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Table of Contents Preface About the Authors 1: Examples and Definitions of Abnormal Behavior Overview Case Study: A Husband's Paranoid Schizophrenia Recognizing the Presence of Disorder Defining Abnormal Behavior Harmful Dysfunction Critical Thinking Matters: Is Sexual Addiction a Meaningful Concept? Cultural and Diagnostic Practice Who Experiences Abnormal Behavior? Case Study: A college Student's Eating Disorder Frequency in and Impact on Community Populations Cross-cultural Comparisons The Mental Health Professions Psychopathology in Historical Context The Greek Tradition in Medicine Creation of the Asylum Worcester Lunatic Hospital: A Model Institution Lessons from the History of Psychopathology Methods for the Scientific Study of Mental Disorders Research Methods: The Null Hypothesis and the Burden of Proof Uses and Limitations of Case Studies Clinical Research Methods Getting Help 2: Causes of Abnormal Behavior Chapter Outline Chapter Opening Questions Overview Case Study: Meghan's Many Hardships Brief Historical Perspective: Twentieth-Century Paradigms The Biological Paradigm The Psychodynamic Paradigm The Cognitive Behavioral Paradigm The Humanistic Paradigm The Problem with Paradigms Systems Theory Holism Reductionism Levels of Analysis Causality Equifinality and Multifinality Reciprocal Causality The Diathesis-Stress Model Developmental Psychopathology Biological Factors The Neuron and Neurotransmitters Neurotransmitters and Psychopathology Major Brain Structures Cerebral Hemispheres Major Brain Structures and Psychopathology Psychophysiology Endocrine System Autonomic Nervous System Psychophysiology and Psychopathology Behavior Genetics Some Basic Principles of Genetics Family Incidence Studies Twin Studies Adoption Studies Misinterpreting Behavior Genetics Findings Genetics and Psychopathology Psychological Factors Human Nature and Temperament Evolutionary Psychology Attachment Theory Dominance Temperament Emotions Learning and Cognition Modeling Cognition and Social Cognition The Sense of Self Stages of Development Social Factors Relationships and Psychopathology Marital Status and Psychopathology Social Relationships Gender and Gender Roles Prejudice and Poverty Societal Values Summary Critical Thinking Key Terms Research Methods: Does Psychology Make You Smarter? Further Thoughts: Mind-Body Dualism Critical Thinking Matters: Do Vaccinations Cause Autism? Getting Help 3: Treatment of Psychological Disorders Chapter Outline Chapter Opening Questions Overview Case Study: Why Is Frances Depressed? Frances and the Four Paradigms Brief Historical Perspective Biological Treatments Electroconvulsive Therapy Psychosurgery Psychopharmacology Psychodynamic Psychotherapies Freudian Psychoanalysis Psychoanalytic Techniques The Decline of Freudian Psychoanalysis Ego Analysis Psychodynamic Psychotherapy Cognitive Behavior Therapy Systematic Desensitization Other Exposure Therapies Aversion Therapy Contingency Management Social Skills Training Cognitive Techniques Beck's Cognitive Therapy Rational-Emotive Therapy Integration and Research Humanistic Therapies Client-Centered Therapy A Means, Not an End? Research on Psychotherapy Does Psychotherapy Work? Do People Improve without Treatment? The Placebo Effect Placebo Control Groups Efficacy and Effectiveness When Does Psychotherapy Work? Psychotherapy Process Research Common Factors Therapy as Social Support Therapy as Social Influence Couples, Family, and Group Therapy Couples Therapy Family Therapy Group Therapy Prevention Specific Treatments for Specific Disorders Summary Critical Thinking Key Terms Further Thoughts: Ethnic Minorities in Psychotherapy Research Methods: Does Therapy Work? Critical Thinking Matters: Are All Therapies Created Equal? Further Thoughts: The Allegiance Effect Getting Help 4: Classification and Assessment of Abnormal Behavior Overview Case Study: Obsessions, Compulsions, and Other Unusual Behaviors Basic Issues in Classification Categories versus Dimensions From Description to Theory Classifying Abnormal Behavior Brief Historical Perspective Labeling Theory The DSM-IV-TR System Culture and Classification Evaluating Classification Systems Reliability Validity Research Methods: Diagnostic Reliability Unresolved Questions Problems and Limitations of the DSM-IV-TR System Basic Issues in Assessment Purposes of Clinical Assessment Assumptions About Consistency of Behavior Evaluating the Usefulness of Assessment Procedures Critical Thinking Matters: Should