comes from its standardization, because it doesnʼt always have content validity • It includes many scales, including a validity scale to measure the participantʼs honesty, and content scales to measure specific complaints • It also has various clinical scales (see chart) • The scales are regarded as a part of a continuum of personality trait (making up for one of the criticisms of the DSM) • The MMPI profiles can also be used to help with diagnosis • Millon Clinical Multiaxial Inventory (MCMI) • This was developed specifically to test for DSM disorders, especially along Axis II • Strengths: • Easy to administer • Very reliable • Quantifies and reveals new information • Weaknesses: • Ultimately, still self-report and ultimately subjective • Tells little about motives • Limited to high functioning individuals Projective Tests • These psychodynamically oriented tests use indirect methods of assessment to circumvent ego defenses by having patients project onto vague images • They have a few characteristics: • Unstructured • Open direction • Involves free interpretation • Free response style • Rorscharch Test • Peopleʼs “percepts” influence what they see • Useful for reality testing, or seeing how in touch people are with reality • This is the only time Dr Isaacs ever got any use out of the test • Thematic Apperception Test (TAT) • Henry Murray came up with this test where subjects would interpret an ambiguous picture • Theoretically, their cognitive structures and relevant past experiences would affect the interpretation in a way that can be analyzed • Also, according to psychodynamics, people identify with the protagonist, so the story in the picture is always biographical • Strengths: • Could reveal new information • Some find it on par with the MMPI, at least for axes I and II • Circumvents tendency to offer socially desirable responses • Weaknesses: • May not work (zero validity) • Horribly unreliable • Acklin tried improving it, but then it became horribly complicated and time- consuming • Its strengths can be brought about in other, easier ways • The TAT picture itself may serve as a prime • If itʼs painted in sad colors, of course the interpretation will be sad Neuropsychological Assessment • Measurement of behavior/performance that may be indicative of brain damage • Bender Visual Motor Gestalt Test • Now in its second version, the Bender-Gestalt II • Geometric figures illustrate that illustrate various Gestalt principles must be memorized and copied • It tests for spacial perception • Halstead-Reitan Neurppsychological Battery • Measures perceptual, intellectual and motor sklls • Itʼs divided into subtests: • Category Test: measures abstract thinking ability, by identifying how different stimuli relate • Activates the frontal lobe of the cerebral cortex • Rhythm Test: measures concentration and attention by identifying whether different beat-pairs in tape recordings are the same or different • Activates right temporal lobe of the cerebral cortex • Tactual Performance Test: measures visual memory by having the blindfolded subject fit wooden blocks into corresponding holes Behavioral Assessment • This method focuses on the objective recording and description of problem behavior • Functional analysis: breaking down problem behavior to its antecedents and results • Behavioral interview: posing questions to perform a functional analysis • Direct observation: done in real life or simulated environment • Limits of observation: • Somewhat unreliable • Observer drift: the tendency for observers to deviate from coding system as time elapses • May show response bias • Reactivity: the tendency of the response to be influenced by the method of observation • But self-monitoring is very accurate • Self-monitoring: clients are the ones who assess the problem behavior, as itʼs naturally occurring. • Done in a few formats: • Behavioral diary • Through a PDA which sends out reminders • May actually improve certain desirable but low-frequency behaviors • Limits of self-monitoring: • Clients may be unreliable, sloppy or embarrassed • Clinicians may need to separately corroborate it • Analogue measures: simulating settings in which a behavior occurs • Ex. Role playing, etc. • Behavioral Approach Task (BAT) is a common therapy for phobias • Behavioral Rating Scale: a checklist that provides information about the frequency, intensity and range of problem behaviors • A popular one is the Child Behavior Checklist (CBCL) Cognitive Assessment • Measures thoughts, beliefs and attitudes which may lead to emotional and behavioral problems • Often involves a “thought diary” • A popular one is Aaron Beckʼs “Daily Record of Dysfunctional Thoughts” where each time the client experiences a negative emotion they should write: 1. The situation in which it occurred 2. The automatic thoughts which took place 3. The category of disordered thinking 4. The rational response 5. The emotional outcome • The Automatic Thoughts Questionnaire has clients rate the frequency of different cognitions • Sorted into four factors: 1. Personal