MODULE 1

Abnormal Psychology

 Concerned with understanding the nature, causes, and treatment of mental disorders.

 No single behavior defines abnormality, but multiple indicators suggest a higher

likelihood of a mental disorder.

Indicators of Abnormality

 Suffering: Psychological pain is often considered abnormal (e.g., depression, anxiety

disorders). However, suffering alone is neither a necessary nor sufficient condition for
abnormality (e.g., worrying about an exam causes distress but is not abnormal).

 Maladaptiveness: Behavior that interferes with well-being or functioning may be

considered abnormal. Examples include:

o An individual with anorexia restricting food intake to a life-threatening degree.

o A person with depression withdrawing from social and work life.

o However, not all disorders involve maladaptive behavior.

 Statistical Deviancy: While abnormal means “away from the norm,” statistical rarity
alone does not define abnormality.

o Some rare traits (e.g., genius, perfect pitch) are not considered abnormal.

o Intellectual disability, which is both rare and undesirable, is classified as

abnormal.

o Common but undesirable traits (e.g., rudeness) are not necessarily considered
mental disorders.

 Violation of Social Standards: Behaviors that go against cultural norms may be

considered abnormal.

o Some behaviors (e.g., watching TV, driving a car) are normal in certain societies
but considered abnormal in others (e.g., among the Amish).

o Certain actions (e.g., honor killings) may be seen as justified in one culture but
criminal in another.

o Behavior is more likely to be seen as abnormal if it violates social standards and

is statistically rare (e.g., a mother drowning her children).
  Social Discomfort: If someone’s actions make others feel uncomfortable, their behavior
may be considered abnormal.

o Example: A stranger discussing their suicide attempt within minutes of meeting

someone may be seen as abnormal unless in a therapeutic setting.

 Irrationality and Unpredictability: Behavior that lacks logic or is unexpected may be

considered abnormal.

o Example: A person suddenly screaming and cursing at nothing would be seen as

irrational.

o Disorganized speech and erratic behavior are common in schizophrenia and the
manic phase of bipolar disorder.

 Dangerousness: People who pose a danger to themselves or others may be considered

abnormal.

o Therapists are required to hospitalize suicidal clients or report threats of

violence.

o However, not all dangerous behavior is abnormal (e.g., race car driving, keeping
poisonous snakes).

o Not all mentally ill people are dangerous, though some may commit serious
crimes.

Changing Definitions of Abnormality

 Societal norms evolve, impacting what is considered abnormal:

o Homosexuality was once classified as a mental disorder but is no longer.

o Body piercings (e.g., nose, navel) were once seen as signs of deviance but are
now fashionable.

DSM-5 and Mental Disorders

 DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is the standard

classification system for mental disorders.

 Defines a mental disorder as a clinically significant disturbance in:

o Behavior

o Emotion regulation

o Cognitive functioning
  These disturbances stem from biological, psychological, or developmental
dysfunctions.

 Disorders cause significant distress or impairment in personal, social, or occupational

life.

 Culturally expected responses to stress (e.g., grieving a loved one’s death) are not
considered disorders.

Diagnostic Manuals

 Two primary classification systems for mental disorders:

o DSM (Diagnostic and Statistical Manual of Mental Disorders) – Used in

psychology and psychiatry.

o ICD (International Classification of Diseases) – A broader classification system

for diseases, including mental disorders.

 Some differences exist between the two systems in how symptoms are grouped, leading
to potential variations in diagnoses.

 Symptoms: Subjective experiences reported by the patient (e.g., sadness, crying, suicidal
thoughts).

 Signs: Objective observations made by the clinician (e.g., avoiding eye contact,
psychological test results).

 Diagnoses are made based on specific criteria from these manuals.

Evolution of the DSM

 DSM-I (1952): Developed to standardize diagnostic practices, especially for military

personnel during WWII.

 DSM-II (1968): Expanded classification based on post-war mental health research but
lacked precise definitions.

 DSM-III (1980) & DSM-IV-TR (2000): Improved diagnostic clarity and classification
systems.

 DSM-5 (2013): Incorporated significant theoretical changes in diagnostic criteria, making

it the most controversial revision yet.

MODULE 2
Anxiety Disorders Overview

 Definition & Impact:

o A group of disorders characterized by clinically significant fear or anxiety.

o Marked by unrealistic, irrational fears or anxieties of disabling intensity.

o Result in enormous personal, economic, and health care problems.

o Associated with increased occurrence of medical conditions such as asthma,

chronic pain, hypertension, arthritis, cardiovascular disease, and irritable bowel
syndrome.

o Individuals with anxiety disorders are very high users of medical services.

 Common DSM-5 Anxiety Disorders:

o Specific Phobia

o Social Anxiety Disorder (Social Phobia)

o Panic Disorder

o Agoraphobia

o Generalized Anxiety Disorder

Fear vs. Anxiety

 Fear:

o An alarm reaction in response to immediate, identifiable danger (e.g.,

dangerous predator, someone with a loaded gun).

o Involves the activation of the “fight-or-flight” response.

o Has clear adaptive value in allowing immediate escape from danger.

o Example: “I’m afraid of snakes.”

