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Abnormal Psychology 2020 Exam 1
Defining Abnormality:
● Abnormal psychology is the study of abnormal behavior to describe or
explain abnormal patterns of functioning
● Abnormality has a subjective definition
● Often described by the 4 D’s
○ Deviance
○ Danger
○ Dysfunction
○ Distress
● Each has its own set of limitations
● Additional components
○ Loss of freedoms
○ Loss of genuine personal contact
○ Loss of connection with one’s self
Historical Perspectives
● Ancient views
○ Abnormal behavior was the work of evil spirits
○ Treatment: force demons out of the body using trephination or
exorcism
● Greek & Roman
○ Hippocrates
■ Illnesses had natural causes
■ Imbalance of the four humors
■ Wanted to correct underlying physical causes
● Middle Ages
○ Rejection of science in favor of religion
■ Abnormality is a conflict between good and evil
■ Subject to demonological treatments
● Loses favor at the end of the Middle Ages
● Renaissance
○ Johann Weyer
■ Believed mind is as susceptible to illness as the body
■ 1st physician to specialize in mental illness
● Increased care for the mentally ill either in private
home care or through religious shrines
○ Asylums
■ Increased recognition of mental health led to their creation

■ Good intentions initially but quickly got overcrowded and
many eventually became like prisons for the patients
● 19th Century
○ 1800
■ Treatment began to improve again
■ Advocacy for more moral treatment (Pinel, Tuke, Rush, and
Dix)
○ End of 19th century saw the reversal of these moral reforms
● Early 20th
○ Somatogenic perspective
■ Abnormal functioning has physical causes’
● Emil Kraeplin
● New biological discoveries
■ Biological approaches often didnt work and were unethical
● e
...
tooth extraction, lobotomy, eugenic sterilization\
■ More medications found in 1950s
○ Psychogenic perspective
■ Hypnotism
● Based on work of
○ Mesmer & mesmerism to treat disorders
○ Breuer
● Can create false memories as easily as it uncovers
real ones
■ Psychoanalysis
● Freud
● Unconscious psychological processes behind
abnormal behavior
● Techniques to uncover unconscious & increase
insight
● Current trends
○ Stigma around mental illnesses still exists
○ 1950’s- discovery of many psychotropic medications
■ Antipsychotics, antidepressants, antianxiety drugs
■ Led to deinstitutionalization & rise in outpatient care
○ Expansion of health insurance plans to cover psychotherapy
■ Outpatient psychotherapy offered in more settings
● e
...
community mental health centers
○ Increased emphasis on prevention
■ Correct social conditions that can contribute to mental illness

○

○

■ Target at-risk populations
More forms of mental health treatment for greater number of mental
health concerns
■ More theoretical perspectives
■ Specialized treatments
■ More than anxiety and depression considered
Increased sensitivity to cultural differences
■ More attention to how aspects of one’s identity can
contribute to their behavior and treatment
Growth of telemental health
Influence of social media

○
○
Clinical Diagnosis
● Diagnosis is a key step in treatment
○ Specific diagnoses lend themselves to certain treatments
● Sign vs
...
to
the category
■ Signs found through clinical observation & interview
● DSM-5
○ Emil Kraeplin
■ 1st modern classification system for abnormal behavior
○ Written by APA
○ Used in North America
○ More descriptive criteria
■ Both categorical and dimensional information
● Categorical: name of distinct category/diagnosis
● Dimensional: rating of symptom severity and level of
distress
○ Estimated the half the US population will qualify for at least one
diagnosis in their lifetime
■ Comorbidity-experiencing two or more disorders at the same
time
○ Recent changes
■ New disorders
● Bulimia, autistic disorders, PTSD, panic disorders, etc

