Psychopathology Flashcards
Anxiety Disorders
WHAT- Anxiety disorders are a group of mental health conditions in the DSM characterized by excessive worry, fear, or nervousness that is irrational, uncontrollable, and disruptive and interferes with daily functioning. Anxiety disorders include GAD, social anxiety disorder, panic disorder, phobias, among others. Causes and risk factors include biological, environmental, behavioral, and psychological. Common treatment for anxiety disorders include CBT, exposure, relaxation and mindfulness, and exposure
WHY- Anxiety disorder are the most common mental disorders, it is important for clinicians to be familiar with their presentation, how it may affect the patient’s life, and viable treatment options
EX- Sarah, a 32 year old with social anxiety disorder, has an intense fear of being judged in social settings. She avoids gatherings and struggles at work to give presentations leading to isolation and stress.
Anxiety Sensitivity
WHAT - Misinterpretation of physical signs of anxiety. Leads individuals to fear these symptoms because they think it will lead to negative consequences (panic attacks). It is how individuals perceive and react to bodily symptoms of anxiety such as a racing heart and shortness of breath. Anxiety sensitivity is commonly addressed in counseling and therapy, particularly in cases of panic disorder, GAD, and other anxiety related conditions
WHY- Addressing anxiety sensitivity is crucial because it can exacerbate or be a maintaining factor for anxiety disorders. Using psychoeducation to teach that a racing heart does not always mean a panic attack is approaching allows the client to habituate to these sensations + decrease psychological distress.
EX- Demi has high anxiety sensitivity. Sometimes, when her heart is racing and she gets sweaty (from walking, etc.), she thinks she’s going to have a panic attack and goes to the ER.
Bipolar I vs Bipolar II
WHAT- Bipolar I is characterized by at least one manic episode lasting at least one week (or requiring hospitalization), often accompanied by depressive episodes but isn’t a requirement for diagnosis. Bipolar II involves at least one hypomanic episode (a less severe form of mania) and one major depressive episode.
WHY- It is important to understand the differences between bipolar I and II as misdiagnosis can be harmful to the patient, and possibly worsen their condition.
EX- Chris has been admitted to psychological care by his wife. His wife reports that for the past two weeks he has not been sleeping, has been talking extremely quickly, and has impulsively bought lots of things they cannot afford. The clinician suspects he may have bipolar I disorder
Borderline Personality
WHAT- BPD is a mental health condition typically begins in early adulthood and is categorized as a cluster B personality disorder. According to the DSM 5, BPD is characterized by a persisting pattern of instability in mood/emotions, relationships, and self image along with marked impulsivity. This results in extreme distress and social and occupational impairment. Some symptoms include fear of abandonment, manipulation, emotional volatility, inability to self-sooth, and self-harm/suicidal behavior.
WHY- It is important to understand and be aware of personality disorders such as BPD and how they vary, as they are highly comorbid
EX- Lisa has intense fears of abandonment and swings between adoring and devaluing her partner. She engages in impulsive shopping sprees and self-harms when feeling overwhelmed by emotions.
Case Study
WHAT- A case study is an in depth analysis of an individual, group, or situation in its natural context. It often involves collecting comprehensive information about the person’s background, symptoms, experiences, behaviors, and treatment progress. In counseling and therapy, they are typically used to explore and understand specific psychological issues, disorders, or therapeutic interventions in a real-world context. They can serve the purpose of answering a how or why question.
WHY- Case studies are valuable because they provide a rich, qualitative understanding of individual experiences and help clinicians and researchers explore nuanced issues.
EX- A client comes to therapy presenting with a rare psychological disorder. The therapist may look at case studies done on other people with this disorder to learn more about prognosis and treatments, since there may not be many manualized txs or larger studies done on it
Categorical vs Dimensional
WHAT- These are two approaches for understanding and diagnosing mental conditions. The categorical approach categorizes mental health as a distinct diagnosis with no overlap, someone either meets the criteria or doesnt. Categorical diagnosis is straightforward and helps communication between clinicians, but it may oversimplify complex disorders. Dimensional diagnosis approach looks at mental health conditions along a spectrum where symptoms vary in frequency and intensity. Dimensional diagnosis captures the nuances of individual experiences.