 Anxiety:

o A complex blend of unpleasant emotions and cognitions oriented toward

potential future threats.

o Characterized by a diffuse sense of apprehension without a specific,

identifiable source of danger.
 o Can enhance planning and preparedness in mild to moderate levels, but
becomes maladaptive when chronic and severe.

o Example: “I’m anxious about my parents’ health.”

 Components Shared by Both (but Loosely Coupled):

o Cognitive/Subjective: Feelings of fear (e.g., “I feel terrified”) or worry (e.g., “I’m

going to die”) for fear; negative mood and apprehension for anxiety.

o Physiological: Increased heart rate, heavy breathing, tension, or overarousal.

o Behavioral: An urge to escape immediately in fear; avoidance behaviors in

anxiety.

 Panic Attacks:

o Occur when the fear response happens without an obvious external threat.

o Symptoms mirror fear (rapid onset, physiological arousal) but include a

subjective sense of impending doom, such as fears of dying or losing control.

Social Anxiety Disorder (Social Phobia)

 Definition & Manifestation:

o Disabling fear of one or more specific social situations (e.g., public speaking,
using a public restroom, eating or writing in public).

o Involves fear of negative evaluation, embarrassment, or humiliation.

o Leads to either avoidance of these situations or enduring them with extreme

distress.

o Intense fear of public speaking is noted as the single most common type.

 Environmental Causes:

o Growing up with emotionally cold, socially isolated, and avoidant parents who
devalue sociability.

o Experiencing problems with peers, such as not fitting in.

o Exposure to uncontrollable and unpredictable stressful events (e.g., parental

separation, family conflict, or sexual abuse).

 Biological Causes:
 o Behaviourally inhibited infants, who are shy, easily distressed by unfamiliar
stimuli, and show traits of neuroticism and introversion, are more prone to
develop social phobia.

o Twin studies indicate a modest genetic contribution to social phobia.

Panic Disorder

 Definition & Key Characteristics:

o Characterized by the occurrence of panic attacks that seem to come “out of the
blue” (unexpected and uncued).

o According to DSM-5, the individual must experience recurrent, unexpected

panic attacks and persistently worry about future attacks or their consequences
(anticipatory anxiety).

 Panic Attack Features:

o Abrupt onset with symptoms reaching peak intensity within 10 minutes and
typically subsiding in 20 to 30 minutes.

o May occur during relaxation or sleep (nocturnal panic).

o Cognitive symptoms during attacks include depersonalization, derealization,

and intense fears of dying or losing control.

 Biological Causes:

o Moderate heritability with a heightened risk if there is a history of social or

specific phobia.

o Increased activity in the amygdala plays a central role in fear and panic, more
so than earlier attributions to the locus coeruleus.

o Biochemical dysfunctions can provoke panic attacks (e.g., altered carbon

dioxide levels, excessive caffeine intake).

o Involvement of neurotransmitter systems:

 Noradrenergic system: Its increased activity can stimulate

cardiovascular symptoms.

 Serotonergic system: Increased activity decreases noradrenergic activity,

reducing cardiovascular symptoms.
  GABA: Low levels are implicated in anticipatory anxiety associated with
panic disorder.

o Individuals with high anxiety sensitivity (belief that bodily symptoms have
harmful consequences) are more prone to developing panic attacks.

 Environmental Causes:

o Automatic attention to threatening cues in the environment can provoke more

attacks.

 Core Components of Panic Disorder:

o Anticipatory Anxiety: Worry about having another attack.

o Agoraphobia: Fear of being in situations where escape might be difficult (see

below).

o Panic Attacks: Recurrent episodes of intense, sudden fear.

Agoraphobia

 Definition & Manifestation:

o Involves fear of public places and assemblies, such as streets, crowded areas,
shopping malls, or movie theaters.

o Often develops as a complication of panic attacks in these situations.

 Behavioral Characteristics:

o Individuals fear being in situations where escape would be physically difficult,

psychologically embarrassing, or where immediate help might be unavailable.

o Fear may extend to avoiding activities that create arousal (e.g., exercising,
watching scary movies, drinking caffeine, or even engaging in sexual activity).

o Initially, avoidance is limited to situations where panic attacks have occurred,

but it can gradually spread to other areas.

o In severe cases, individuals may feel anxious even when venturing outside their
home alone; in extreme cases, they may be confined to their home or even
specific parts of it.

 Note:
 o Although agoraphobia frequently complicates panic disorder, many patients
with agoraphobia do not experience panic attacks.

o DSM-5 now lists agoraphobia as a distinct disorder.

 Risk Factors (as noted outside of textbook information):

o Having depression, other phobias (e.g., claustrophobia, social phobia), other

anxiety disorders (e.g., generalized anxiety disorder, obsessive-compulsive
disorder), a history of physical or sexual abuse, substance abuse problems, or a
family history of agoraphobia.