maladjustment and desire for change 2. Negative self-concept and expectations 3. Low self-esteem 4. Helplessness • Identifies depression • The Dysfunctional Attitudes Scale (DAS) measures a 1-7 set of stable underlying attitudes associated with depression • Behaviorists object to cognitive techniques Physiological Measurement • Probes: • Electrodermal response/galvanic skin response (GSR): measures sweat • Electroencephalograph (EEG): measures brain waves • Electromyograph (EMG): monitors muscle tension • Brain imaging: • EEG • May be used to detect abnormal functioning and even tumors • Computed axial tomography (CAT) scan: targeted X-ray • Reveals abnormality in shape and structure • Because it takes the picture from many angles, it can make a 3-D image of the brain • Positron emission tomography (PET) scan: uses positrons, a radioactive tracer, in bloodstream to detect neuron activities based on how much blood it needs • Detects schizophrenia • Magnetic resonance imaging (MRI): uses radio waves instead of X rays • Also reveals abnormality in shape and structure • Ex. Schizophrenia and OCD • fMRI: works like a video to watch brain areas activate • Brain electrical activity mapping (BEAM): sophisticated type of EEG Sociocultural and Ethnic Factors in Assessment (p. 99-100) • We need to be conscious of the fact that assessment techniques in one culture are not always reliable or valid in another • The Chinese version of the Beck Depression Inventory works, but not the Chinese MMPI • But there is no cultural bias in the MMPI within America Chapter 4: Methods of Treatment • There are many types of helping professionals. A partial list includes: • Clinical psychologist • Counseling psychologist • Psychiatrist • Clinical/psychiatric social worker • Psychoanalyst • Counselor • Psychiatric nurse • Many states donʼt have any standards for calling yourself a professional therapist Psychotherapy (p. 104-125) • Psychotherapy is defined by: • A systematic interaction between client and therapist • Drawing on psychological principles • Aiming to bring about changes in the clientʼs affect, behavior and cognitions • Can be used for abnormal behavior, problem solving or merely personal growth • Always a “talking therapy” • Skillful therapists are active, empathetic listeners as well • Often instills clients with a sense of hope Psychodynamic Therapy • Psychoanalysis is the Freudian method of psychoanalysis which uses psychodynamic therapy to help clients gain insight into unconscious conflicts and resolve them • Methods include: • Free association • Dream analysis to differentiate manifest content and latent content • This is especially difficult because symbols change from person to person • Freud believed that the repressed impulses heʼs trying to reveal make a compulsion to utter • But since itʼs so personal, clients usually display resistance • One of the analystʼs jobs is to monitor the dynamic conflict between the compulsion to utter and resistance • A two-way transference relationship also develops, for the analyst to monitor • In order to be prepared for countertransference, psychoanalysts are expected to undergo psychoanalysis themselves • Due to the expense, modern psychodynamic approaches are briefer, less intensive and less costly • They focus on the clientʼs present relationships • The client and therapist generally face each other, with more give-and-take than Freud would have had • But there still is interpretation • Heinz Hartmann calls it ego analysis • Margaret Mahler does object-relations psychodynamics: • It focuses on how people need to separate their own ideas and feelings from the foreign ones they have introjected from others • 45% of psychologists report using psychodynamic techniques along with others Behavior Therapy • Behavior Therapy is the systematic application of learning theory to treat disorders • Itʼs relatively brief • Very effective against phobias, with systematic desensitization • It progresses from imaginary to real an distance to proximity through the method of gradual exposure • It runs along the fear-stimulus herarchy • Modeling is also an effective method • Token economies use the laws of operant conditioning to use secondary reinforcements as rewards for desired behaviors • Works especially in institutions and with disorderly children Humanistic Therapy • Humanistic therapists focus on clientsʼ subjective, conscious experiences • A goal of theirs is to expand clientsʼ self-insight • They champion person-centered therapy, where a warm, accepting therapeutic relationship frees clients to engage in self-exploration to achieve self-acceptance • Also referred to as client-centered therapy or Rogerian therapy • Carl Rogers emphasized that people have natural tendencies to self-knowledge and growth, and that only a misplaced need for social approval can mask that up • At worst, it can even lead to a distorted self-concept • Well-adjusted people, on the other hand, are able to take actions consistent with who they are • As such, the goal of a therapist is not to impose a