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PSYCHOPATHOLOGY
DIAGNOSIS
AND
TREATMENT STRATEGIES
ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS
Disorder
Subtypes
Major Symptoms
Anxiety
disorders
Phobias
Intense, irrational fear of objectively nondangerous situations or things,
leading to disruptions of behavior.
Generalized anxiety
disorder
Excessive anxiety not focused on a specific situation or object; freefloating anxiety.
Panic disorder
Repeated attacks of intense fear involving physical symptoms such as
faintness, dizziness, and nausea.
Obsessive-compulsive
disorder
Persistent ideas or worries accompanied by ritualistic behaviors
performed to neutralize the anxiety-driven thoughts.
Conversion disorder
A loss of physical ability (e.g., sight, hearing) that is related to
psychological factors.
Hypochondriasis
Preoccupation with or belief that one has serious illness in the absence
of any physical evidence.
Somatization disorder
Wide variety of somatic complaints that occur over several years and
are not the result of a known physical disorder.
Pain disorder
Preoccupation with pain in the absence of physical reasons for the
pain.
Amnesia/fugue
Sudden, unexpected loss of memory, which may result in relocation
and the assumption of a new identity.
Dissociative identity
disorder (multiple
personality disorder)
Appearance within same person of two or more distinct identities, each
with a unique way of thinking and behaving.
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Somatoform
disorders
Dissociative
disorders
InRev15a
ANXIETY DISORDERS
 PANIC
DISORDER
 GENERALIZED ANXIETY DISORDER
 PHOBIAS
 OBSESSIVE-COMPULSIVE DISORDER
 POST-TRAUMATIC STRESS DISORDER
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PANIC DISORDER
Experience reoccurring episodes of anxiety
attacks; unpredictable;
some situations might become related to it.
Anxiety attack: 5 needed may last a couple of minutes to hours
heart palpitations
tense muscles, especially chest muscles often misinterpreted
for heart attack,
choking sensation from tight neck muscles,
faint or dizzy feeling,
increase sweat,
hot or cold flashes.
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GENERALIZED ANXIETY
DISORDER
Persistent level of anxiety lasting at least one month
Symptoms:
Motor: Tension of muscles: shakes, tremble,
unable to relax, twitch, startle easily
Autonomic hyperactivity: Sweat, increased heart
rate, cold hands, hot, cold flashes, light headed
and dizzy
Apprehension--worry constantly
Vigilance and scanning: hyperattentive to things in
the environment, distractible, hard to
concentrate, impatient, irritable.
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PHOBIA
Irrational fear response of
specific stimuli
SOCIAL PHOBIAS
AGORAPHOBIA
SPECIFIC PHOBIAS
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OBSESSIVE-COMPULSIVE
DISORDER
Marked by overt ritualistic
behavior and persistent
intruding thoughts
Occurs at a frequency so high
as to interfere with daily
functioning
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SOMATOFORM DISORDERS
HYPOCHONDRIASIS
CONVERSION
HYSTERIA
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HYPOCHONDRIASIS
Preoccupation with body and
illness
No relief if given healthy
diagnosis
Just as tense--travel and search
for new physicians
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CONVERSION DISORDER
Individual has dramatic physical symptoms with no organic cause.
1. Paralysis of legs/arms/ total
2. Anesthesia--lost sense of touch with parts of body
3. Analgesia--feel no pain
4. Other common experiences: nausea, lower back pain, dizziness,
hysterical blindness, deafness, unexplained headaches
5. Unusually INDIFFERENT to symptoms
6 .Secondary gain for having symptoms
7. May disappear while asleep or under hypnosis
8. Craft Paralysis: symptoms selective to job--paralyzed hands of
violinist or tennis player.
9. Symptoms make no common sense neurologically
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DISSOCIATIVE DISORDERS
DISSOCIATIVE
AMNESIA
DISSOCIATIVE FUGUE
DISSOCIATIVE IDENTITY
DISORDER
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DISSOCIATIVE AMNESIA
Memory for certain events from 1 hour to 3
months is lost
Person is not distressed by loss of memory-intellectual and skills still there.
Theorized as a loss of memory (repression) for
traumatic event
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DISSOCIATIVE FUGUE
Amnesia for entire life & self
Starts a new life in a new location
-called travelling amnesiac
Cause: extreme stress & need to flee
Can last for days, weeks, years.
Extremely rare except on Soaps!
