NORMAL OR ABNORMAL
Lauryn Igwe – Clinical Psychology
1 APRIL 2020
ERASMUS SCHOOL OF SOCIAL AND BEHAVIOURAL SCIENCES
Psychology
,Inhoud
Just Scared?..................................................................................................................................................................................................3
Summary Book chapters ..................................................................................................................................................................3
Specific phobias ..............................................................................................................................................................................4
Social phobias ..................................................................................................................................................................................5
Summary Articles ................................................................................................................................................................................7
D-cycloserine augmentation of behaviour therapy for anxiety and obsessive compulsive
disorders – Bürkner et al. (2017) ......................................................................................................................................7
Unusual Preferences? ..............................................................................................................................................................................8
Summary Book chapters ..................................................................................................................................................................8
DSM-5 ..................................................................................................................................................................................................8
Paraphilic disorders ................................................................................................................................................................... 10
Gender Dysphoria ....................................................................................................................................................................... 12
Summary Articles ............................................................................................................................................................................. 13
Toward a new understanding of mental illness – Insel (2013) .................................................................... 13
The Future of Psychology Is Here – Frank, Davidson (2017) ......................................................................... 14
Blue and Beyond .................................................................................................................................................................................... 15
Depression ........................................................................................................................................................................................... 15
Types of depression ................................................................................................................................................................... 15
Prevalence and course of depression ................................................................................................................................. 16
Theories of depression ............................................................................................................................................................. 17
Bipolar disorder ................................................................................................................................................................................ 19
Diagnosing bipolar disorder .................................................................................................................................................. 19
Prevalence of Bipolar disorder ............................................................................................................................................. 20
Theories of Bipolar Disorder ................................................................................................................................................. 20
Treatments for mood disorders ................................................................................................................................................. 21
Biological Treatments for Mood Disorders ..................................................................................................................... 21
Psychological Treatments for Mood Disorders ............................................................................................................. 23
I see, I see, What you don’t see......................................................................................................................................................... 25
Schizophrenia ..................................................................................................................................................................................... 25
Prevalence ...................................................................................................................................................................................... 25
Symptoms of schizophrenia ................................................................................................................................................... 25
Genetic and Biological Factors .............................................................................................................................................. 27
Psychosocial and Cultural Factors ....................................................................................................................................... 29
Treatments and Outcomes ...................................................................................................................................................... 30
You are what you eat ............................................................................................................................................................................ 32
Anorexia Nervosa ............................................................................................................................................................................. 32
Treatment of anorexia .............................................................................................................................................................. 33
Bulimia Nervosa ................................................................................................................................................................................ 34
Treatment of Bulimia Nervosa .............................................................................................................................................. 35
, Binge Eating-Disorder .................................................................................................................................................................... 35
Treatment of Binge Eating Disorder ................................................................................................................................... 36
General info and risk factors ....................................................................................................................................................... 36
Comorbidity ................................................................................................................................................................................... 37
Biological factors ......................................................................................................................................................................... 37
Sociocultural Factors ................................................................................................................................................................. 38
Family influences ........................................................................................................................................................................ 38
Individual Risk Factors ............................................................................................................................................................. 38
Summary Articles ............................................................................................................................................................................. 39
Selective visual attention for ugly and beautiful body parts in eating disorders – Jansen,
Nederkoorn (2005) ................................................................................................................................................................. 39
Lost in the labyrinth ............................................................................................................................................................................. 40
Neurocognitive disorders ............................................................................................................................................................. 40
Cognitive impairments ............................................................................................................................................................. 40
Delirium........................................................................................................................................................................................... 41
Major/minor neurocognitive disorder .............................................................................................................................. 42
Treatment and rehabilitation ................................................................................................................................................ 46
Young, fast and wild .............................................................................................................................................................................. 49
Attention Deficit Hyperactivity Disorder (ADHD) ............................................................................................................. 49
Factors behind ADHD ................................................................................................................................................................ 49
Summary article ................................................................................................................................................................................ 50
Non-pharmacological treatments for ADHD – S. Young, M. Amarasinghe .............................................. 50
Autism Spectrum Disorder (ASD) ............................................................................................................................................. 52
Characteristics of ASD ............................................................................................................................................................... 52
Factors behind ASD .................................................................................................................................................................... 53
Intervention and treatment of ASD ..................................................................................................................................... 55
Weekly Lecture Notes .......................................................................................................................................................................... 56
Opening lecture – Normal or Abnormal ........................................................................................................................... 56
Determining abnormality ........................................................................................................................................................ 56
Lecture 2 – Autism Spectrum Disorder Diagnosis & Treatment ........................................................................ 57
Diagnosis ......................................................................................................................................................................................... 57
Treatment ....................................................................................................................................................................................... 58
Lecture 3 – Clinical cases ........................................................................................................................................................... 59
Diagnosing ...................................................................................................................................................................................... 59
Treatment ....................................................................................................................................................................................... 59
Lecture 4 – Depression and anxiety among students ............................................................................................... 59
,Just Scared?