■ Dropped multiaxial assessment system
■ New names for existing disorders
● Mental retardation = intellectual disability
● Manic-depressive disorder= bipolar disorder
● Multiple personality disorder= DID
● Hypochondriasis = illness anxiety disorder
● Dementia = neurocognitive disorder
○ Potential limitations
■ Normal grief reactions classified as depression
■ Anxiety about disease classified as somatic symptom
disorder
■ All forms of autism combined into autism spectrum disorder
■ Substance dependence and abuse combined into substance
use disorder
■ Common old-age forgetfulness diagnosed as mild
neurocognitive disorder
■ Might not reflect current gender or racial biases
Theories of Abnormality
● Oldest model by Freud at start of 20th century (Original Drive Theory)
○ Biologically-derived
○ Orderly progression of bodily preoccupations
■ Oral (birth-18 months)
■ Anal (18 months- 3 years)
■ Phallic (3-5 years)
● Later part of phase is oedipal
■ Latency (5-12 years)
■ Genital (12- adulthood)
○ Fixation
■ Seeking balance between gratification of desires and
appropriate frustration in caregiving
■ Fixation- failure to resolve developmental challenge, stuck at
particular phase
● Oral stage= depressive
● Anal stage= obsessional
● Phallic stage= hysterical
● Freud’s Structural Model
○ 3 unconscious forces
■ Id
● Instinctual needs

●
●
■ Ego
●
●
●
●

Pleasure principle
Entirely unconscious

Reality principle
Mediate id and superego
Repression defense mechanism
Ego defenses adaptive in childhood but maladaptive
later in life
■ Superego
● Morality principle
● Conscience
● Psychoanalytic techniques/ therapy
○ Help uncover past trauma & unconscious conflicts
■ Promote insight
○ Techniques
■ Free association
■ Interpretation
■ Catharsis
● Reliving past repressed feelings to resolve conflicts
● Have to achieve emotional insight as well as
intellectual insight
● Object Relations Traditions
○ Rejected freud’s biologism
○ Emphasis on early attachment figures
■ Introjects- internalized representations of the self
○ More focus on fostering emotional safety
■ Corrective emotional experience
● Self Psychology
○ Many problems that other theories don’t fully explain
○ Clients describe
■ Feelings of emptiness
■ Problems w/ narcissism and chronic need for validation
■ Problems in sense of self and self-esteem
○ Heinz kohut
■ Defenses protect from anxiety and help self-esteem stay
intact
■ Attachment figures idealized first, then gradually and
non-traumatically deidealized

● Cognitive-Behavioral Therapies
○ Focus on behaviors, thoughts
■ How they interplay and affect moods and feelings
○ Mental illness viewed as
■ Maladaptive behaviors
■ Dysfunctional thinking
● Both can be unlearned/ changed
○ Behavioral Dimension
■ Classical conditioning
● Phobias
■ Operant conditioning
● Substance use disorders
■ Behavioral extinction
○ Cognitive dimension
■ Distorted automatic thoughts and beliefs affect perceptions
of experiences and create patterns
■ ID dysfunctional thoughts
● Validity testing
● Cognitive reframing
○ Dysfunctional thoughts common in anxiety and
depression
■ Interplay between cognition and behavior
● Important for treatment paths
○ Strengths
■ Easily tested
■ Observable outcomes
■ Strong empirical support
○ Limitations
■ Superficial treatment gains possible
■ Narrow focus
Depression
● Americanization of Mental Illness
○ Mental illness shaped by cultural norms
■ Cultures provide symptom repertoire
● How symptoms of an illness present
■ Cultural beliefs used to make sense of illness
○ America has exported our symptom repertoire to other countries
■ e
...
rapid spread of anorexia in Hong Kong in the mid 90s
after exposure to the American diagnosis