framework, but rather to let the client figure out what theirs it • Hence, “client-centered” • The therapy is nondirective, with the client taking the lead for directing the course • To enable this, the therapist reflects, or rephrases, what the client is saying without any judgement • An effective humanist therapist has four qualities: 1. Unconditional positive regard: the expression of unconditional acceptance of another personʼs basic worth as a person 2. Empathy: the ability to understand someone elseʼs perspective 3. Genuineness: the ability to recognize and express oneʼs feelings 4. Congruence: the fit between oneʼs thoughts/feelings and behavior Cognitive Therapy • Cognitive therapy helps clients identify and correct faulty cognitions believed to underlie emotional problems and maladaptive behavior • Ellisʼs rational emotive behavior therapy (REBT) has the therapist actively disputing clientsʼ irrational beliefs and the premises on which they lie • It often involves behavioral homework assignments to bring the cognitions into practice • It also could involve role play to accomplish that goal • Beckʼs cognitive therapy is similar to Ellisʼs in that it aims to correct cognitive distortions • It also involves behavioral homework assignments • Another homework is reality testing where clients test their negative beliefs in light of reality • Less confrontational than REBT Cognitive-Behavioral Therapy • Cognitive-behavioral therapy (CBT) is a learning-based approach which incorporates both cognitive and behavioral techniques, depending on the situation • Most therapists identify with this method See table 4.2 on p 115 for a summary Eclectic Therapy • Eclectic therapy approaches psychotherapy with techniques from various theories • The majority of therapists identify as using eclectic therapies rather than one orientation • Especially those with more experience • Technical eclectics believe in tailoring the therapeutic experience to each client by using the techniques best suited for them • Integrative eclectics actively try to synthesize the different theories Group, Family and Couple Therapy • Group therapy • Itʼs less costly • Sometimes itʼs more effective if the clients have similar problems • At the same time, clients may feel uncomfortable disclosing their problems to a group • Family therapy • It looks at the family, not the individual, as the unit of treatment • Emphasizes communicaion • Helps ease familyʼs way through transitional points • Adopts a systems approach to understanding the family by seeing problem behaviors as a breakdown of the system, not the individual • Couple therapy • Similar to family therapy Evaluating Psychotherapy • Strengths: • It has strong support from research literature • The greatest gains take place in the first several months of treatment • Different forms of therapy all yield similar results because they all have nonspecific treatment factors like: • Active listening and empathy that alone are therapeutic • Often just the idea of therapy makes for a placebo effect of change • The therapeutic alliance • The working alliance • Ultimately, itʼs best to tailor the therapy based on the client and problem • Weaknesses: • Some therapies just arenʼt empirically supported to do anything special besides for the nonspecific treatment factors (see Table 4.3 for examples of ones that are) • These days, because of managed care systems, where health care companies impose limits on treatment, therapy must tailor itself to cost as well Multicultural Issues in Psychotherapy • Therapists should be sensitive to cultural differences and have accurate knowledge about them • Obviously, stereotyping is also out of the question • Multicultural competence is perceived as empathy and general competence • Blacks • It must be recognized that they face the most extreme racial discrimination • Some even internalize them • Tend to minimize vulnerability by being less self-disclosing • Marked by strong kinship bonds, even with those not biologically related • Strong religious/spiritual orientation • Distribution of child-care responsibilities • Asians • Difficult because they value restraint • Often somaticize psychological problems by expressing them in terms of physical symptoms • But this may just be a difference in communication style • Hispanics • Marked by adherence to a strong patriarchal family structure with strong kinship ties • Strongly value interdependency within family • Therapists should be trained to work within this community in particular because itʼs structured so differently • Native Americans • Tribal culture is still present Biomedical Therapies (p. 126-130) • This uses biological methods to help the patient • Often through the use of psychopharmacology since psychosurgery has been all but eliminated • The major classes of psychiatric drugs are antianxiety, antipsichotic and antidepressant • Antianxiety drugs combat anxiety and reduce states of muscle tension. • They include: • Mild tranquilizers, like Valium and Xanax • Hypnotic-sedatives, like Halcion and Dalmane • They