Generalized Anxiety Disorder (GAD)

 Definition & Duration:

o Involves chronic, excessive, and unreasonable anxiety and worry about many
aspects of life, including minor events.

o Worry must persist for at least 6 months and be experienced as difficult to

control.

o The anxiety cannot be exclusively related to another concurrent disorder (e.g.,

fear of panic attacks).

 Core Characteristics:

o Constant future-oriented anxious apprehension and diffuse uneasiness.

o Chronic tension, worry, and a sense of being unable to predict or control

potential threats.

o Marked vigilance for possible signs of threat and engagement in subtle

avoidance behaviors (e.g., procrastination, checking, or frequently calling a
loved one to check on their safety).

o These pervasive worries lead to difficulty in decision-making and persistent

rumination over potential errors or unforeseen negative outcomes.

 Environmental Causes:

o History of trauma in childhood.

o A lack of safety signals in the environment due to unpredictable or unsignaled

stressors.
 o Overcontrolling and intrusive parenting styles that promote the view of the
world as unsafe.

o Exposure to unpredictable or uncontrollable life events (e.g., having a boss or

spouse with unpredictable moods or temper outbursts).

 Biological Causes:

o Modest heritability has been noted.

o Functional deficiency in GABA, which normally helps inhibit anxiety in stressful

situations.

o Involvement of serotonin in modulating anxiety.

o The anxiety-producing hormone, corticotropin-releasing hormone (CRH), plays

an important role.

Obsessive-Compulsive and Related Disorders

 General Characteristics:

o Involve the presence of obsessions and/or compulsions.

o Obsessions: Persistent, recurrent, intrusive thoughts or images that are

disturbing, inappropriate, and uncontrollable.

o Compulsions: Repetitive behaviors (e.g., handwashing, checking) or mental acts

(e.g., counting, praying) performed to neutralize or prevent distress or a
dreaded outcome.

o These disorders aim to reduce distress or prevent feared events.

 Obsessive-Compulsive Disorder (OCD):

o Requires that obsessions and compulsions take up at least 1 hour per day.

o Individuals recognize that the obsessions are self-generated (as opposed to

being imposed from external forces).

o Symptoms interfere significantly with daily functioning.

o Common Obsession Themes: Contamination, fear of harming oneself or others,

pathological doubt, need for symmetry, sexual obsessions, and aggressive or
religious obsessions.
 o Common Compulsive Rituals:

 Cleaning (e.g., excessive handwashing)

 Repeated checking

 Repeating actions

 Ordering or arranging

 Counting

o Some individuals may also experience “primary obsessional slowness”

(performing routine actions extremely slowly) or have rigid rules about
symmetry.

 Biological Causes of OCD:

o Moderate genetic heritability, with early-onset OCD showing a higher genetic

loading.

o Abnormally high levels of activity in parts of the frontal cortex, particularly the
orbital frontal cortex, which interacts with the corpus striatum/caudate nucleus
and the thalamus.

o Strong implication of the neurotransmitter serotonin, with increased activity

and heightened sensitivity in certain brain structures.

o Deficits in inhibiting motor responses and filtering out irrelevant information

contribute to compulsive behaviors.

o Low confidence in memory ability may also drive repetitive checking behaviors.

 Body Dysmorphic Disorder (BDD):

o Characterized by an obsessive preoccupation with perceived or imagined flaws

in appearance.

o The preoccupation is so intense that the individual firmly believes they are
disfigured or ugly, leading to significant distress and impairment in social or
occupational functioning.

o Common behaviors include compulsive checking of appearance (e.g., mirror

gazing) and avoidance of situations for fear of negative evaluation.

o Individuals may engage in excessive grooming or attempt to camouflage the

perceived defect.
 o BDD affects concerns over various body parts (e.g., skin blemishes, facial
features, body build) and shows some gender differences in focus (men may
focus on genitals, build, balding; women on skin, stomach, breasts, hips, etc.).

o Approximately half of those with BDD experience concerns of delusional

intensity.

 Biological Causes of BDD:

o Involvement of serotonin, with increased activity and sensitivity implicated.

o A moderate heritable component, particularly regarding over-concern with

slight physical defects.

o Performance deficits in executive functioning (e.g., planning, organization)

linked to prefrontal brain regions.

 Note on Classification:

o Although BDD was once classified as a somatoform disorder in DSM-IV-TR, it is

now grouped with OCD and related disorders in DSM-5 due to strong
similarities.

Trauma and Stressor-Related Disorders

 Posttraumatic Stress Disorder (PTSD):

o Occurs after an extreme traumatic event (e.g., combat, rape, concentration

camps, natural disasters).

o Diagnostic Criteria (Minimum Duration: 1 month):

 Intrusion: Recurrent reexperiencing of the traumatic event (nightmares,

intrusive images, physiological reactivity).

 Avoidance: Avoidance of thoughts, feelings, or reminders associated

with the trauma.

 Negative Cognitions and Mood: Includes detachment, negative

emotions (shame, anger), and distorted blame.