We Always Trust Clinical Judgments? Types of Assessment Procedures Assessing Psychological Systems Interviews Observational Procedures Personality Tests and Self-Report Inventories Projective Personality Tests Assessing Social Systems Assessing Biological Systems Psychophysiological Assessment Brain Imaging Techniques Getting Help 5: Mood Disorders and Suicide Overview Case Study: An attorney's major depressive episode Case Study: Debbie's manic episode Symptoms Emotional symptoms Cognitive symptoms Somatic symptoms Behavioral symptoms Other problems commonly associated with depression Diagnosis Brief historical perspective Contemporary diagnostic systems Course and outcome Frequency Incidence and prevalence Gender differences Cross-cultural differences Risk for mood disorders across the life-span Comparisons across generations Causes Social factors Psychological factors Biological factors The Interaction of social, psychological, and biological factors Research Methods: Analogue Studies of Psychopathology Treatment Unipolar disorders Critical Thinking Matters: Do Anti-Depressant Drugs Cause Violent Behavior? Bipolar disorders Electroconvulsive Therapy Seasonal mood disorders Suicide Brief Case Study: An Admiral's Suicide Classification of suicide Frequency of suicide Causes of suicide Common Elements of Suicide Treatment of suicidal people Getting Help 6: Anxiety Disorders Overview Case study: A writer's panic disorder with agoraphobia Symptoms Anxiety Excessive worry Panic attacks Phobias Obsessions and compulsions Case study: Ed's obsessive-compulsive disorder Diagnosis Brief historical perspective Contemporary diagnostic systems "Lumpers" and "Splitters" Course and Outcome Frequency Prevalence Comorbidity Gender differences Anxiety across the lifespan Cross-cultural comparisons Causes Adaptive and maladaptive fears Social factors Psychological factors Biological factors Critical Thinking Matters: Can a Strep Infection Trigger OCD in Children? Treatment Brief Case Study: Ed's Treatment Psychological interventions Research Methods: Statistical Significance and Clinical Iimportance Biological interventions Getting Help 7: Acute and Posttraumatic Stress Disorders, Dissociative Disorders, and Somatoform Disorders Chapter Outline Chapter Opening Questions Overview Acute and Posttraumatic Stress Disorders Case Study: Sexual Assault and Stephanie's PTSD Symptoms of ASD and PTSD Reexperiencing Avoidance Arousal or Anxiety Dissociative Symptoms Diagnosis of ASD and PTSD Brief Historical Perspective Contemporary Classification Frequency of Trauma, PTSD, and ASD Trauma and PTSD Are Not Random Course and Outcome Causes of PTSD and ASD Social Factors in ASD and PTSD Biological Factors in ASD and PTSD Psychological Factors in ASD and PTSD Integration and Alternative Pathways Prevention and Treatment of ASD and PTSD Emergency Help for Trauma Victims Treatment of ASD Cognitive Behavior Therapy for PTSD EMDR Antidepressant Medication Dissociative Disorders Case Study: Dissociative Fugue: Dallae's Journey Hysteria and the Unconscious Charcot, Freud, and Janet Cognitive Science and the Unconscious Hypnosis: Altered State or Social Role? Symptoms of Dissociative Disorders Trauma and Dissociative Symptoms Diagnosis of Dissociative Disorders Brief Historical Perspective Contemporary Classification Brief Case Study: A New York City Firefighter's Amnesia for September 11 Brief Case Study: The Three Faces of Eve Frequency of Dissociative Disorders Disorder or Role Enactment? Causes of Dissociative Disorders Psychological Factors in Dissociative Disorders Biological Factors in Dissociative Disorders Social Factors in Dissociative Disorders Treatment of Dissociative Disorders Somatoform Disorders Symptoms of Somatoform Disorders Unnecessary Medical Treatment Diagnosis of Somatoform Disorders Conversion Disorder Brief Case Study: Janet's Patient Somatization Disorder Hypochondriasis Pain Disorder Body Dysmorphic Disorder Brief Case Study: Body Dysmorphic Disorder Malingering and Factitious Disorder Frequency of Somatoform Disorders Gender, SES, and Culture Comorbidity Causes of Somatoform Disorders Biological Factors-The Perils of Diagnosis by Exclusion Psychological Factors-Imagined or Real Trauma Social Factors in Somatoform Disorders Treatment of Somatoform Disorders Summary Critical Thinking Key Terms The Trauma of Sexual Assault Critical Thinking Matters: Recovered Memories? Research Methods: Remembering the Past Getting Help 8: Stress and Physical Health Chapter Outline Challenge Questions