Summary Book chapters
Anxiety is apprehension about possible future danger and fear is an alarm reaction in response to actual
immediate danger. Anxiety disorders share obvious symptoms of clinically significant fear or anxiety.
A panic attack is the fear response that occurs in the absence of any obvious external danger. The three
components of a panic attack are:
1. Cognitive component: feeling afraid
2. Physiological component: increased heart rate
3. Behavioural component: urge to flee
Mostly people with anxiety disorders will experience at least one other anxiety disorder/depression
concurrently or at a different point in life.
Neuroticism is a personality trait that manifest common genetic vulnerability to anxiety disorders.
Exposure therapy is when clients are
encouraged to expose themselves to their feared
situations till their fear subsides. The participant
modelling version is when the therapist first
models the interaction, then the clients learn that
these situations are not so frightening.
Cognitive restructuring techniques and
medication is also used, however exposure based
therapy works best.
Phobia is disproportionate fear of specific situations/objects that are not necessarily dangerous. There
are three phobia categories: specific phobia, social phobia, agoraphobia
,Specific phobias
Specific phobia is when there is an immediate fear response triggered by the presence of a specific object
or situation. Because of this, they try hard to avoid encounters with their stimuli – phobic behaviour.
Phobic behaviour is reinforced as when the person avoids their
stimuli, their anxiety decreases. Furthermore, increased attention,
sympathy and control over others’ behaviour when suffering from
phobia also reinforces this phobia.
Lifetime prevalence of phobia is about 12% and it is more common
in women than men.
One such phobia is blood-injection injury phobia. Sufferers experience disgust and fear when
confronted with blood and injuries. They show acceleration and a dramatic drop in heart rate and blood
pressure together with nausea, dizziness or fainting which is unique to their phobia. This phobia also
seems to be very heritable. It usually begins in childhood.
DSM-5 CRITERIA
❖ The phobic object causes immediate fear or anxiety almost all the time
❖ The phobic object is being actively avoided
❖ The fear is out of proportion compared to the actual danger that is being caused by the specific object
or situation and in comparison with sociocultural context
❖ The fear and anxiety are persistent and present for more than 6 months
❖ The anxiety and avoidant behaviour cause clinical significant fear or lessened functioning
❖ The disorder can not be explained by symptoms of other mental disorders
Psychoanalytic viewpoint
The psychoanalytic view states that phobia is a defence against anxiety
from repressed impulses from the ID. The anxiety is then displaced on
external objects and situations with a symbolic relationship to the real
object of anxiety.
Learned Behaviour view
Wolpe and Rachman suggest that classical conditioning acquire for
irrational fears and phobias. Fear responses are conditioned to neutral
stimuli when these are paired with traumatic events. These phobic fears
then generalize to other similar objects.