 Arousal and Reactivity: Hypervigilance, an exaggerated startle response,

aggression, and reckless behavior.
 o Although PTSD was classified as an anxiety disorder in DSM-IV, DSM-5 now
categorizes it under trauma- and stressor-related disorders.

o Causal Considerations:

 The nature of the traumatic stressor and the degree of direct exposure
influence development.

 Not everyone exposed to trauma develops PTSD, highlighting individual

differences in vulnerability.

 Acute Stress Disorder (ASD):

o Occurs within 4 weeks after a traumatic event.

o Symptoms must last for at least 2 days and no more than 4 weeks.

o Provides an early diagnosis when symptoms appear shortly after trauma; if

symptoms persist beyond 4 weeks, the diagnosis may change to PTSD.

These pointers capture the key elements of anxiety spectrum disorders, including definitions,
symptomatology, differences between fear and anxiety, and the various causal factors (both
biological and environmental) associated with each disorder.

MODULE 3

Personality Disorders Overview

 Definition:
 o Result from the gradual development of inflexible and distorted personality and
behavioral patterns.

o Involve persistently maladaptive ways of perceiving, thinking about, and relating

to the world.

 Key Characteristics:

o Chronic interpersonal difficulties.

o Problems with one’s identity or sense of self.

 Diagnostic Criteria (DSM-5):

o Enduring pattern of behavior must be pervasive, inflexible, stable, and of long

duration.

o Causes clinically significant distress or impairment in functioning.

o Manifested in at least two of the following areas:

 Cognition

 Affectivity

 Interpersonal functioning

 Impulse control

 Additional Points:

o Major early-life stressful events often set the stage for these patterns.

o Frequently comorbid with anxiety disorders, mood disorders, substance use

problems, and sexual deviations (approximately three-quarters have another
disorder).

o Their behavior often creates as much difficulty for others as for themselves.

DSM-5 Cluster Organization of Personality Disorders

 Cluster A (Odd or Eccentric Behavior): PSS

o Paranoid Personality Disorder

o Schizoid Personality Disorder

o Schizotypal Personality Disorder

  Cluster B (Dramatic, Emotional, or Erratic Behavior): HNAB

o Histrionic Personality Disorder

o Narcissistic Personality Disorder

o Antisocial Personality Disorder

o Borderline Personality Disorder

 Cluster C (Anxious or Fearful Behavior): ADO

o Avoidant Personality Disorder

o Dependent Personality Disorder

o Obsessive-Compulsive Personality Disorder

Paranoid Personality Disorder

 Core Features:

o Pervasive suspiciousness and distrust of others.

o Tendency to see oneself as blameless and to attribute mistakes to others’ evil

motives.

o Chronic tension and hypervigilance, expecting trickery and validating suspicions

while ignoring contrary evidence.

o Preoccupation with doubts about the loyalty of friends, leading to reluctance to

confide in others.

o Prone to grudges, quick to anger, and sometimes violent responses to perceived

insults.

 Contact with Reality:

o Individuals are usually not psychotic, though transient psychotic symptoms may
occur under stress.

 Distinction from Schizophrenia:

o Unlike paranoid schizophrenia, they generally maintain contact with reality and
do not have persistent delusions or hallucinations.

 Causes:
 o Biological Factors:

 Modest genetic liability related to low agreeableness (high antagonism)

and high neuroticism (angry-hostility).

o Environmental Factors:

 Parental neglect or abuse and exposure to violent adults.

Schizoid Personality Disorder

 Core Features:

o Inability or lack of interest in forming social relationships.

o Few or no close friends, aside from possibly a relative.

o Difficulty expressing feelings, appearing cold and distant.

o Limited social skills; often classified as loners or introverts with solitary interests
or occupations.

o Little pleasure in most activities, including sexual activity; rarely marry.

o Generally apathetic, not emotionally reactive, showing a consistently cold and

aloof mood.

 Five-Factor Model Correlates:

o Extremely high levels of introversion (low warmth, gregariousness, and positive

emotions).

o Low on openness to feelings and achievement striving.

 Causes:

o Biological Factors:

 Very modest genetic link; traits show only modest heritability.

o Psychosocial Factors:

 Severe impairment in the affiliative system.

 Maladaptive underlying schemas (e.g., “I am basically alone” or

“Relationships are messy and undesirable”).
Schizotypal Personality Disorder

 Core Features:

o Excessive introversion combined with pervasive social and interpersonal deficits

(similar to schizoid).

o Cognitive and perceptual distortions along with oddities and eccentricities in

communication and behavior.

o Maintains contact with reality, but shows highly personalized, superstitious

thinking.

o May experience transient psychotic symptoms under extreme stress.

o Belief in magical powers and engagement in magical rituals.

o Cognitive–perceptual problems include ideas of reference, odd speech, and

paranoid beliefs.

 Relation to Schizophrenia:

o Many view schizotypal personality disorder as a weakened form of schizophrenia;

odd thinking and behaviors are reminiscent of schizophrenic symptoms.

 Trait Models:

o Not fully explained by the five-factor model; core symptoms form the trait of
psychoticism (including unusual beliefs/experiences, eccentricity, and cognitive–
perceptual dysregulation).