Overview Case Study: Bob Carter's Heart Attack Defining Stress Stress as a Life Event Stress as Appraisal of Life Events Symptoms of Stress Psychophysiological Responses to Stress Adrenal Hormones Immune System Responses Illness and Chronic Stress Coping Predictability and Control Outlets for Frustration Repression Optimism Religion Health Behavior Following Medical Advice Illness Behavior Social Support Illness as a Cause of Stress Diagnosis of Stress and Physical Illness Brief Historical Perspective Contemporary Approaches The Role of Psychological Factors in Some Familiar Illnesses Cancer Acquired Immune Deficiency Syndrome (AIDS) Pain Management Sleep Disorders Cardiovascular Disease Symptoms of Hypertension and CHD Diagnosis of CVD Frequency of CVD Risk Factors for CHD Behavior and CHD Risk Factors for Hypertension Causes of CVD Biological Factors in CVD Psychological Factors in CVD Cardiovascular Reactivity to Stress Life Stressors and CVD: Job Strain Type A Behavior and Hostility Depression and Anxiety Social Factors in CVD Integration and Alternative Pathways Prevention and Treatment of CVD Primary Prevention Secondary Prevention Tertiary Prevention Summary Critical Thinking Key Terms Tend and Befriend: The Female Alternative to Fight or Flight? Research Methods: Lives Over Time Critical Thinking Matters: Resilience Getting Help 9: Personality Disorders Overview Case Study: A car thief's antisocial personality disorder Symptoms Social motivation Cognitive perspectives regarding self and others Temperament and personality traits Context and personality Diagnosis Cluster A: Paranoid, schizoid, and schizotypal personality disorders Critical Thinking Matters: Do You Have to be Paranoid to Survive? Cluster B: Antisocial, borderline, histrionic, and narcissistic personality disorders Brief case study: Borderline PD Cluster C: Avoidant, Dependent, and Obsessive-compulsive personality disorders A dimensional perspective on personality disorders Brief case study: Narcissism from the perspective of the five-factor model Frequency Prevalence in community and clinical samples Research Methods: Cross-cultural comparisons Gender differences Stability of personality disorders over time Culture and personality Schizotypal Personality Disorder (SPD) Brief case study: Schizotypal personality disorder Symptoms Causes Treatment Borderline Personality Disorder (BPD) Brief case study: Borderline personality disorder Symptoms Impulse Control Disorders Causes Treatment Antisocial Personality Disorder (ASPD) Brief case study: Antisocial personality disorder Symptoms Causes Treatment Dependent Personality Disorder (DPD) Brief case study: Dependent personality disorder Symptoms Causes Treatment Getting help 10: Eating Disorders Chapter Outline Challenge Questions Overview Case Study: Serrita's Anorexia Symptoms of Anorexia Refusal to Maintain a Normal Weight Disturbance in Evaluating Weight or Shape Fear of Gaining Weight Cessation of Menstruation Medical Complications Struggle for Control Comorbid Psychological Disorders Symptoms of Bulimia Case Study: Michelle's Secret Binge Eating Inappropriate Compensatory Behavior Excessive Emphasis on Weight and Shape Comorbid Psychological Disorders Medical Complications Diagnosis of Eating Disorders Brief Historical Perspective Contemporary Classification Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder and Obesity Frequency of Eating Disorders Standards of Beauty Age of Onset Causes of Eating Disorders Social Factors Troubled Family Relationships Psychological Factors A Struggle for Perfection and Control Depression, Low Self-Esteem, and Dysphoria Negative Body Image Dietary Restraint Biological Factors Integration and Alternative Pathways Treatment of Anorexia Nervosa Course and Outcome of Anorexia Nervosa Treatment of Bulimia Nervosa Antidepressant Medications Cognitive Behavior Therapy Interpersonal Psychotherapy Course and Outcome of Bulimia Nervosa Prevention of Eating Disorders Summary Critical Thinking Key Terms Critical Thinking Matters Eating Disorders in Males RESEARCH METHODS: What is a Psychotherapy Placebo? Getting Help 11: Substance Use Disorders Overview Case study: Ernest Hemingway's alcohol dependence Symptoms The concept of substance dependence Alcohol Nicotine Amphetamine and cocaine Opiates Brief case study: Feelings after injecting heroin Barbiturates and benzodiazepines Cannabis Hallucinogens and related drugs Diagnosis Brief history of legal and illegal substances DSM-IV-TR Proposed subtypes Course and outcome Other disorders