Clinical Psychology

Persistent disturbance or dysfunction in behavior, thoughts, or emotions that causes significant DISTRESS and IMPAIRMENT

Like physical illnesses, mental illnesses have biological and environmental causes, defined symptoms, and cures

Disorder: common set of signs (OBJECTIVELY observed indicators) and symptoms (SUBJECTIVELY reported thoughts, behaviors, emotions) Disease: known pathological process affecting the body Diagnosis: determination of whether a disorder or disease is present

• DSM = Diagnostic & Statistical Manual of Mental Disorders • Standardization of diagnoses; classification system for each known mental disorder, symptoms/diagnostic criteria, etc • Most recent release is DSM-5 + DSM-5-TR (test revision) • Used to use roman numerals to number them but now use arabic numbers so we can do updates to the same version (5.1, 5.2, etc) –> publish updates more frequently instead of every 20 yrs Drawbacks: - May feel like “labeling” - Can be problematic if just “below” the cutoff - Doesn’t acc for subjective experience (ppl can experience things in different ways)

USA uses DSM but many other countries use WHO’s International Classification of Diseases (ICD)

• Research Domain Criteria project • Initiative aiming to guide classification of mental disorders by focusing on underlying processes • Addresses growing concern that research findings on biopsychosocial factors that appear to cause psychopathology don’t neatly map onto DSM/ICD diagnoses • Can help explain comorbidity • Not meant to replace DSM/ICD in any way, but serve as a guide+ inform future revisions • CONSTRUCT: biopsychosocial processes that, at extremes, can give rise to mental disorders (e.g. fear, anxiety)

States that mental disorders are the result of interactoins btw biological, psychological, and social factors Biological: genetics, epigenetics, chem imbalances, brain structure Psychological: maladaptive learning + coping, biases, dysfunctional attitudes Social: poor socialization, stress life experience, cultural and social inequities

• Specific theory within biopsychosocial model; DESCRIBES how the biological, psychological, and social factors interact w each other • States that a person may be predisposed to a psychological disorder that remains unexpressed unless triggered by stress • Diathesis –> stress –> psychological disorder Diathesis: the predisposition (e.g. brain structure, hormones, genes) Stress: the catalyst (e.g. abuse, loss, onset of physical illness)

Co-occurrence of 2+ diseases in a person

• Anxiety is the predominant feature • Significant comorbidity w depression

Phobic disorders, panic disorders, social anxiety disorder, Generalized Anxiety Disorder (GAD)

• Persistent, excessive fear and avoidance of spceific objects, activities, or situations • Ppl w phobic disorders recognize the fear is irrational but can’t prevent it from interfering w everyday function • 2 main types: specific and social phobia

Specific phobia: irrational fear of particular object or situation that markedly INTERFERES w everyday func Social phobia: irrational fear of public humiliation or embarrassment - Could be specific situations like public speaking or eating in public, but could also include general social situations involving interacting w unfamiliar ppl - Social phobia dependent on subjective experience, not physiological response

• Subtype of diathesis-stress model focusing on fear and phobias specifically • Ppl evolutionarily predisposed to fear objects we’re supposed to avoid – supported by heritability • Temperament (e.g. shyness) + neurological factors may also play role

Panic disorder: sudden occurrence of multiple physiological and psychological symptoms that contribute to stark feeling of terror (i.e. panic attacks) - Acute symptoms can last a few mins and include shortness of breath, heart palpitations, sweating, dizziness • Occasional panic attack not sufficient for diagnosis; must cause significant dread and anxiety + IMPAIRMENT in person’s life • Intense anxiety and avoidance related to attack for at least 1 mo Agoraphobia: specific phobia involving public places - Often comorbid w panic disorder - Not frightened of public places themselves but afraid that smthn terrible will happen and they won’t be able to escape or get help

Fear of social situations –> worry and diminished day-to-day func

• Chronic excessive worry abt everyday things that is out of proportion to the specific cause of worry • Generalized bc worries aren’t focused on a particular threat • At least 6 mo of excessive anxiety + symptoms like fatigue, restlessness, irritability, conc problems • Mild-modest heritability • Unpredictable experiences in childhood increase risk of developing GAD

• Post-traumatic stress disorder • Caused by exposure to traumatic event • Chronic psychological arousal, recurrent unwanted thoughts or images of the trauma, avoidance of things that call the traumatic event to mind for 1+ mo • Most evident in soldiers returning from war; not everyone develops PTSD –> supports preparedness theory • Cortical regions: heightened amygdala activity, smaller hippocampus

• Obsessive-Compulsive Disorder • Obsessive thoughts and/or compulsions that seem irrational or nonsensical • Obsession: intrusive, obsessive thoughts that produce anxiety • Compulsion: repetitive, often ritualistic behavior to remedy intrusive thoughts; may cause relief, but only temporarily • Classified separately from anxiety disorders bc researchers believe it has a distinct cause maintained by different neural circuitry than anxiety disorders • Obsession suppression can backfire • Take up significant amt of time (1+ hrs/day) • Cause significant distress or impairment in func • Moderate-strong heritability

• Mood disturbance as predominant feature • 2 main forms: depression/depressive disorders and bipolar disorder

• Major depressive disorder/unipolar depression • Severely depressed mood and/or inability to experience pleasure • Must have either depressed mood, anhedonia (reduced pleasure in things that used to cause joy), or both + other symptoms • Symptoms must last 2+ wks + cause significant distress or impairment in function

• Persistent depressive disorder • Same cog and physiological symptoms as depression; less severe but lasts longer (2+ yrs)

• MDD and PDD co-occur • Moderately depressed mood that persists for 2+ yrs; punctuated by periods of MDD

• Seasonal affective disorder • Recurrent depressive episodes in a seasonal pattern • Episodes tend to begin in fall or winter and remit in spring due to lower light lvls in colder seasons