 Causes:

o Biological Factors:

 Moderate heritability; similar deficits (tracking moving targets, attention,

working memory) seen in schizophrenia.

 Some teenagers with schizotypal traits are at increased risk for

schizophrenia-spectrum disorders.

o Environmental Factors:

 A possible subtype linked to childhood abuse and early trauma.

 Associated with elevated exposure to stressful life events and low family
socioeconomic status in adolescence.
Histrionic Personality Disorder

 Core Features:

o Excessive attention-seeking and emotionality.

o Feelings of being unappreciated unless the center of attention.

o Lively, dramatic, and overtly extraverted behaviors that charm others

temporarily.

o Theatrical, emotionally expressive, and often sexually provocative or seductive

behavior.

o Attempts to control partners through seduction and emotional manipulation.

o Shows dependence and vague, impressionistic speech.

o Generally seen as self-centered, vain, overly reactive, shallow, and insincere.

 Comorbidity:

o Highly comorbid with borderline, antisocial, narcissistic, and dependent

personality disorders.

 Five-Factor Model Correlates:

o Very high levels of extraversion (gregariousness, excitement seeking, positive

emotions).

o High neuroticism (depression, self-consciousness) and high openness to

fantasies.

 Causes:

o Biological Factors:

 Some evidence for a genetic link with antisocial personality disorder.

o Cognitive Factors:

 Maladaptive schemas based on the need for attention to validate self-

worth (e.g., “Unless I captivate people, I am nothing” or “If I can’t
entertain people, they will abandon me”).
Narcissistic Personality Disorder

 Core Features:

o Exaggerated sense of self-importance and preoccupation with being admired.

o Lack of empathy for others.

 Subtypes:

o Grandiose Narcissism:

 Overestimation of abilities and accomplishments; underestimation of

others’.

 Stereotypically self-referential and bragging.

 Sense of entitlement; believes only high-status people can understand

them.

 Unwilling to forgive and quick to take offense.

o Vulnerable Narcissism:

 Fragile, unstable self-esteem hidden behind arrogance and

condescension.

 Intense shame and hypersensitivity to rejection or criticism.

 Preoccupied with outstanding achievements yet deeply insecure; may

avoid relationships due to fear of rejection.

o Some individuals may fluctuate between grandiosity and vulnerability.

 Five-Factor Model Correlates:

o Both subtypes exhibit high interpersonal antagonism (low modesty, arrogance,

grandiosity, superiority) and low altruism.

o Grandiose narcissists are exceptionally low in certain facets of neuroticism and

high in extraversion, while vulnerable narcissists show very high
neuroticism/negative affectivity.

 Causes:

o Grandiose Narcissism:

 Associated with parental overvaluation.

 o Vulnerable Narcissism:

 Associated with histories of emotional, physical, or sexual abuse and with

intrusive, controlling, and cold parenting styles.

Antisocial Personality Disorder (ASPD)

 Core Features:

o Persistent disregard for and violation of the rights of others through deceitful,
aggressive, or antisocial behavior.

o Lack of remorse or loyalty; unsocialized and irresponsible behavior with little

regard for personal or others’ safety.

o Tendency to be impulsive, irritable, and aggressive.

o Requires a history of conduct disorder symptoms (aggression, property

destruction, deceitfulness/theft, serious rule violations) before age 15.

 Causes:

o Biological Factors:

 Moderate heritability; strong common genetic vulnerability shared with

other externalizing disorders (e.g., alcohol/drug dependence, conduct
disorder).

o Environmental Factors:

 Adopted-away children with biological risk are more likely to develop

ASPD if raised in adverse environments (e.g., marital conflict, divorce,
legal problems, parental psychopathology) versus more stable
environments.

Borderline Personality Disorder (BPD)

 Core Features:

o Marked by impulsivity and instability in interpersonal relationships, self-image,

and mood.

o Affective Instability:
  Unusually intense emotional responses to environmental triggers with
slow recovery to baseline.

 Drastic, rapid shifts from one emotion to another.

o Unstable Self-Image:

 A fragmented or impoverished sense of self.

o Impulsivity:

 Rapid, unconsidered responses to triggers; may lead to self-destructive

behaviors such as self-mutilation, gambling, or reckless driving.

o Interpersonal Instability:

 Stormy, intense relationships characterized by overidealization followed

by disillusionment and anger.

o Cognitive Symptoms:

 Transient episodes of being out of touch with reality, including delusions,

hallucinations, paranoid ideas, or dissociative symptoms.

 Causes:

o Genetic Factors:

 Significant heritability for traits such as affective instability and

impulsivity.

o Biological Factors:

 Lowered functioning of serotonin (leading to impulsive-aggressive

behavior) and disturbances in noradrenergic regulation.

o Psychosocial/Environmental Factors:

 Childhood adversity and maltreatment (abuse, neglect, separation, or

loss) are commonly reported, though research findings have limitations
regarding causality.