WHY- Important to know that the DSM leans much more towards categorical diagnoses. It is important to know the strengths and limitations of using categorical diagnoses versus dimensional ones in order to effectively evaluate and design a treatment plan
EX- Dimensional - someone diagnosed with major depressive disorder must meet a specific number of symptoms over a set period. Categorical - instead of diagnosing depression categorically, a clinician might rate the severity of depressive symptoms (e.g., mild, moderate, or severe)
Comorbidity
WHAT- The co-occurrence of two or more disorders in one individual that may be interacting with one another. It is common in counseling, where the lines between diagnostic categories can be blurred.
WHY- Understanding comorbidity is essential in counseling because it helps counselors create holistic integrated treatments tailored to the clients unique needs
EX- Jake a 28-year old has social anxiety and substance use disorder. He began drinking to manage his fear of social interactions, but over time his alcohol use worsened his anxiety and led to dependency
Diagnosis
WHAT- The process of identifying and labeling a mental health condition based on an individual’s symptoms, behaviors, and history. Diagnoses are usually made using established criteria from diagnostic tools such as the DSM5. Diagnostic tools make it easy for clinicians to communicate with one another, but a diagnosis might not fit an individual perfectly. A diagnosis meets a set of criteria but might present different between individuals depending on unique situations, cultures, and individual differences
WHY- Diagnosis is essential because it helps clinicians communicate effectively, access evidence-based interventions, and provide clients with validation and understanding of their experiences
EX- After an assessment interview, Caroline’s symptoms of a weight below a healthy BMI, starvation behavior, and fixation on food and weight meet all criteria to diagnose her with anorexia
DSM
WHAT- The DSM is a comprehensive guide published by the APA that is the primary manual used for diagnosis by clinical practitioners. It provides criteria for diagnosis based on symptoms and is used for assessment and to create a treatment plan.The DSM is used widely in counseling, therapy, and psychiatry to provide common language for professions to discuss disorders.
WHY- The DSM is an essential tool as it is used by all mental health professionals and ensures consistency and standardizes diagnostic practices
EX- For example, a counselor might use the DSM to diagnose a client presenting with persistent sadness, loss of interest, and fatigue as having major depressive disorder based on the manual’s criteria.
Diathesis Stress Model
WHAT- The diathesis stress model explains how mental health conditions result from the interaction between a person’s biology and their environmental conditions. This model hypothesizes that individuals who develop disorders have a genetic predisposition which is then activated by environmental stressors.
WHY- This model is widely used in counseling and therapy and is important to understand why some individuals develop mental health issues while others do not, even when exposed to similar stressors. This guides clinicians in addressing both inherent vulnerabilities and external stressors to provide comprehensive care.
EX- For example, Jane has a family history of depression (genetic predisposition), and recently went through a divorce (stressor). The combination triggers depression symptoms and leads to her coming to therapy.
Differential Diagnosis
WHAT- The process of determining which disorder a patient might have when two or more disorders have overlapping symptoms. The goal is to determine which diagnosis accurately fits the patient’s symptoms. Tools like the DSM and structured interviews aid in this process
WHY- Differential diagnosis is crucial because accurate diagnosis guides effective treatment and avoids harmful interventions
EX- A client comes to therapy presenting with symptoms of depression, but also with an extensive history of trauma. The therapist may look in the DSM to see if the patient’s symptoms best meet criteria for depression or PTSD
Dissociative Disorders
WHAT- A group of mental health conditions characterized by disruptions or discontinuity of memory, consciousness, identity, or perception of the environment. These conditions often arise in response to extreme stress or trauma. According to the DSM these disorders include dissociative amnesia, dissociative identity disorder, dissociative fugue, derealization/depersonalization
WHY- These disorders are important to understand as people who develop these diagnoses have a high risk of suicide and self-harm. Treatment typically involves trauma related therapy such as EMDR or CBT
EX- Jane was sexually abused as a child. She tells her therapist she has little to no memory of her childhood. Her therapist suspects she is suffering from dissociative amnesia as a response to her trauma
Dopamine
WHAT- Dopamine is a neurotransmitter involved in the brain’s reward system, motivation, mood regulation, attention, and motor behavior. In counseling and therapy, dopamine is implicated in numerous mental health conditions like depression, Parkinsons, and schizophrenia
WHY- Understanding how dopamine can be affecting a patient’s psychological state is essential for clinicians to develop effective treatments that could include a combination of medication and therapy.