○ American conception of mental illness increases the stigma
■ Other cultures are much less individualistic
● The group is put before the individual
● Therefore the group stigmatizes the individual less
and is more inclined to help them
■ Individualistic culture
● The individual is responsible for taking care of their
mental illness
● Increases stigma, belief that it’s the individual’s “fault”
● Treat others more harshly when mental illness is
described as a disease
● Is Depression A Disease?
○ Yes
■ Antidepressant effectiveness
● Don’t work on those without depression
■ Reliably diagnosed w/ predictable course
■ Brain imaging studies show differences in those w/
depression and those without
● Low levels of serotonin
■ Times when depression has no discernible cause in life
circumstances
○ No
■ Diagnosis made by signs of pathophysiology rather than
behaviors
■ Caused by a spiritual problem/ problems in life
● Hopelessness
■ Medication as a band-aid
● Still have to solve behavioral problems
■ Ethical concerns
● Diagnostic criteria for Major Depressive Episode
○ 5 or more of the following during same 2 week period
■ Low/depressed mood
■ Diminished interest/pleasure in (almost) all activities
■ Changes in appetite and weight gain/loss
■ Insomnia/hypersomnia
■ Low energy/fatigue
■ Concentration difficulties

● Major Depressive Disorder
○ Criteria met for major depressive episode
○ No history of mania or hypomania
○ Specifiers
■ Depressive specifiers
● Mood congruent psychotic features
● Mood incongruent psychotic features
● Catatonia
● Seasonal patterns
■ w/ melancholic features
● 1 of following in most severe part of episode
○ Complete absence of capacity for pleasure
○ Lack of mood reactivity to stimuli
● 3 of following
○ Marked empty mood
○ Worse in morning
○ Early morning waking
○ Psychomotor agitation/retardation
○ Anorexia/weight loss
○ Excessive/inappropriate guilt
● Persistent Depressive Disorder
○ Depressed mood for most of the day, more days than not, for at
least 2 years
■ In children mood can be irritable and duration is at least 1
year
○ 2 or more of the following
■ Poor appetite/overeating
■ Insomnia/hypersomnia
■ Low energy/fatigue
■ Low self-esteem
■ Poor concentration/indecisiveness
● Issues in diagnosis
○ Grief vs Major Depression
■ In normal grief the source of pain/ mood is known or more
obvious
○ Need to rule out non-psychiatric biological causes of depression
■ Just because a person might have ample reason to be
depressed it doesn't mean their depression isn't organic
■ Physical and psychological illnesses often go hand-in-hand

■ Many disease exhibit depressive symptoms that are
associated with the illness
● Unipolar Depression Prevalence
○ 20% of all adults experience an episode at some point in their life
○ Average age of onset is 19
○ Rates of depression higher among poor than wealthy people
○ Hispanic americans and African americans are 50% more likely to
have recurrent episodes
○ Twice as likely in females than males
● Biological Models
○ Genetics
■ Family pedigree, twin studies
■ Gene studies
○ Biochemical
■ Low levels of neurotransmitters
● Serotonin
● Norepinephrine
■ Hypothalamic pituitary adrenal pathway tends to be overly
reactive in depressed people
● Causes excessive release of cortisol and relate
hormones
○ Brain Circuitry
■ Depression-related brian circuit
● Prefrontal cortex, hippocampus, amygdala, subgenual
cingulate
○ Operates abnormally in depressed people
○ Activity and blood flow unusually low and high
in other parts of prefrontal cortex
■ Undersized hippocampus and production of new neurons is
low
■ High activity and blood flow in amygdala
■ Problematic communication between structures
● Biological Treatments
○ Antidepressants
■ Monoamine oxidase inhibitors (MAOIs)
● Phenelzine
● Slows production of enzyme that degrades serotonin
and norepinephrine