Avoidant Personality Disorder

 Core Features:

o Extreme social inhibition and introversion resulting in limited social relationships.

 o Intense feelings of ineptitude and social inadequacy.

o Hypersensitivity to criticism and fear of rejection, though desiring affection.

o Chronic feelings of loneliness and boredom.

o Generalized timidity and avoidance of novel situations and emotions, including

positive ones.

o Low self-esteem and excessive self-consciousness, often accompanied by

depression.

 Relation to Social Phobia:

o Some researchers view avoidant personality disorder as a more severe

manifestation of generalized social phobia due to substantial overlap.

 Five-Factor Model Correlates:

o Elevated introversion and neuroticism.

 Causes:

o Biological Factors:

 May stem from an innate “inhibited” temperament; traits show modest

genetic influence and share vulnerability with social phobia.

 The fear of negative evaluation is moderately heritable.

o Environmental Factors:

 May develop in children who experience emotional abuse, rejection, or

humiliation from unaffectionate parents.

Dependent Personality Disorder

 Core Features:

o Extreme need to be taken care of, leading to clinging and submissive behavior.

o Acute fear of separation or being alone, perceiving oneself as inept.

o Life organized around others, often subordinating personal needs to maintain

relationships.
 o Difficulty expressing anger for fear of losing support, sometimes resulting in
remaining in abusive relationships.

o Inability to make even simple decisions without extensive advice and

reassurance, reflecting low self-confidence and helplessness despite adequate
competencies.

o Function well only when not required to be alone.

 Comorbidity:

o Often co-occurs with mood disorders, anxiety disorders, and eating disorders.

 Five-Factor Model Correlates:

o Associated with high neuroticism and high agreeableness.

 Causes:

o Biological Factors:

 Modest genetic influence on traits such as neuroticism and

agreeableness.

o Environmental Factors:

 Parental styles (authoritarian and overprotective) may foster reliance on

others and a belief in personal incompetence.

o Cognitive Factors:

 Maladaptive schemas include core beliefs like “I am completely helpless”

and “I can function only if I have access to somebody competent.”

Obsessive-Compulsive Personality Disorder (OCPD)

 Core Features:

o Preoccupation with perfectionism, order, and control.

o Excessive attention to rules, order, and schedules to maintain mental and

interpersonal control.

o Rigidity, stubbornness, and inflexibility; reluctance to delegate tasks.

o Tendency to focus on trivial details at the expense of seeing the larger picture,
leading to inefficiency and unfinished projects.
 o Devotion to work to the exclusion of leisure, with difficulty relaxing.

o Perceived by others as cold and overly controlling.

 Differences from OCD:

o Lacks true obsessions or compulsions that cause extreme distress; instead, it is

characterized by a lifestyle of overconscientiousness and perfectionism.

o Individuals with OCD are more likely to have comorbid avoidant or dependent
personality disorders.

 Five-Factor/Dimensional Approaches:

o According to the five-factor model, individuals exhibit excessively high

conscientiousness, high assertiveness (facet of extraversion), and low compliance
(facet of agreeableness).

o Cloninger’s dimensions:

 Low novelty seeking (avoidance of change)

 Low reward dependence (excessive work at the expense of pleasure)

 High harm avoidance (strong response to aversive stimuli).

 Causes:

o Biological Factors:

 OCPD traits show a modest genetic influence.

o Environmental Factors:

 Family history of personality disorders, anxiety, or depression; childhood

trauma (including abuse) that promotes the belief that perfection is
necessary for survival; pre-existing mental health conditions, especially
anxiety.
 MODULE 4

Mood Disorders Overview

 Definition:

o Disturbances of mood that are intense, persistent, and clearly maladaptive.

o Involve extreme variations in mood that interfere with normal functioning.

  Key Mood States:

o Mania:

 Characterized by intense, unrealistic feelings of excitement and euphoria.

 May include irritability or even violent outbursts when thwarted.

o Depression:

 Marked by extraordinary sadness and dejection.

o Hypomania:

 A milder form of mania with similar symptoms (elevated mood, inflated

self-esteem, decreased need for sleep, racing thoughts) but with less
impairment and no hospitalization requirement.

 Clinical Presentations:

o Some individuals experience only depressive episodes.

o Others cycle between manic (or hypomanic) and depressive episodes.

o In some cases, normal mood states occur between episodes.

o Mixed Episodes:

 Simultaneous symptoms of mania and depression; rapid alternation

between moods (e.g., sadness, euphoria, irritability) during the same
episode.

 Types of Mood Disorders:

o Unipolar Depressive Disorders:

 Only depressive episodes occur (e.g., Major Depressive Disorder).

o Bipolar and Related Disorders:

 Both manic (or hypomanic) and depressive episodes occur (e.g., Bipolar I,
Bipolar II, Cyclothymia).

Major Depressive Disorder (MDD)

 Definition:

o A moderate-to-severe mood disorder involving only major depressive episodes.

 o Also known as unipolar major depression.

 Diagnostic Criteria:

o Must experience either a markedly depressed mood or a significant loss of

interest in pleasurable activities nearly every day for at least two consecutive
weeks.

o No history of manic, hypomanic, or mixed episodes.

o Often specified as a first/single episode or recurrent episodes.