depress the level of activity in the CNS, which decreases the activity of the sympathetic nervous system • Mild tranquilizers grew in popularity because psychiatrists grew concerned about the more potent depressants • But itʼs still potentially fatal when combined with alcohol • Side effects include: • Fatigue • Drowsiness • Impaired motor function • Drug tolerance • Addiction, followed by rebound anxiety when a person gets off it • Antipsychotic drugs are used to treat schizophrenia and other psychotic disorders • They include: • Thorazine and Prolixin which block dopamine action • Clozaril, if the other ones donʼt work • But it has potentially dangerous side effects • Their introduction in the 1950ʼs was one of the major factors that led to deinstitutionalization • Side effects include: • Motor issues which may be handled by other drugs • Tardive dyskinesia, a potentially irreversible and disabling motor disorder • Antidepressants affect the availablility of neurotransmitters in the brain • They include: • Tricyclics (TCA) and monoamine oxidase inhibitors (MAOI) which increase the availability of norepinephrine and serotonin, like Tofranil, Elavil. Sinequan and Nardil • TCAs are preferable because they cause fewer side effects • More than half of patients respond favorably • Selective serotonin-reuptake inhibitors (SSRI) specifically target serotonin, like Prozac and Zoloft • Overall response is modest at best, with full remission at 30% • No antidepressant works particularly better than others • They can treat a wide variety of disorders • Antimaniac drugs, like Lithium carbonate, helps stabilize dramatic mood swings • Electroconvulsive therapy (ECT) uses targeted shocks to the head to “reboot” the brain • Helps those with extreme depression • Controversial because: • Shocks seem cruel • Carries potential side effects, like memory loss • May not be more effective than strong antidepressants • We donʼt know why it works • It has a high relapse rate • Psychosurgery is rarely practiced today • Frontal lobotomies were popular • Now, in cases of last resort, targeted surgery is used to relieve extreme cases of OCD, bipolar disorder and depression • Strengths: • Could be very effective in getting somebody in a state to begin therapy • It has helped many people in ways therapy possibly could not • Weaknesses: • Itʼs tough to say whether drug therapy is conducive to working with psychotherapy • It may reduce the urgency of getting better • Itʼs tough to say whether the coping methods will work after the drugs are worn off • Some drugs may be as effective as psychotherapy, with no side effects • MDs have been blamed for being too quick to prescribe • They often feel pressured to do so Hospitalization and Community-Based Care • State mental hospitals care for people with severe psychological problems • Municipal/community-based hospitals focus more on short-term care for people with serious problems • Hospitalization may be followed by outpatient treatment • Todayʼs hospitals focus on deinstitutionalization, a policy shifting care away from the state hospital towards the community-based care • They aim their treatment at preparing residents to return to community living • They provide structure which is necessary for many • Community mental health centers (CMHCs) primarily function to help discharged mental patients adjust through therapy and consultative services. They can be: • Day hospitals • Halfway houses • Shelters • The Institute of Medicine divided up disorder into three parts: prevention, treatment and maintenance (see diagram on p 132) • Primary prevention efforts are designed to prevent problems from occurring in the general public or “at risk” groups. Ex. Sending in a social worker to a low-income public school • Secondary prevention efforts target specific people with developing problems. Ex. That social worker calls in a child from a one-parent home to discuss positive ways to cope • Minorities typically have less access to mental health care due to: 1. Cultural mistrust: they donʼt think the therapistʼs on their side 2. Institutional barriers 3. Cultural barriers: Latinos generally turn to friends and family for help, not professionals 4. Language barriers 5. Economic and accessibility barriers • Blacks are more likely to be admitted to a mental hospital • But at the same time, deinstitutionalization still has a long way to go • It often ends with just dumping the psychotic onto the streets with no support system or available housing to catch them • 1/3 of all homeless adults have psychological disorders • Thereʼs no integrated effort among the different groups of healthcare workers • Homeless typically do not seek out mental health services • While some CMHCs show promise, others are found lacking Chapter 5: Stress, Psychological Factors, and Health Adjustment Disorders (p. 141-143) • Health psychologists study the role of psychological factors in physical illness • Stress is a demand made on an organism to adapt or adjust which originates from a stressor • Adjustment disorders are