● Have to avoid consumption of foods that have
tyramine which can elevate blood pressure (cheese,
wine, bananas)
■ Tricyclics
● Share a three-ring structure
● Act on neurotransmitter reuptake mechanisms
● Take time for improvements to go into effect
● High rate of relapse after stopping use
■ Second-Generation Antidepressants
○ Rival tricyclics in effectiveness and speed of
action
○ Fewer side effects
■ Weight gain
■ Drowsiness
■ Reduced libido
○ Target fewer neurotransmitters
● Selective Serotonin Reuptake Inhibitors (SSRIs)
○ e
...
prozac, zoloft, lexapro
○ Increase serotonin specifically, w/o affecting
other neurotransmitters
● Selective Norepinephrine Reuptake Inhibitors (SNRIs)
○ e
...
strattera
○ Increases norepinephrine activity only
● Serotonin-Norepinephrine Reuptake Inhibitor
○ e
...
effexor
○ Brain Stimulation
■ Electroconvulsive Therapy (ECT)
● Two electrodes pass 65-140 volts of electricity
through the brain for half a second or less
● Causes a brain seizure
● 6-12 treatments over 2-4 weeks
● Patients given strong muscle relaxants to minimize
convulsions and prevent broken bones
● Can be very effective and fast-acting
● 50-80% of patients show improvement
● Potential for memory loss and neurological damage
■ Vagus Nerve Stimulation
● Attempts to mimic ECT without the undesired trauma
● Pulse generator implanted under skin of chest

● Wire from pulse generator attached to vagus nerve
● 30 seconds of stimulation every 5 minutes
■ Transcranial Magnetic Stimulation
● Electromagnetic coil placed above patient’s head,
sending current to the prefrontal cortex
● Increases neuron activity
■ Deep Brain Stimulation
● In early stages of research
● Implant two electrodes into patient’s subgenual
cingulate, which are attached to battery in chest or
stomach and send stream of low volt electricity to
structure
● Designed to reduce activity in subgenual cingulate
and recalibrate depression brain circuit
● Psychodynamic Explanations for MDD
○ Major losses early in life may contribute
■ Unconscious grief over real or imagined loss
■ Struggle to accept actual loss of a loved one or symbolic
loss
● Loss of valued object unconsciously interpreted as
loss of loved one
○ Aims:
■ Make unconscious grief conscious
■ Facilitate grieving
○ Anaclitic vs
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pop
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6%
○ Molecular studies
■ Linked to abnormalities in number of chromosomes
Biochemical
○ Neurotransmitter activity
■ Overactivity or norepinephrine
■ Low serotonin activity
● Can lead to mood disorder
○ depression= low serotonin, low epinephrine

○ mania= low serotonin, high epinephrine
○ Ion activity
■ Relay messages w/in a neuron
■ Sodium ion channel makes inside of neuron positive
● Initiates electric charge that travels down neuron and
makes it fire
■ Irregularity in this ion transport can cause neurons to fire too
easily (mania) or resist firing (depression)
● Brain Structure
○ Hippocampus, basal ganglia, and cerebellum smaller
○ Smaller amount of gray matter in brain
● Treatment
○ Mood stabilizers
■ Lithium approved in 70s
● Rapid cycling doesn't typically respond
■ Anticonvulsants
● Fewer side effects, more effective
■ Some antipsychotics
○ Effectiveness
■ Over 60% with mania improve on stabilizers
■ Some effectiveness in resolving depressive episodes
■ Risk of relapse 28x higher if patient stops taking mood
stabilizers
■ May combine w/ antidepressants for bipolar depression
○ Mechanism
■ Not fully understood
■ Change synaptic activity
● Impact secondary messengers rather than primary
(antidepressants)
■ Increase health and functioning of neurons
■ Lithium increases size of hippocampus and amount of gray
matter
○ Psychotherapy
■ Increase medication compliance
● Psychoeducation helps
■ Improve social skills and interpersonal concerns
■ Resolve academic/occupational problems