 Special Note:

o Even infants may show a form of depression (formerly known as anaclitic

depression) when separated for prolonged periods from their attachment figure.

 Causes – Biological Factors:

o Moderate genetic contribution.

o Deficiencies in neurotransmitters:

 Norepinephrine and Serotonin: Involved in regulating behavior, stress,

emotional expression, appetite, sleep, and arousal.

 Dopamine: Reduced activity may impair the experience of pleasure.

o Elevated cortisol levels.

o Dysregulation of the immune system and activation of the inflammatory

response.

o Brain abnormalities:

 Damage or lowered activity (especially in the left anterior prefrontal

cortex).

 Sleep problems (early morning awakening, difficulty falling asleep, etc.).

o Circadian rhythm dysfunction:

 Either a blunted magnitude or desynchronization of normally

synchronized rhythms.

o In some high-risk women, hormonal fluctuations may trigger episodes.

 Causes – Environmental Factors:

 o Serious childhood family problems and anxious personality traits in childhood.

o Seasonal influences (depression in fall/winter with normalization in

spring/summer).

o Severely stressful life events (loss of a loved one, relationship or occupational

threats, severe economic/health problems).

o Stress may be exacerbated by poor interpersonal problem-solving leading to

additional stressful events.

Bipolar Disorders (I and II)

 Definition:

o Also known as manic-depressive illness.

o Involve both manic (or hypomanic) and depressive episodes.

 Bipolar I Disorder:

o Manic episodes that may include mixed features (simultaneous manic and
depressive symptoms).

o Diagnosis is given even if depressive periods do not meet full criteria for a major
depressive episode.

 Bipolar II Disorder:

o Characterized by clear-cut hypomanic episodes along with major depressive

episodes.

 Common Features:

o Typically recurrent; single episodes are rare.

o Manic/hypomanic episodes tend to be of shorter duration than depressive

episodes.

o Episodes may occur with intervals of relatively normal functioning and can be
seasonal (leading to a “seasonal pattern” diagnosis).

 Causes – Biological Factors:

o Greater genetic contribution in bipolar I disorder compared to unipolar

depression.
 o Neurotransmitter Imbalances:

 Excess norepinephrine or serotonin may trigger mania (although

serotonin may be low in both phases).

 Increased dopaminergic activity in certain brain areas is linked to manic

symptoms (hyperactivity, grandiosity, euphoria).

 Drugs such as cocaine (increase dopamine) can produce manic-like

behavior; lithium reduces dopaminergic activity and is antimanic.

o Cortisol levels are elevated during bipolar depression but usually not during
mania.

o Variations in brain glucose metabolic rates (reduced blood flow to the left
prefrontal cortex during depression, increased in other regions during mania).

o Disturbances in biological rhythms (e.g., sleep patterns):

 Minimal sleep during mania (by choice rather than insomnia);

hypersomnia during depression; even interepisode periods may show
insomnia.

 Causes – Environmental Factors:

o Stressful life events can precipitate both manic and depressive episodes.

o Poor social support and other adverse social environmental variables may affect
the course.

Cyclothymic Disorder

 Definition:

o A mild mood disorder characterized by cyclical hypomanic and depressive

symptoms that are less severe than in bipolar disorder.

o The cyclical mood changes persist for at least 2 years.

 Symptom Characteristics:

o Depressive Phase:

 Dejection, loss of interest in customary activities, low energy, feelings of

inadequacy, social withdrawal, and a pessimistic, brooding attitude.
 o Hypomanic Phase:

 Increased physical and mental energy, often associated with enhanced

creativity and productivity.

 Risk:

o Individuals with cyclothymia are at a greatly increased risk for later developing
full-blown bipolar I or II disorder.

Psychotic Disorders Overview

Schizophrenia

 Definition:

o A severe disorder marked by significant impairments in functioning and a

profound loss of contact with reality (psychosis).

 Key Symptoms:

o Delusions:

 Fixed, false beliefs resistant to contradictory evidence.

 Common themes include:

 Thought control (belief that one’s thoughts or actions are

controlled by external forces).

 Thought broadcasting, insertion, or withdrawal.

 Delusions of reference (neutral events having personal meaning).

 Delusions of bodily changes or removal of organs.

 Delusions of grandeur or persecution.

o Hallucinations:

 Sensory experiences without external stimuli; most commonly auditory

(e.g., hearing voices).

 Can occur in any sensory modality.

o Disorganized Speech:
  Speech that sounds communicative but is incoherent or lacks clear
meaning.

 May include neologisms (made-up words).

o Disorganized Behavior:

 Disruption of goal-directed activities; impairment in daily functioning

(work, social relations, self-care).

 May manifest as unusual or inappropriate dress, silliness, or neglect of

personal hygiene.

o Catatonia:

 Severe disturbance where a patient may show near-complete absence of

movement and speech (catatonic stupor) or hold unusual postures.

o Positive Symptoms:

 Excesses or distortions of normal behavior (e.g., delusions,

hallucinations).

o Negative Symptoms:

 Deficits or absences of normal behaviors (e.g., flat affect, alogia [poverty

of speech], avolition [lack of goal-directed activity]).