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DISSOCIATIVE IDENTITY
DISORDER
Dominance of 2 or more distinct
personalities
Generally amnesic for existence of
others
Controversial Diagnosis
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Fig131
Precursors
Diathesis
Genetic
factors
Stress
Outcome
Poor selfunderstanding
Brain disease
Disorder (e.g.
schizophrenia)
Vulnerability
Early learning
experiences
Stressful family
dynamics
Bad family
dynamics
Social stresses
Diathesis Stress Model of Disorders
AFFECTIVE DISORDERS
 MAJOR
DEPRESSION
 DYSTHYMIC DISORDER
 BIPOLAR DISORDER
 CYCLOTHYMIC DISORDER
 SEASONAL AFFECTIVE DISORDER
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CLINICAL DEPRESSION
Emotions major disturbing problem but also problem in cognition (selfdefeating thoughts)
1. Dysphoric mood for a minimum of 2 weeks
plus 4 of following:
Change in appetite usually decrease
Change in sleep--insomnia or hypersomnia
Change in amount of psychomotor activity-slow or agitated
Fatigue or loss of energy
Feelings of worthlessness, self critical or inappropriate guilt
Poor concentration
Suicide or suicidal ideation
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BIPOLAR DISORDER
MANIC-DEPRESSION
Elevated mood-elation and mania alternating
with depressive thoughts
Mania:
inflated self esteem: too self confident
talkative w/flight of ideas
increased activity, interests, social
decreased need of sleep, distracted
concern that will harm selves
not judge consequences of actions
shopping spree--self destructive buying pattern
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INCIDENCE
OF
DEPRESSION
Major depression
Bipolar disorder
Fig147
80
70
60
50
Risk 40
30
20
10
Prevalence in
general population
Fraternal twins
Identical twins
Prevalence in
general population
Fraternal twins
Identical twins
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Creativity and Madness
Artists
Pa u l Ga u gu in ( SA) ,
Vince n t v a n G og h (H , S) ,
Ern st Lu d wig Ki rchner ( H, S) ,
Ed wa r d Lea r,
Miche la nge lo,
Ed va r d Meu n ch (H ) ,
Ge o r gia O 'Kee ff e (H ) ,
Ge o r ge R om ney ,
Da nte Ga b r ie l Ro ss et t i( SA)
Writers
Poets
Ha n s Chr is t ia n An d er sen
Willia m Fa u lk ner (H)
F. Scot t Fit zger ald (H ) ,
Erne stH em in gwa y (H, S) ,
Her ma nn Hess e (H , SA) ,
Hen r ik Ibs en
Henr y Ja me s
Willia m Jam es
Sa m u el Cle m en s ( Ma r kT wa in )
Jos ep h Co n ra d ( SA)
Ch a r les Di cken s
Isak Dine sen (SA )
Ral ph Wald o Eme r so n
Her m a n M elvill e
Eu gene O'Ne ill (H , SA)
Ma r y Sh elley
Rob ert Lo u is Ste ven so n
Leo Tols t o y
Tenne ss ee Wil liam s ( H)
Ma ry Wo llsto necr a ft ( SA)
Vir gi n ia Woolf ( H, S)
Willia m Blak e
Rob ert Burn s
Lo r d Byr o n
Sa m u el Tay lo r Col er id ge
Emil yD ickin so n
T.S. Eli o t (H)
Oli ve r Golds m it h
Ger a r d Ma n ley Hop kin s
Victo r Hu go
Sa m u el Jo hn so n
Jo hn Kea ts
Jam es Ru ss ell Lo well
Rob ert Lo well (H )
Ed n a S t . Vincen t Mill ay ( H)
Bo ri s Pa st ern ak ( H)
Sylv ia Plat h (H , S)
Ed ga r A lla n P o e ( SA)
Ezr a P o u nd ( H)
An ne Sex to n (H , S)
Pe r cy Byss he She lley ( SA)
Alf re d , Lor d Te n ny so n,
Dy la n Th om a s
Wa lt W h it ma n
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SCHIZOPHRENIA
 PARANOID
 CATATONIA
 DISORGANIZED
HEBEPHRENIA
 SIMPLE
 RESIDUAL
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22
15_05
Fig15_5
C
Max
Schizophrenic
behavior
A
Threshold
Challenging
events
Normal
behavior
D
B
Min
Low
Vulnerability
High
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PERSONALITY DISORDERS
ANTISOCIAL
AVOIDANT
BORDERLINE
DEPENDENT
HISTRIONIC
NARCISSISTIC
OBSESSIVE- PARANOID
COMPULSIVE
SCHIZOTYPAL
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Fig15_5
Type
Typical Features
Paranoid
Suspiciousness and distrust of others, all of whom are assumed to be hostile.
Schizoid
Detachment from social relationship; restricted range of emotion.
Schizotypal
Detachment from, and great discomfort in, social relationships; odd
perceptions, thoughts, beliefs, and behaviors.
Depedent
Helplessness; excessive need to betaken care of; submissive and clinging
behavior; difficulty in making decisions.
Obsessivecompulsive
Preoccupation with orderliness, perfection, and control.
Avoidant
Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism.
Histrionic
Excessive emotionality and preoccupation with being the center of attention;
emotional shallowness; overly dramatic behavior.
Narcissistic
Exaggerated ideas of self-importance and achievements; preoccupation with
fantasies of success; arrogance.
Borderline
Lack of stability in interpersonal relationships, self-image, and emotion;
impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal
gestures.
Antisocial
Shameless disregard for, and violation of, other people's rights.