commonly associated with addictions Frequency Prevalence of alcohol abuse and dependence Gender differences Prevalence of drug and nicotine dependence Critical Thinking Matters: Should tobacco products be illegal? Risk for addiction across the life span Brief case study: Ms. E's drinking Causes Social factors Biological factors Psychological factors Research Methods: Risk, Risk Factors, and Studies of High-Risk Samples Integrated systems Treatment Detoxification Medications during remission Self-help groups: Alcoholics Anonymous Cognitive behavior therapy Brief Case Study: Relapse to Heroin Use Outcome results and general conclusions Getting help 12: Sexual and Gender Identity Disorders Overview Case study: Margaret and Bill's sexual communication Brief historical perspective Sexual Dysfunctions Symptoms Diagnosis Brief case study: sexual aversion disorder Brief case study: male erectile disorder Research Methods: Hypothetical constructs, or "What is sexual arousal?" Brief case study: Genital pain Frequency Causes Brief case study: Vaginismus and alcohol dependence Treatment Critical Thinking Matters: Does medication cure sexual dysfunction? Paraphilias Symptoms Brief case study: Paraphilia Diagnosis Brief case study: Masochism The Classification of Rapists Frequency Causes Treatment Gender Identity Disorders Symptoms Frequency Causes Treatment Getting Help 13: Schizophrenic Disorders Overview Case study: A new mother's paranoid schizophrenia Case study: Edward's disorganized schizophrenia Symptoms Positive symptoms Negative symptoms Disorganization Case study: Marsha's disorganized speech and bizarre behavior Diagnosis Brief historical perspective DSM-IV-TR Subtypes Critical Thinking Matters: Are symptom-based subtypes of schizophrenia useful? Related psychotic disorders Course and outcome Frequency Gender differences Cross-cultural comparisons Causes Biological Factors Social factors Psychological factors Integration and multiple pathways Research methods: Comparison groups in psychopathology research The search for markers of vulnerability Treatment Antipsychotic medication Psychosocial treatment Getting Help 14: Dementia, Delirium, and Amnestic Disorders Overview Case study: A physician's developing dementia Case study: Dementia and delirium - a niece's terrible discoveries Symptoms Delirium Dementia Cognitive symptoms Memory changes in normal aging Amnestic disorder Case study: Alcohol-induced persisting amnestic disorder - 19 going on 45 Diagnosis Brief historical perspective Specific disorders associated with dementia Critical Thinking Matters: How Can Clinicians Establish an Early Diagnosis of Research Methods: Gene Identification Frequency of Delirium and Dementia Prevalence of dementia Prevalence of subtypes of dementia Cross-cultural comparisons Causes Delirium Dementia Treatment and Management Medication Environmental and behavioral management Support for caregivers Getting help 15: Mental Retardation and Pervasive Developmental Disorders Chapter Outline Challenge Questions Overview Mental Retardation Case Study: Should This Mother Raise Her Children? Symptoms of Mental Retardation Significantly Subaverage IQ Limitations in Adaptive Skills Onset Before Age 18 Years Diagnosis of Mental Retardation Early Diagnostic Efforts Contemporary Diagnosis Axis II and Co-Morbid Psychological Problems Frequency of Mental Retardation Causes of Mental Retardation Biological Factors Psychological Factors Social Factors Treatment: Prevention and Normalization Primary Prevention Secondary Prevention Tertiary Prevention Normalization Autistic Disorder and Pervasive Developmental Disorders Case Study: Temple Grandin: An Anthropologist on Mars Symptoms of PDD Early Onset Impaired Communication Impaired Social Interaction Stereotyped Behavior, Interests, and Activities Apparent Sensory Deficits Self-Injury Savant Performance Diagnosis of Autism and PDD Brief Historical Perspective Contemporary Classification Frequency of Autism and PDD Causes of Autism Psychological and Social Factors Biological Factors Treatment of PDD Course and Outcome Medication Applied Behavior Analysis Summary Key Terms Research Methods: What Do IQ Scores Mean? Eugenics: Our History of Shame Critical Thinking Matters: The Bogus Treatment Called Facilitated Communication Getting Help 16: Psychological Disorders of Childhood Chapter Outline Challenge Questions Overview Externalizing Disorders Case Study: Bad Boy, Troubled Boy, or All Boy? Symptoms of Externalizing Disorders Rule Violations Negativity, Anger, and