EX- A client with Parkinson’s disease has abnormal levels of dopamine where the deficit leads to motor impairments. This understanding informs treatment options, such as medications that increase dopamine levels to improve attention and behavior
Eating Disorders
WHAT- Eating disorders are mental health conditions characterized by persistent disturbances in eating behaviors and attitudes toward food, body weight, or shape. These disorders significantly impact physical health, emotional well-being, and daily functioning. They often arise from a combination of genetic, psychological, cultural, and environmental factors. According to the DSM-5, the primary eating disorders include anorexia nervosa, binge eating disorder, pica, and rumination disorder.
WHY- Eating disorders typical age of onset is adolescence so it is essential clinicians be aware because they can have deadly consequences on young individuals.
EX- Alexa has Anorexia Nervosa, she has an intense fear of gaining weight, leading to severe food restriction and significantly low body weight. She limits herself to a few hundred calories a day, avoids social situations involving food, and believes she is overweight despite being underweight.
GABA
WHAT- GABA is neurotransmitters in the brain that plays a role in neural excitability and promoting calmness. GABA is inhibitory, causing neurons not to fire, regulating mood, anxiety and sleep. GABA is often discussed in relation to conditions such as anxiety, depression, and insomnia
WHY- Understanding how GABA can be affecting a patient’s psychological state is essential for clinicians to develop effective treatments that could include a combination of medication and therapy.
EX- Avery has a GABA deficiency. Because of this, she is frequently anxious. Her doctor has prescribed her benzos to regulate her symptoms
Heritability
WHAT- The capacity for a trait or mental disorder to be passed down genetically. It is represented as a statistical estimate of how much genetics contribute to traits and disorders compared to other factors like environment and lifestyle (ranging from 0-1)
WHY- It is important for clinicians to understand which disorders are highly heritable when assessing and treating
EX- Demi is a new therapy client. Her therapist takes a family history from her. The therapist learns her dad and her grandmother have both been diagnosed with bipolar I. The therapist knows that bipolar I is extremely heritable, and will be looking for signs of it moving forward
HPA Pathway
WHAT- Critical system in the body that regulates the sympathetic nervous system, endocrine system and stress response. It involves the hypothalamus, pituitary gland, and adrenal glands. Dysregulation of the HPA axis has been linked to mental health conditions such as anxiety, depression, PTSD, and burnout
WHY- The HPA pathway is important in counseling and therapy because it connects biological stress responses to mental health, enabling clinicians to address both physiological and psychological aspects of well-being
EX- Someone with chronic stress may have an overactive HPA axis, leading to excessive cortisol levels. This can contribute to symptoms like fatigue, irritability, difficulty concentrating, and immune suppression.
Idiographic vs nomothetic assessment/understanding
WHAT- Involved in case conceptualization and diagnosis. The idiographic approach focuses on the individual, emphasizing unique personal experiences, characteristics, and the specific context of a client. This approach is often used in case studies, qualitative research, and therapeutic settings. The nomothetic approach seeks general laws or patterns by focusing on commonalities across groups of individuals. It uses standardized measures, such as surveys or diagnostic criteria, to assess and categorize individuals based on shared traits or behaviors
WHY- It is important to consider that good practice involves aspects from both approaches. Considering unique patient factors as well as knowing about overall trends aids in developing effective treatment plans
EX- A client comes in with depression symptoms. From a nomothetic assessment approach, the clinician checks for symptoms being present that are based on the norms listed in the DSM for depression. From an idiographic assessment, clinician can consider unique characteristics to create an effective treatment for the specific client
Mania
WHAT- Mania is a mental state characterized by abnormally elevated mood, heightened energy, and exaggerated behaviors that significantly impair functioning. It is a key feature in Bipolar I disorder that must last at least a week. Symptoms include inflated self-esteem, decreased need for sleep, impulsivity, rapid speech, risky behavior, and in severe cases can cause psychosis hallucinations and delusions
WHY- Mania is critical to address in counseling and therapy because it can have dangerous and severe consequences if left untreated.