■ Promote understanding of maladaptive behaviors and
cognitions
■ Suicide prevention
● Suicide
○ Prevalence
■ One of leading causes of death
● 1 million die of suicide every year
● 42,000 in US alone
● Many more attempts
○ 25 million attempts worldwide
○ Estimates low bc often not reported
■ Gender
● Women 3x more likely to attempt
● Men 3x more likely to die
○ More lethal means
■ Race/Ethnicity (US)
● Highest rate: Native Americans
● White Americans 2x higher than African, Hispanic,
and Asian Americans
■ Age
● Adolescents
○ Second leading cause of adolescent death
(19%)
○ LGBTQ teens 3x more likely to have suicidal
thoughts and attempts
○ Ratio of attempted to completed approx 100:1
■ Reflects ambivalence
● Elderly
○ Proportionately high rate of suicide
○ Time of numerous losses
○ Rate low in elderly Native Americans
■ High respect in community
○ Four Types of Suicidal Individuals
■ Death seeker
● Clear intent to take their lives
■ Death initiator
● Clear intent to take their lives but act out of belief
they’re just expediting the process
○ Elderly, terminally ill

■ Death ignorer
● Believe they are trading their lives for a happier
existence
■ Death darer
● Experience ambivalence about intent to die, which
manifests in the act itself
○ Subintentional deaths
■ People who play an indirect/unconscious part in own death
■ Drug and alcohol abuse
■ Self-harm
○ Risk Factors
■ Previous attempts
■ Acute stressors
● Divorce, natural disasters
■ Chronic stressors
● Serious illness
● Job stress
○ High rates of suicide in psychologists,
psychiatrists, healthcare professionals, police,
firefighters, lawyers
○ May be emotional strain of job or ongoing
struggle w/ mental illness that led to chosen
field
■ Abusive environment/trauma
■ Hopelessness
■ Substance use
■ Mental illness
● 70% of attempters had been experiencing severe
depression
● 20% alcohol use disorder
● 10% schizophrenia
■ Modeling
● Suicides of family, friends, or celebrities can trigger
○ Protective factors
■ Religious beliefs
● Sense of community
■ Social support
■ Availability of mental and physical care
■ Distress tolerance and emotional regulation skills

○ Intervention
■ Establishment of therapeutic rapport
● Genuine efforts to understand
■ Assess suicide potential
● Presence and frequency of ideation
● Do they have a plan?
○ Access to means
○ Level of lethality
○ Level of impulsivity
● Substance use
● Previous attempts
● Assess demotivators
○ Reasons to live
○ Reasons to die
■ Capitalize on ambivalence
■ Form Action/Safety Plan
● What can they do to keep themselves safe?
● Call support system
● Fosters sense of control
● Therapy and hotline
● Make environment safe
Anxiety Disorders
Fear vs anxiety:
● fear=response to imminent threat
● both can be adaptive
○ Fear- makes us aware of danger: fight or flight response
○ Anxiety: can be motivating
● Maladaptive
○ Too severe, interferes with daily life, impairment in functioning,
disproportionate to threat, too frequent, lasts too long, too easily triggered
Anxiety
● Most common mental disorder in us
● GAD
○ Generalized
○ Excessive worry
○ What if thinking
○ Not result of real life trauma
○ Worry is difficult to control/suppress

■ Sleep problems
○ Physical symptoms
■ Restless
■ Fatigue
■ Diminished concentration
■ Muscle tension
○ 3-6 symptoms to be diagnosed
○ Persist for ~6 months
○ Can be at any age
○ More diagnosed in women + white people
● Psychodynamic explanations
○ Children that suffer punishments for id impulses
■ Learns to regard id impulses as dangerous
○ Overprotected children
■ Shielded from all threats, don't develop ego defense mechanisms
○ Treatments aims
■ More accepting of id
■ Better coping
● Humanistic perspective
○ Conditional sense of worth
■ Denial of true thoughts/feelings
■ Threatening self judgment
○ Person centered therapy
■ Genuine acceptance
■ More accepting of self
● Cognitive behavioral
○ Problematic behavior + dysfunctional thinking
■ Too critical
■ Overestimate impending negative event
■ Underestimating ability to cope
● Cbt
○ Relaxations techniques
■ Meditation
■ Muscle relaxation
■ Breathing exercises
■ Grounding
○ Challenging maladaptive assumptions, decatastrophizing
■ Imagining worst outcome and deconstructing it