 A preponderance of negative symptoms is associated with a poorer

prognosis.

 Causes – Biological Factors:

o Moderate genetic heritability with risk increasing with the closeness of blood
relationship.

o Maternal infections during fetal development (e.g., rubella, toxoplasmosis) and

prenatal nutritional deficiencies increase risk.

o Maternal stress during early pregnancy may elevate risk.

o Abnormalities in brain structure and function, including dysfunctions in

dopamine and glutamate neurotransmission.

o Attentional dysfunctions may indicate a biological susceptibility.

 Causes – Environmental Factors:

 o Family disturbances and communication problems may result from, rather than
cause, schizophrenia.

o Urban upbringing increases risk.

o Recent immigrants show higher risks, possibly due to cultural misunderstandings

or stress.

o Increased rates of cannabis use among patients with schizophrenia (though most
cannabis users do not develop the disorder).

Schizoaffective Disorder

 Definition:

o A psychotic disorder in which symptoms of schizophrenia co-occur with

significant mood disorder symptoms.

o Mood symptoms must meet criteria for a full major mood episode and be
present for more than 50% of the total duration of the illness.

 Diagnostic Considerations:

o The diagnosis lies between that of schizophrenia and mood disorders.

o Reliability has been an issue, but DSM-5 clarifies mood symptom duration to
improve consistency.

 Causes:

o Likely a combination of stressful or traumatic life events, childhood trauma, brain

chemistry, and genetics.

Schizophreniform Disorder

 Definition:

o Schizophrenia-like psychosis lasting at least 1 month but less than 6 months.

 Prognosis:

o Generally better than established schizophrenia due to the possibility of early

recovery.

 Causes:
 o Thought to involve a combination of genetic, biochemical (neurotransmitter
imbalances), and environmental factors (e.g., poor social interactions, highly
stressful events).

Delusional Disorder

 Definition:

o Characterized by fixed false beliefs (delusions) that are bizarre or non-bizarre, yet
the individual’s behavior is relatively normal otherwise.

 Subtype – Erotomania:

o Involves delusions centered on an intense love for a person of higher status; may
be linked to stalking behaviors.

 Causes:

o Not yet fully understood; may include genetic factors, brain abnormalities, and
environmental influences such as social isolation, envy, distrust, suspicion, and
low self-esteem.

OTHER IMPORTANT COMPARISONS AND DIFFERENCES

Schizoid Personality Disorder vs. Avoidant Personality Disorder

 Schizoid Personality Disorder:

o Inability or lack of interest in forming social relationships.

o Individuals are aloof, cold, and indifferent to criticism.

o They enjoy their aloneness.

 Avoidant Personality Disorder:

o Extreme social inhibition and introversion leading to limited relationships.

o Individuals are shy, insecure, and hypersensitive to criticism.

o They do not enjoy their aloneness and avoid social interactions due to fear of
negative evaluation.
Dependent Personality Disorder vs. Borderline and Histrionic Personality Disorders

 Borderline vs. Dependent:

o Borderline:

 Fear of abandonment accompanied by intense, stormy relationships; may

react with emptiness or rage when abandoned.

o Dependent:

 Fear of separation leads to submissive and appeasing behavior; urgency

to find a new relationship when abandonment occurs.

 Histrionic vs. Dependent:

o Histrionic:

 Strong need for attention; flamboyant, gregarious, and actively

demanding of attention.

o Dependent:

 Need for reassurance and approval; more docile, self-effacing, and reliant
on others.

 Dependent vs. Avoidant:

o Avoidant:

 Difficulty initiating relationships due to fear of criticism or rejection.

o Dependent:

 Difficulty separating from relationships due to feelings of incompetence

and a need for care.

Obsessive-Compulsive Disorder (OCD) vs. Obsessive-Compulsive Personality Disorder (OCPD)

 OCD:

o Characterized by unwanted, intrusive obsessive thoughts or images and

compulsive behaviors performed to neutralize these thoughts or prevent
dreaded outcomes.

o Patients feel driven to perform these rituals with rigid rules.

  OCPD:

o A personality disorder marked by perfectionism, excessive concern with order

and control, overconscientiousness, inflexibility, and perfectionism.

o Lifestyles are characterized by devotion to work and rigid behavior rather than
true obsessions or compulsions that cause extreme distress.

Social Anxiety Disorder vs. Avoidant Personality Disorder

 Social Anxiety Disorder:

o An anxiety disorder with disabling fears of one or more specific social situations
(e.g., public speaking, eating around others).

o Patients tend to avoid specific social situations but may otherwise interact
socially.

 Avoidant Personality Disorder:

o A personality disorder with extreme social inhibition and a pervasive fear of

criticism or rejection, leading to avoidance of almost all social interactions and
novel situations.

o Individuals may desire social contact but avoid it due to deep-seated fears and a
strong sense of inadequacy.