, When a questionnaire was given, it was found that 58% of phobic
adults cited traumatic conditioning experiences as sources of
their phobia.
Phobia can also be acquired by watching a phobic person behave
fearfully to an object. This distress can result to the observer to
get that phobia – through vicarious conditioning.
Laboratory-reared monkeys were made to be afraid of snakes by
observing a wild-reared monkey behaving fearfully with snakes.
However conditioning depends on the individual. When one has
had positive experiences with an object or situation at first, it is much more difficult to develop phobia
through classical conditioning after one bad experience and also through vicarious conditioning.
On top of this the inflation effect is when negative situations occur after a conditioned fear, this fear
might be worse.
Cognition also maintain our phobia as phobic people are always on alert for their phobic objects or
situations.
Evolutionary view
This view states that human are more inclined to quickly associate certain objects to frightening and
unpleasant events. This prepared learning gave humans a selective advantage as over the course of
evolution. So, the fears are not innate, but quickly acquired. Fear is conditioned more effectively to the
fear-relevant stimuli. Then the responses can even be elicited when present subliminally.
Biological factors
Genetic and temperament variable could affect the speed and strength of conditioned fear. The serotonin-
transporter gene is linked with superior fear conditioning.
Monozygotic twins were also more likely to share animal- and situational phobias than dizygotic twins.
Furthermore, behaviourally inhibited toddlers are at higher risk of developing multiple specific phobias
by 7/8 years.
Social phobias
Social phobias are the disabling fears of one or more specific
social situations. They fear they might be exposed to negative
evaluation, therefore embarrassing or humiliating themselves.
About 12% will qualify for social phobia at some point and
only 37% will recover in 12-year period. They originate
during early/middle adolescence and 2/3 suffer from an
additional anxiety disorder.
In cognitive restructuring techniques the therapist tries to help the client to identify heir underlying
negative thoughts. Then they help with changing these thoughts and beliefs through logical reanalysis.
Lauryn Igwe – Clinical Psychology
1 APRIL 2020
ERASMUS SCHOOL OF SOCIAL AND BEHAVIOURAL SCIENCES
Psychology
,Inhoud
Just Scared?..................................................................................................................................................................................................3
Summary Book chapters ..................................................................................................................................................................3
Specific phobias ..............................................................................................................................................................................4
Social phobias ..................................................................................................................................................................................5
Summary Articles ................................................................................................................................................................................7
D-cycloserine augmentation of behaviour therapy for anxiety and obsessive compulsive
disorders – Bürkner et al. (2017) ......................................................................................................................................7
Unusual Preferences? ..............................................................................................................................................................................8
Summary Book chapters ..................................................................................................................................................................8
DSM-5 ..................................................................................................................................................................................................8
Paraphilic disorders ................................................................................................................................................................... 10
Gender Dysphoria ....................................................................................................................................................................... 12
Summary Articles ............................................................................................................................................................................. 13
Toward a new understanding of mental illness – Insel (2013) .................................................................... 13
The Future of Psychology Is Here – Frank, Davidson (2017) ......................................................................... 14
Blue and Beyond .................................................................................................................................................................................... 15
Depression ........................................................................................................................................................................................... 15
Types of depression ................................................................................................................................................................... 15
Prevalence and course of depression ................................................................................................................................. 16
Theories of depression ............................................................................................................................................................. 17
Bipolar disorder ................................................................................................................................................................................ 19
Diagnosing bipolar disorder .................................................................................................................................................. 19
Prevalence of Bipolar disorder ............................................................................................................................................. 20
Theories of Bipolar Disorder ................................................................................................................................................. 20
Treatments for mood disorders ................................................................................................................................................. 21
Biological Treatments for Mood Disorders ..................................................................................................................... 21
Psychological Treatments for Mood Disorders ............................................................................................................. 23
I see, I see, What you don’t see......................................................................................................................................................... 25
Schizophrenia ..................................................................................................................................................................................... 25
Prevalence ...................................................................................................................................................................................... 25
Symptoms of schizophrenia ................................................................................................................................................... 25
Genetic and Biological Factors .............................................................................................................................................. 27
Psychosocial and Cultural Factors ....................................................................................................................................... 29