○ Confronting avoidance
■ Imagining exposure, in vivo exposure
■ Eliminating worry behaviors
● Anxious behaviors to prevent something bad from happening
○ Reassurance seeking
● Biological explanations
○ Neurochemical
■ 1950s discovery of benzos decrease anxiety
■ Receive GABA
○ Brain circuitry
■ Fear circuit v active
● Low GABA activity
● Prefrontal cortex, amygdala
● Pharma treatment
○ Benzos
■ Less addictive, less side effects, bind to receptor sites in fear circuit
increase GABA
■ Short-lived
■ Physical dependence
■ Bad interactions w alcohol + antideps
○ Antidepressants
■ Not as fast acting
■ Increase serotonin and norepinephrine
■ Improve function of fear circuit
Social Anxiety
● Severe, persistent, irrational
● Fear of being negatively evaluated
● Social situations provoke anxiety
● Lasts at least 6 months
● Causes avoidance of social situations
● High prevalence
○ Late childhood to early adolescence onset
● cog/behav exp
○ Dysfunctional beliefs
■ Unrealistic high social standards
■ Believe they're socially unskilled/ awkward
■ Believe behavior will have bad consequences
● Can be caused by low self-esteem
○ Behavioral

■ avoid/ perform safety behavior
● Rehearsal
● Heavy drinking
● Negatively reinforced
○ Treatment
■ antidepressants/ benzos
■ Cbt
● Reduced likelihood of relapse
● Reexamine maladaptive beliefs
○ Noticing and challenging them in the moment
● Exposure
○ Habituation
○ Shows that feared outcome doesn't happen
○ Gradual
● Social skills training
○ Model effective social behaviors + rehearsed
○ Positive reinforcement
Panic Disorder
● Discrete period of intense fear/ discomfort
● Symptoms can switch from one attack to the next
● Attack occurs at random
○ Trigger can be subconscious
● Third of all people experience an attack
○ 2 times more likely in women
● Symptoms different across cultures
● Biological perspective
○ Abnormal activity of norepinephrine in locus coeruleus
○ Hyperactivity of panic circuit
■ Amygdala, hippocampus, blah
■ Amygdala stimulated first
○ Antidepressants
■ ⅔ show improvement
● Psychological factors
○ Belief that physical symptoms are in some way harmful
○ derealization/ depersonalization
○ Source of symptom usually based on personal experience
○ Learned anxiety
● Cbt
○ Psychoeducation

■ Educate clients
■ Tendency to misinterpret symptoms
■ Symptoms are time-limited, won't continue to escalate
● Parasympathetic nervous system
○ Coping skills
■ Breathing skills/ relaxation training
○ Cognitive therapy directed at negative cognitions
○ Exposure
■ Interoceptive somatic cues
● Induce symptoms, apply new skills under supervision
● Simulation exercises
● Feelings are tolerable
■ In vivo exposure to agoraphobic situations
● Situations avoided bc of anticipation of panic
Phobias & OCD-related Disorders
Phobias & OCD
● Phobia
○ Irrational fear of an object or situation
■ Causes panic or anxiety
○ ~6 months
○ Different from everyday fears
■ Longer duration
■ Disrupts functioning
○ Prevalence
■ Height phobia most common
■ Often experience more than one phobia at a time
● 50% found to have 3 or more in lifetime
■ 2:1 ratio women to men
■ Occur out of fear of bodily harm/danger or revulsion/disgust
● Agoraphobia
○ Fear of public places where it's hard to escape
○ Severe cases=unable to leave home
○ Formerly diagnosed w/ panic disorder
○ 2
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