Aggression Impulsivity Hyperactivity Attention Deficits Diagnosis of Externalizing Disorders Brief Historical Perspective Attention-Deficit/Hyperactivity Disorder Oppositional Defiant Disorder ADHD Versus ODD Comorbidity Subtypes of ADHD Conduct Disorder Frequency of Externalizing Disorders Family Risk Factors Causes of Externalizing Disorders Biological Factors Social Factors Brief Case Study: Ms. B's Son Psychological Factors Integration and Alternative Pathways Treatment of Externalizing Disorders Psychostimulants and ADHD Behavioral Family Therapy for ODD Treatment of Conduct Disorders and Juvenile Delinquency Course and Outcome Internalizing and Other Disorders Case Study: Turning the Tables on Tormentors Symptoms of Internalizing Disorders Depressive Symptoms Children's Fears and Anxiety Separation Anxiety Disorder and School Refusal Troubled Peer Relationships Specific Developmental Deviations Diagnosis of Internalizing and Other Disorders Brief Historical Perspective Contemporary Classification Overinclusive Listing of Disorders Contextual Classifications? Frequency of Internalizing Disorders Suicide Causes of Internalizing Disorders Biological Factors Social Factors: A Focus on Attachments Psychological Factors Treatment of Internalizing Disorders Course and Outcome Summary Critical Thinking Key Terms Research Methods: Samples and Sampling Critical Thinking Matters: ADHD's False Causes and Cures What Are Learning Disorders? Getting Help 17: Adjustment Disorders and Life-Cycle Transitions Chapter Outline Challenge Questions Overview Case Study: Left for Another Man Symptoms Diagnosis Brief Historical Perspective Contemporary Classification The Transition to Adulthood Symptoms of the Adult Transition Identity Crisis Changes in Roles and Relationships Emotional Turmoil Diagnosis of Identity Conflicts Frequency of Identity Conflicts Causes of Identity Conflicts Treatment During the Transition to Adult Life Brief Case Study: Samantha's Birth Mother Family Transitions Symptoms of Family Transitions Family Conflict Emotional Distress Cognitive Conflicts Diagnosis of Troubled Family Relationships Frequency of Family Transitions Causes of Family Transitions Psychological Factors Social Factors Biological Factors Treatment During Family Transitions Prevention Programs Couples Therapy and Family Therapy Brief Case Study: Jan and Bill: Learning to Listen Behavioral Marital Therapy Treating Individual Problems with Couples Therapy or Family Therapy Aging and the Transition to Later Life Ageism Symptoms Physical Functioning and Health Life Satisfaction, Work, and Relationships Brief Case Study: Mrs. J's Loss Grief and Bereavement Mental Health Diagnosis of Aging Frequency of Aging Causes of the Psychological Problems in Later Life Treatment of Psychological Problems in Later Life Summary Critical Thinking Key Terms Research Methods: Genes and the Environment Critical Thinking Matters: Divorce is Genetic?! Reliving the Past Getting Help 18: Mental Health and the Law Chapter Outline Challenge Questions Overview Case Study: John Hinckley and the Insanity Defense Expert Witnesses Free Will versus Determinism Rights and Responsibilities Mental Illness and Criminal Responsibility The Insanity Defense M'Naghten Test Irresistible Impulse and the Product Test Legislative Actions Guilty but Mentally ill Burden of Proof Defining "Mental Disease or Defect" Use of the Insanity Defense Competence to Stand Trial Sentencing and Mental Health Mental Retardation Sexual Predators Mental Health and Civil Law A Brief History of U.S. Mental Hospitals Libertarianism Versus Paternalism in Treating Mental Patients Civil Commitment Grounds and Procedures Predicting Dangerousness and Suicidal Risk Commitment of Minors The Rights of Mental Patients The Right to Treatment Treatment in the Least Restrictive Alternative Environment The Right to Refuse Treatment Almost a Revolution Deinstitutionalization The Case for Paternalism Mental Health and Family Law Children, Parents, and the State Child Custody Disputes Expert Witnesses in Custody Determinations Divorce Mediation Brief Case Study: A Custody Dispute Child Abuse Professional Responsibilities and the Law Professional Negligence and Malpractice Informed Consent on Alternative Treatments Confidentiality The Duty to Warn Summary Critical Thinking Key Terms The Battered Woman Syndrome as a Defense Critical Thinking Matters: Violence and Mental Illness Research Methods: Justice Blackman's Error Getting Help
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