Treatments and Outcomes ...................................................................................................................................................... 30
You are what you eat ............................................................................................................................................................................ 32
Anorexia Nervosa ............................................................................................................................................................................. 32
Treatment of anorexia .............................................................................................................................................................. 33
Bulimia Nervosa ................................................................................................................................................................................ 34
Treatment of Bulimia Nervosa .............................................................................................................................................. 35
, Binge Eating-Disorder .................................................................................................................................................................... 35
Treatment of Binge Eating Disorder ................................................................................................................................... 36
General info and risk factors ....................................................................................................................................................... 36
Comorbidity ................................................................................................................................................................................... 37
Biological factors ......................................................................................................................................................................... 37
Sociocultural Factors ................................................................................................................................................................. 38
Family influences ........................................................................................................................................................................ 38
Individual Risk Factors ............................................................................................................................................................. 38
Summary Articles ............................................................................................................................................................................. 39
Selective visual attention for ugly and beautiful body parts in eating disorders – Jansen,
Nederkoorn (2005) ................................................................................................................................................................. 39
Lost in the labyrinth ............................................................................................................................................................................. 40
Neurocognitive disorders ............................................................................................................................................................. 40
Cognitive impairments ............................................................................................................................................................. 40
Delirium........................................................................................................................................................................................... 41
Major/minor neurocognitive disorder .............................................................................................................................. 42
Treatment and rehabilitation ................................................................................................................................................ 46
Young, fast and wild .............................................................................................................................................................................. 49
Attention Deficit Hyperactivity Disorder (ADHD) ............................................................................................................. 49
Factors behind ADHD ................................................................................................................................................................ 49
Summary article ................................................................................................................................................................................ 50
Non-pharmacological treatments for ADHD – S. Young, M. Amarasinghe .............................................. 50
Autism Spectrum Disorder (ASD) ............................................................................................................................................. 52
Characteristics of ASD ............................................................................................................................................................... 52
Factors behind ASD .................................................................................................................................................................... 53
Intervention and treatment of ASD ..................................................................................................................................... 55
Weekly Lecture Notes .......................................................................................................................................................................... 56
Opening lecture – Normal or Abnormal ........................................................................................................................... 56
Determining abnormality ........................................................................................................................................................ 56
Lecture 2 – Autism Spectrum Disorder Diagnosis & Treatment ........................................................................ 57
Diagnosis ......................................................................................................................................................................................... 57
Treatment ....................................................................................................................................................................................... 58
Lecture 3 – Clinical cases ........................................................................................................................................................... 59
Diagnosing ...................................................................................................................................................................................... 59
Treatment ....................................................................................................................................................................................... 59
Lecture 4 – Depression and anxiety among students ............................................................................................... 59
,Just Scared?
Summary Book chapters
Anxiety is apprehension about possible future danger and fear is an alarm reaction in response to actual
immediate danger. Anxiety disorders share obvious symptoms of clinically significant fear or anxiety.
A panic attack is the fear response that occurs in the absence of any obvious external danger. The three
components of a panic attack are:
1. Cognitive component: feeling afraid
2. Physiological component: increased heart rate
3. Behavioural component: urge to flee
Mostly people with anxiety disorders will experience at least one other anxiety disorder/depression
concurrently or at a different point in life.
Neuroticism is a personality trait that manifest common genetic vulnerability to anxiety disorders.
Exposure therapy is when clients are
encouraged to expose themselves to their feared
situations till their fear subsides. The participant
modelling version is when the therapist first
models the interaction, then the clients learn that
these situations are not so frightening.