maladaptive reactions to an identified stressor which occurs within a few months of the onset of the stressor • These are among the mildest of psychological disorders • Itʼs a catch-all disorder for any reaction which comes with significant impaired functionality or emotional distress • But at the same time, it cannot be sufficient enough to meet other clinical syndromes • And while it must start soon after a disorder, it must also subside within 6 months • Resolved by taking the stressor away, or learning to deal with it • 5 to 20% of people receiving outpatient mental health services present an adjustment disorder Diagnostic criteria: 1. Behavioral or emotional symptoms must develop in response to an identifiable event(s) & occur within 3 months of the onset of that event(s) / stressor(s). 2. These behaviors or symptoms must be clinically significant as evidenced by at least 1 of the following: 1. After exposure to the event(s) / stressor(s), the behavioral or emotional symptoms seem in excess of what would be normally expected. 2. Significant impairment in social or occupational (academic) functioning. 3. The disturbance does not meet the criteria for another specific Axis I disorder or is not part of a preexisting Axis I or Axis II disorder. 4. The behavioral or emotional symptoms do not represent Bereavement. 5. Once the stressor (or its consequences) has terminated , the symptoms do not last more than an additional six months. • There are also different levels of adjustment disorder: • Acute: symptoms last less than 6 months • Chronic: symptoms last more than 6 months • By definition, acute anxiety disorder may not last more than 6 months, but it may be in response to a chronic stressor • Also, see associated subtypes below Chapter 6: Anxiety Disorder Overview of Anxiety Disorders (p. 171-172) • Anxiety is a generalized state of apprehension or foreboding. It effects a few areas: • Physical - jumpiness, shortness of breath, nausea, etc • Behavioral - avoidance behavior, clinging behavior • Cognitive - worry, dread, fear, nervousness • Sometimes, anxiety disorders will overlap • Until 1980, they were referred to as “neuroses” because people thought to have resulted from the nervous system Panic Disorder (p. 172 - 179) • Panic disorder is a type of anxiety disorder characterized by repeated episodes of intense anxiety or fear • There is a stronger bodily component to panic attacks than to other forms of anxiety disorder • Itʼs usually accompanied by thoughts of losing control, going crazy, or dying • People can even think theyʼre having a heart attack • Diagnostic criteria for a panic attack are listed to the right. People must experience at least four criteria within ten minutes of onset • It often goes hand in hand with agoraphobia • But not all panic attacks are signs of a panic disorder - 10% of people may experience an isolated attack in a year. For it to be diagnosable, the following must be satisfied: • At least a month of persistent attacks • Worry about consequences of attack • Significant change in behavior Theoretical Etiology • See Appendix for summary • The prevailing view of panic disorder reflects a combination of misattributions (cognitive) and physiological (biological) factors • People feel a small physiological change, and work themselves up into a full panic attack • Eventually, they get in the habit of such attacks, and it turns into a full blown disorder • Biological factors: • Genetics come into play • Possibly from a sensitive alarm system involving the limbic system and frontal lobe • Donald Klein termed it the suffocation false alarm theory where a defect in the brainʼs respiratory alarm system triggers a false alarm in response to minor cues of suffocation • This specific theory has mixed support • Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter which may be lowered in anxious people • Benzodiadepines like Valium and Xanax aim to make GABA receptors more receptive • Serotonin plays a significant role as well • Cognitive factors: • Anxiety sensitivity (AS) magnifies fear reactions to cues of body arousal • Asian and Hispanic students report higher levels of AS, but not proportionally equal levels of panic attacks • CBT aims to discount AS • The fact that panic attacks sometimes come out of the blue is evidence for a biological explanation • But that said, it very well may be an interplay between the two factors Treatment Approaches • Most treatment stems from a combination of drug therapy and CBT • Drug therapy: • Antidepressants aim to normalize neurotransmitters in the brain: • Tricyclics: Tofranil (imipramine) and Anafranil (clomipramine) • SSRIs: Paxil (paroxetine) and Zoloft (sertraline) • But they come with side effects, like heavy sweating and ironically, heart palpitations • The high-potency antianxiety drug Xanax (alprazolam) is a benzodiazepine • CBT: • Breathing retraining exercises • A medical examination to show the patient that they have no relevant health issues • CBT produces as good short-term results, and better long-term results • Development