EX- Sarah, a 35-year-old, is experiencing mania. She feels euphoric, sleeps only two hours a night but remains energized, spends large amounts of money impulsively, and starts multiple ambitious projects she cannot finish
Mood Disorder
WHAT- Mood disorders are a category of mental health conditions primarily characterized by pervasive emotional disturbances such as intense feelings of sadness, euphoria, or irritability that disrupts daily functioning. Mood disorders are divided into depressive disorders (Major depressive, persistant depressive, and Premenstral disphoric) and bipolar disorders (Bipolar I and II and Cyclothymic).
WHY- Individuals with mood disorders, especially major depression and bipolar disorder, have an increased risk of suicidal ideation and behaviors. Understanding mood disorders is important in learning how it can affect a person’s day-today life and aid in developing an effective treatment plan
EX- Patricia tells her therapist that for the last month she has trouble getting out of bed, no longer engages in hobbies she once enjoyed, and has generally been sad. Her therapist suggests she may be suffering from depression
Obsessive Compulsive Disorder
WHAT- Obsessive Compulsive and related disorders are a group of mental health conditions characterized by intrusive, unwanted, recurrent thoughts (obsessions) that drive repetitive behaviors or mental acts (compulsions) to reduce anxiety or prevent a feared event. These disorders can significantly impair daily functioning and cause distress. Types of these disorders include OCD, Body Dysmorphic disorder, hoarding, among others
WHY- Important to understand how obsessions and compulsions are maintained through negative reinforcement in order to effectively intervene
EX- Miranda, a 27-year-old, has OCD. She has an extreme fear and overwhelming thoughts of contamination and therefore feels compelled to wash her hands repeatedly until her hands are raw despite knowing it is irrational. The hand washing temporarily relieves her anxiety
Panic
WHAT- A panic attack is a sudden episode of anxiety where an individual may experience a rapid or pounding heart rate, sweating, choking sensations, dizziness, and thoughts such as they are “going to die” or “going crazy”. Panic attacks escalate rapidly and are intense. They can be unexpected or triggered. Panic attacks can occur in the context of any anxiety disorder as well as other mental disorders
WHY- Studying panic attacks helps researchers understand how the brain and body respond to intense fear and can be an indicator of panic disorder or another condition
EX- Jason suddenly experiences a racing heart, difficulty breathing, and a strong sense of impending doom while driving, even though there’s no immediate threat. This episode left him feeling exhausted and fearful of experiencing another panic attack.
Personality Disorders
WHAT- Personality disorders are a group of mental health conditions characterized by enduring patterns of inner experience and behavior that deviate significantly from cultural norms. These patterns are pervasive, inflexible, and stable over time, leading to significant distress or impairment in social, occupational, or other areas of functioning. The DSM-5 categorizes personality disorders into three clusters: Cluster A (Odd or Eccentric): Includes Paranoid, Schizoid, and Schizotypal Personality Disorders. Cluster B (Dramatic, Emotional, or Erratic): Includes Borderline, Narcissistic, Histrionic, and antisocial personality disorders. Cluster C (Anxious or Fearful): Includes Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders.
WHY- This is important as personality disorders have high comorbidity and are often resistant to treatment
EX- Lisa had BPD, she has intense fears of abandonment and swings between adoring and devaluing her partner. She engages in impulsive shopping sprees and self-harms when feeling overwhelmed by emotions.
Positive vs Negative symptoms
WHAT- Refer to the two main categories of symptoms that occur in disorders such as schizophrenia and mood disorders. Positive symptoms refer to the presence of abnormal behaviors or experiences not seen in the general public such as hallucinations, delusions, disorganized thinking, and paranoia. Negative symptoms refer to the absence or reduction of normal emotional or behavioral functions such as affect flattening, avolition, anhedonia, social withdrawal.