Cognitive restructuring techniques and
medication is also used, however exposure based
therapy works best.
Phobia is disproportionate fear of specific situations/objects that are not necessarily dangerous. There
are three phobia categories: specific phobia, social phobia, agoraphobia
,Specific phobias
Specific phobia is when there is an immediate fear response triggered by the presence of a specific object
or situation. Because of this, they try hard to avoid encounters with their stimuli – phobic behaviour.
Phobic behaviour is reinforced as when the person avoids their
stimuli, their anxiety decreases. Furthermore, increased attention,
sympathy and control over others’ behaviour when suffering from
phobia also reinforces this phobia.
Lifetime prevalence of phobia is about 12% and it is more common
in women than men.
One such phobia is blood-injection injury phobia. Sufferers experience disgust and fear when
confronted with blood and injuries. They show acceleration and a dramatic drop in heart rate and blood
pressure together with nausea, dizziness or fainting which is unique to their phobia. This phobia also
seems to be very heritable. It usually begins in childhood.
DSM-5 CRITERIA
❖ The phobic object causes immediate fear or anxiety almost all the time
❖ The phobic object is being actively avoided
❖ The fear is out of proportion compared to the actual danger that is being caused by the specific object
or situation and in comparison with sociocultural context
❖ The fear and anxiety are persistent and present for more than 6 months
❖ The anxiety and avoidant behaviour cause clinical significant fear or lessened functioning
❖ The disorder can not be explained by symptoms of other mental disorders
Psychoanalytic viewpoint
The psychoanalytic view states that phobia is a defence against anxiety
from repressed impulses from the ID. The anxiety is then displaced on
external objects and situations with a symbolic relationship to the real
object of anxiety.
Learned Behaviour view
Wolpe and Rachman suggest that classical conditioning acquire for
irrational fears and phobias. Fear responses are conditioned to neutral
stimuli when these are paired with traumatic events. These phobic fears
then generalize to other similar objects.
, When a questionnaire was given, it was found that 58% of phobic
adults cited traumatic conditioning experiences as sources of
their phobia.
Phobia can also be acquired by watching a phobic person behave
fearfully to an object. This distress can result to the observer to
get that phobia – through vicarious conditioning.
Laboratory-reared monkeys were made to be afraid of snakes by
observing a wild-reared monkey behaving fearfully with snakes.
However conditioning depends on the individual. When one has
had positive experiences with an object or situation at first, it is much more difficult to develop phobia
through classical conditioning after one bad experience and also through vicarious conditioning.
On top of this the inflation effect is when negative situations occur after a conditioned fear, this fear
might be worse.
Cognition also maintain our phobia as phobic people are always on alert for their phobic objects or
situations.
Evolutionary view
This view states that human are more inclined to quickly associate certain objects to frightening and
unpleasant events. This prepared learning gave humans a selective advantage as over the course of
evolution. So, the fears are not innate, but quickly acquired. Fear is conditioned more effectively to the
fear-relevant stimuli. Then the responses can even be elicited when present subliminally.
Biological factors
Genetic and temperament variable could affect the speed and strength of conditioned fear. The serotonin-
transporter gene is linked with superior fear conditioning.
Monozygotic twins were also more likely to share animal- and situational phobias than dizygotic twins.
Furthermore, behaviourally inhibited toddlers are at higher risk of developing multiple specific phobias
by 7/8 years.
Social phobias
Social phobias are the disabling fears of one or more specific
social situations. They fear they might be exposed to negative
evaluation, therefore embarrassing or humiliating themselves.
About 12% will qualify for social phobia at some point and
only 37% will recover in 12-year period. They originate
during early/middle adolescence and 2/3 suffer from an
additional anxiety disorder.
In cognitive restructuring techniques the therapist tries to help the client to identify heir underlying
negative thoughts. Then they help with changing these thoughts and beliefs through logical reanalysis.