of coping responses • Exposure • Self-monitoring Phobic Disorders (p. 179-193) • A phobia is an excessive, irrational fear of a specific stimulus • Different types of phobias appear at different ages (see table) • Women are twice as likely as men to develop phobias • Specific phobias are persistent, excessive fears of a specific object or situation • They are the most common psychological disorder, affecting 9% of the population at some point • People with specific phobias are often aware of its irrationality • Social phobia is an excessive fear of social situations • The underlying problem is an excessive fear of evaluation from others • This is different from other phobias which can be for any reason at all • Itʼs associated with the diathesis-stress model, with childhood shyness as a particular indicator • It can last up about 16 years on average • Despite the fact that it first creeps up at about 15, people usually donʼt receive help until 27 • Agoraphobia is a fear of open spaces • Itʼs often a result of a panic disorder, but not necessarily • Panic disorder-agoraphobia affects 1.1% of the population at some point • But there is only a .17% lifetime prevalence of agoraphobia without panic disorder Theoretical Etiology • See Appendix for summary • Psychodynamic: anxiety is a danger signal that threatening impulses of a sexual or aggressive nature are nearing the level of awareness • Learning: O Herbert Mowrerʼs two-factor model incorporates both classical and operant conditioning into his theory • People begin with an avoidance of an object and receive negative reinforcement when they avoid anything associated with it • Then they become classically conditioned to fear it more through more reinforcement, and it continues until fully-realized phobia • Also, observational learning can come into play here • Biological: • Genetic predisposition • Over-active amygdala, and under-active pre-frontal cortex to quiet it down • There is also a belief that people are subject to prepared conditioning, where evolution favored certain fears, like snakes • Cognitive: Albert Ellis says that fearful people display more irrational beliefs than do nonfearful • Oversensitivity to threatening cues • Overprediction of danger/potential discomfort • Self-defeating thoughts and irrational beliefs Treatment Approaches • Psychoanalysis: awareness of how fears symbolize inner conflict • Learning: • Systematic desensitization - • Developed by Joseph Wolpe • Client learns relaxation technique • Client and therapist develop fear-stimulus herarchy • Client works along it with the help of therapist • Gradual exposure - imagined or in vivo exposure which involves experiencing and overcoming fear along the fear-stimulus hierarchy • The treatment of choice • Flooding - hardcore exposure therapy through exposure to high levels of fear- inducing stimuli • Virtual reality therapy is a new technology being used to perform these exposure therapies • Cognitive: • Ellis and others aimed to identify and correct dysfunctional or distorted beliefs • CT outperformed Prozac and self-administered exposure training • Cognitive restructuring is when the therapist helps the client pinpoint self- defeating thoughts and generate rational alternatives they can use to cope with anxiety-provoking situations • Drugs: • Zoloft and Paxil are the drugs of choice • Sometimes theyʼre used in concert with exposure therapy Obsessive-Compulsive Disorder (p. 194-198) • OCD is a disorder characterized by recurrent obsessions and compulsions. Also, they: • Cause marked distress • Take up more than an hour a day • Impair functioning • Obsessions are intrusive and recurrent thoughts • Compulsions are repetitive, and often ritualistic behaviors • Usually, theyʼre either cleaning rituals or checking rituals • Often, theyʼre reactions to obsessions • People with OCD often recognize how excessive or irrational their concerns are • Between 2% and 3% of people have it • Equally in men and women Diagnostic criteria: • Either obsessions or compulsions • Obsessions are defined by: • Recurrent, persistent thoughts that are experienced, at some time during the disturbance, as intrusive, inappropriate & cause distress • the thoughts, impulses, or images are not simply excessive worries about real-life problems • the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action • the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind and not imposed from without • Compulsions are defined by: • repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly • the behaviors or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation • however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or are clearly excessive Etiology • Psychodynamic - leakage of unconscious impulses into consciousness, accompanied by actions which try to repress them • Biological • There is genetic evidence for OCD and tic disorders • The neurotransmitter glutamate is deficient in people with OCD • It may be connected to the “worry circuit” in the brain • As are the frontal lobes and basal ganglia • Psyc