WHY- The distinction between positive and negative symptoms is important in counseling and therapy because they guide comprehensive and individualized treatment strategies
EX- Positive symptom - a person with schizophrenia may hear voices (auditory hallucinations) telling them to act in certain ways Negative symptom - a person might stop participating in social activities or lose interest in hobbies they once enjoyed
Psychosis
WHAT- A mental health condition characterized by disconnection from reality. Common symptoms include hallucinations, delusions, disorganized thinking or speech. People with psychosis may have difficulty distinguishing what is real from what is not, which can impact their ability to function in daily life. Psychosis can occur in various disorders such as schizophrenia, bipolar, substance use, among others
WHY- Psychosis is critical in counseling and therapy because it often requires urgent intervention and comprehensive care. It can disrupt relationships, employment, and overall quality of life. Understanding the impact of psychosis helps counselors and psychologists tailor their treatment approaches to meet the client’s specific needs.
EX- John, a 40-year-old, begins experiencing paranoid delusions, believing that people are spying on him, despite no evidence. He also hears voices telling him what to do
Primary vs secondary gain
WHAT- Derived from psychodynamic theory to describe the subconscious motivation for symptoms in somatic disorders. Primary gain refers to the direct internal psychological benefit that an individual receives from experiencing a symptom. It usually serves to reduce anxiety, internal conflict, or emotional distress. Secondary gain refers to the external benefits or advantages a person might receive as a result of their symptoms. This can include receiving attention, sympathy, or financial support, or avoiding responsibilities at work
WHY- Primary and secondary gains may help to explain the causes or motivations behind behaviors. Helps therapists understand how symptoms may unconsciously serve as a coping mechanism for deeper psychological struggles and be reinforced by rewards.
EX- Jane doesn’t like school, and sometimes she gets stomach aches in the morning before school. Each time this happens, her mother lets her stay home and makes her all her favorite foods. Not having to go to school is a primary gain, and receiving extra care and food from her mother is a secondary one
PTSD
WHAT- Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after an individual experiences, witnesses, hears about a traumatic event. These events can range from natural disasters, accidents, and combat to personal experiences like sexual assault, childhood abuse, or violent crimes. PTSD can manifest in various psychological and physical symptoms, including intrusive memories (e.g., flashbacks, nightmares), avoidance of situations or people that remind the person of the trauma, negative changes in thinking and mood, such as guilt, shame, or detachment from others, and heightened arousal, including difficulty sleeping, irritability, or an exaggerated startle response
WHY- PTSD is important to understand how trauma affects each person differently. Presentation of symptoms vary, and not everyone develops PTSD after a traumatic event
EX- Jenny has come to treatment following a sexual assault in the parking garage she uses for work. She says that she has been late to work because she has to find parking outside of the garage, she has been having flashbacks, and has overall been depressed since the assault. After assessment, Jenny is diagnosed with PTSD
Remission
WHAT- Refers the reduction or elimination of symptoms of a disorder. Remission can be partial or complete depending on the extent to which symptoms are alleviated. It’s important to note that remission does not always mean the complete elimination of the disorder, but it generally refers to a phase where the symptoms are manageable or have diminished.
WHY- In counseling and therapy, remission is an important concept, as it helps measure the effectiveness of interventions and indicates progress in the client’s mental health journey. Achieving remission can provide a sense of hope for the client, reinforcing the idea that their mental health condition can improve. This motivates clients to engage more actively in their treatment and recovery journey.
EX- A client with major depressive disorder may experience remission after undergoing therapy and medication. Their symptoms, such as sadness, low energy, and lack of interest, may significantly decrease, and they may return to their normal functioning
Schizophrenia
WHAT- Chronic and severe psychotic disorder that causes lossing touch with reality characterized by distortions in thinking, perception, and behavior. The two types of symptoms seen in schizophrenia are positive and negative symptoms including delusions, hallucinations, disorganized speech and behavior, and negative mood. To be diagnosed, symptoms must persist for at least six months with one month of active phase symptoms (two or more of the symptoms listed above with at least one being delusions, hallucinations, or disorganzied speech). Schizophrenia usually emerges in late adolescence or early adulthood and requires long-term treatment and management
WHY- Schizophrenia is important for clincians to be aware of because this condition has a severe impact on daily life. Schizophrenia affects a person’s ability to work, form relationships, and function independently. Without treatment, individuals may struggle with homelessness, unemployment, and social isolation
EX- Sarah, a 23-year-old, experiences auditory hallucinations and delusions of believing her neighbors are plotting against her. She also shows signs of avolition, neglecting her hygiene and withdrawing from friends and family. Her symptoms significantly interfere with her ability to maintain a job, she is diagnosed with schizophrenia.