Tab15_5
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DEVELOPMENTAL
DISORDERS
Autism
Academic Skills Disorder
Attention Deficit Disorder
w/hyperactivity
Senile Dementia
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TREATMENT
PSYCHOANALYSIS
BEHAVIOR
HUMANISTIC
COGNITIVE
BIOMEDICAL
SIGMUND FREUD
PSYCHOANALYSIS
Resistance
Catharsis
Transference
Interpretation
Insight
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DEINSTITUTIONALIZATION
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APPROACHES TO PSYCHOLOGICAL TREATMENT
Dim ens ion
Classical
Psychoanalytic
Contem porary
Psychodynam ic Phenom enological Behavioral
Nature of the human
being
Driven by sexua l and
aggressive urges
InRev16a
Therapist’s role
Neutral; help s client
explore mea ning of free
association s and other
material from the
unconscio us
Active; develops
Facilitates clien t’s growth;
relationsh ip with clien t as some therapists are
a model for other
active, some nondirective
relationsh ips
Teacher/trainer wh o
helps client replace
undesira ble though ts and
behavio rs; active, actionoriented
Time frame
Emphasizes un resolved
unconscio us conflicts
from the distant past
Understand ing the past,
but focusing on curre nt
relationsh ips
Current beha vior and
thoughts; may not need
to know origin al causes in
order to create chang e
Goals
Psychosexual ma turity
through insi ght;
strengthenin g of ego
functions
Correction of effects of
Expanded a wareness,
failures of early
fulfillment of potentia l;
attachment; develop ment self-acceptance
of satisfying intimate
relationsh ips
Changes in thinking an d
behavin g in particular
classes of situations;
better self-manage ment
Typical methods
Free association ; dream
analysis, ana lysis of
transference
Analysis of transference
and countertransferen ce
Systematic
desensitiza tion, modelin g,
assertiveness an d social
skills training, positive
reinforcement , aversive
condition ing, punish ment,
extinction, cognitive restructuring
Driven by the nee d for
human rela tionships
Has free will, choi ce, and
capacity for selfactualizatio n
Here and no w; focus on
immediate exp erience
Reflection-o riented
interviews de signed to
convey uncon ditional
positive rega rd, empathy,
congruence; exercises to
promote self-awa reness
A product of social
learning and condi tioning;
behaves on the b asis of
past experien ce
CARL ROGERS
CLIENT CENTERED
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HUMANISTIC THERAPY
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BASIC HUMAN
NEEDS
Need for
self-actualization
OTHERS'
RESPONSES
RESULT
Unconditional
positive regard
Self-actualization
SELF GUIDES
Self = ideals
Need for
positive regard
Conditional
positive regard
MENTAL HEALTH
EFFECTS
Sadness
Disappointment
Depression
Selfdiscrepancies
Self = oughts
Anxiety
Shame
Guilt
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ROLLO MAY
EXISTENTIAL THERAPY
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ALBERT BANDURA
MODELING
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BEHAVIOR AND COGNITIVE
SYSTEMATIC
DESENSITIZATION
FLOODING
IMPLOSIVE
AVERSION
MODELING
RATIONAL
EMOTIVE
ELLIS
STRESS
INNOCULATION
COGNITIVE --BECK
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BIOLOGICAL TREATMENTS FOR PSYCHOLOGICAL DISORDERS
M ethod
Typical
Disorde rs Treated
Possible Side Effects
M echanism of Action
InRev16b
Electroconvulsive
therapy (ECT)
Severe depression
Temporary confusion,
memory loss
Uncertain
Psychosurgery
Schizophrenia,
severe depression,
obsessivecompulsive
disorder
Listlessness,
overemotionality,
epilepsy
Uncertain
Psychoactive
drugs
Anxiety disorders,
depression,
obsessivecompulsive
disorder, mania,
schizophrenia
Variable, depending on
drug used: movement
disorders, physical
dependence
Alteration of
neurotransmitter
systems in the brain
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ELECTRO-CONVULSIVE
SHOCK TREATMENT (ECT)





Single most effective treatment for psychotic
depression
Used as treatment of last resort
Actual understanding of how it works is not
complete--disrupts electrical impulses of brain
Within two to four weeks many see profound mood
elevation
Side Effects include memory loss (usually short
term)
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PSYCHOSURGERY

PREFRONTAL LOBOTOMY
 Removal of brain tissue to relieve symptoms
 Pre-frontal lobotomy first used on gorillas and found to calm
aggression; applied to patients in mental institutions beginning in the
1950’s
 Often used on schizophrenics bringing flat affect
 Today smaller amount of tissue can be removed from specific areas
showing malfunction--cingulotomy
 Can be very effective at removing tumor and other tissue causing
abnormal behaviors
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BIOMEDICAL TREATMENTS
 Drug

Treatment Options:
Anti-Anxiety Xanax
 GABA
neurotransmitter
 Anti-Depressant
 Serotonin
drugs Prozac
and Norepinephrine
 Anti-Psychotic
drugs
Thorazine
 Dopamine
40
Average
untreated
person
Average
treated
person
Number
of
people
80% of
untreated
persons
No improvement
Outstanding
improvement
PSYCHOTHERAPY VS NONE
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