Serotonin
WHAT- Serotonin is a neurotransmitter in the brain that plays a vital role in regulating mood, emotion, sleep, and appetite. It is often referred to as the “feel good” chemical. Serotonin is frequently discussed for mental health conditions such as depression, anxiety, bipolar, among others. In fact, many antidepressant medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), are designed to increase serotonin activity in the brain, helping to improve mood and reduce symptoms of depression.
WHY- Understanding how Serotonin can be affecting a patient’s psychological state is essential for clinicians to develop effective treatments that could include a combination of medication and therapy. Recognizing serotonin’s role in mental health can help clients understand the biological aspect of their conditions, which can reduce stigma and foster a more comprehensive view of their mental health.
EX- A client with major depressive disorder may experience low levels of serotonin, contributing to symptoms like persistent sadness, fatigue, and loss of interest
State vs trait
WHAT- State anxiety refers to temporary feelings of anxiety usually in response to specific situations or stressors that typically dissipates once the situation is resolved. Trait anxiety refers to a more persistent and stable characteristic of an individual, part of their personality. People with high trait anxiety experience anxiety more frequently and intensely without pose of an immediate threat
WHY- Understanding the distinction between state and trait anxiety is important in therapy because it helps clinicians tailor interventions
EX- One client might experience state anxiety before giving a presentation at work, feeling nervous and uneasy. Once the presentation is over, their anxiety fades, and they return to a calmer state. Another person with high trait anxiety might feel anxious in a wide range of situations, including both major events like a career change and minor occurrences like an unexpected phone call
Substance use and related disorders
WHAT- Substance-Related Disorders encompass conditions associated with the excessive use of substances that cause maladaptive behavior patterns, leading to significant impairment or distress. It affects the brain’s reward system, leading to compulsive behaviors, cravings, and an inability to stop use. Risk factors include biology, environmental factors, psychological factors and brain chemistry. Treatment options include: behavioral therapy, medication, support groups, inpatient and outpatient rehab. Symptoms are grouped under four categories: Impaired control, social impairment, risky use, pharmacological criteria. Substances involved include alcohol, opioids, stimulants, cannabis, hallucinogens, among others.
WHY- Important to know that SUD is highly heritable, highly comorbid, and also is maintained through learning (positive/neg reinforcement, modeling).
EX- Mark drinks excessively, neglects his job, and has tried to quit multiple times without success, meeting criteria for alcohol use disorder
Tolerance and Withdrawal
WHAT- Symptoms in the context of substance related disorders. Tolerance refers to when a person’s body becomes accustomed to a substance after repeated use, leading to a diminished effect over time. As tolerance builds, the person might need more of the substance to have the same effect. Withdrawals occurs when someone has reduced or stopped using a substance they were dependent on. These symptoms arise as the body reacts to the absence of the substance which can include shaking, sweating, nausea, irritability, and depression.
WHY- Important to remember that a client may have a psychological and physical reaction to discontinuing using a substance, and this altered state of mind and being may affect the client’s response to therapy
EX- Tolerance - a person taking pain medication for chronic pain may need increasingly higher doses over time to manage the same level of discomfort, as their body becomes tolerant to the effects of the drug. Withdrawal - someone who has been using alcohol heavily may experience withdrawal symptoms such as tremors, anxiety, nausea, or seizures when they try to stop drinking
Trauma and Stress related disorders
WHAT- Trauma and Stressor-Related Disorders are a group of mental health conditions triggered by exposure to traumatic or stressful events. Individuals may experience symptoms such as Intrusive symptoms (reexperiencing the trauma, flashbacks nightmares), avoidance, negative alterations of mood, and alterations in reactivity and arousal. Types of trauma and stressor-related disorders are post-traumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders. PTSD includes the sympotms listed above that must persist for more than 1 month while ASD occurs between 3 days and a month
WHY- Following trauma, only some will develop ASD and even fewer will develop PTSD, thus, understanding risk and protective factors, such as social support and biological vulnerability, may help identify those at risk
EX- A client who was an earthquake survivor comes to treatment after having unwanted memories, nightmares, and intrusive thoughts of the injuries an deaths they witnessed
