1 Introduction and Historical Overview 1
Psychological Disorders and Stigmas 2
Defining Psychological Disorder 6
Personal Distress 6
Disability and Dysfunction 6
Violation of Social Norms 7
History of Psychopathology 8
Supernatural Explanations 8
Early Biological Explanations 9
The Dark Ages: Back to the Supernatural 9
Development of Asylums 10
The Evolution of Contemporary Thought 13
Biological Approaches 14
Psychological Approaches 15
Have We Learned From History? 23
The Mental Health Professions 25
Summary 26
2 Current Paradigms in Psychopathology 28
The Genetic Paradigm 28
Behavior Genetics 30
Molecular Genetics 31
Gene-Environment Interactions 33
Evaluating the Genetic Paradigm 33
The Neuroscience Paradigm 35
Neurons and Neurotransmitters 35
Structure and Function of the Human Brain 36
The Neuroendocrine System 39
The Immune System 39
Neuroscience Approaches to Treatment 39
Evaluating the Neuroscience Paradigm 40
The Cognitive Behavioral Paradigm 41
Influences from Behavior Therapy 41
Cognitive Science 42
The Role of the Unconscious 43
Cognitive Behavior Therapy 43
Evaluating the Cognitive Behavioral Paradigm 45
Factors That Cut Across Paradigms 45
Emotion and Psychopathology 46
Sociocultural Factors and Psychopathology 47
Interpersonal Factors and Psychopathology 49
Summary 54
3 Diagnosis and Assessment 56
Cornerstones of Diagnosis and Assessment: Reliability and Validity 57
Reliability 57
Validity 58
Diagnosis 60
The Diagnostic System of the American Psychiatric Association: DSM-5 60
Specific Criticisms of the DSM 66
General Criticisms of Diagnosing Psychological Disorders 69
Psychological Assessment 70
Clinical Interviews 71
Assessment of Stress 73
Personality Tests 75
Intelligence Tests 78
Behavioral and Cognitive Assessment 79
Direct Observation of Behavior 79
Self-Monitoring 80
Cognitive-Style Questionnaires 80
Neurobiological Assessment 81
Brain Imaging: "Seeing" the Brain 81
Neuropsychological Assessment 84
Psychophysiological Assessment 85
A Cautionary Note About Neurobiological Assessment 85
Cultural and Ethnic Diversity and Assessment 86
Cultural Bias in Assessment 87
Strategies for Avoiding Cultural Bias in Assessment 88
Summary 89
4 Research Methods in Psychopathology 91
Science, Theory, and Hypotheses 92
Research Designs in Psychopathology 92
The Case Study 92
The Correlational Method 94
The Experiment 101
One Example of Experimental Research: Treatment Outcome Research 105
Defining the Treatment Condition 106
Defining Control Groups 108
Defining a Sample 109
Assessing and Implementing Treatments in the Real World 109
Analogues in Psychopathology Research 112
Integrating the Findings of Multiple Studies 114
Replication 114
Meta-Analysis 116
Summary 118
5 Mood Disorders 120
Clinical Descriptions and Epidemiology of Depressive Disorders 121
Major Depressive Disorder 122
Persistent Depressive Disorder 122
Epidemiology and Consequences of Depressive Disorders 123
Clinical Descriptions and Epidemiology of Bipolar Disorders 127
Bipolar I Disorder 128
Bipolar II Disorder 128
Cyclothymic Disorder 128
Epidemiology and Consequences of Bipolar Disorders 129
Etiology of Mood Disorders 131
Genetic Factors 131
Neurotransmitters 133
Neural Regions Involved in Emotion and Reward Processing 134
Cortisol Dysregulation 136
Social Factors in Depression: Childhood Adversity, Life Events, and Interpersonal Difficulties 137
Psychological Factors in Depression 139
Social and Psychological Factors in Bipolar Disorder 142
Treatment of Mood Disorders 144
Psychological Treatment of Depression 144
Psychological Treatment of Bipolar Disorder 147
Biological Treatment of Mood Disorders 148
Suicide 152
Epidemiology of Suicide and Suicide Attempts 153
Risk Factors for Suicide 155
Preventing Suicide 157
Summary 159
6 Anxiety Disorders 161
Emotions of Anxiety and Fear 162
Clinical Descriptions of the Anxiety Disorders 163
Specific Phobias 164
Social Anxiety Disorder 165
Panic Disorder 167
Agoraphobia 167
Generalized Anxiety Disorder 168
Comorbidity in Anxiety Disorders 169
Gender and Cultural Factors in the Anxiety Disorders 170
Gender 170
Culture 170
Common Risk Factors Across the Anxiety Disorders 172
Fear Conditioning 172
Genetic Factors 174
Neurobiological Factors: The Fear Circuit and the Activity of Neurotransmitters 175
Personality: Behavioral Inhibition and Neuroticism 176
Cognitive Factors 176
Etiology of Specific Anxiety Disorders 179
Etiology of Specific Phobias 179
Etiology of Social Anxiety Disorder 180
Etiology of Panic Disorder 181
Etiology of Agoraphobia 183
Etiology of Generalized Anxiety Disorder 184
Treatments of the Anxiety Disorders 185
Commonalities Across Psychological Treatments 185
Psychological Treatments of Specific Anxiety Disorders 186
Medications That Reduce Anxiety 189
Summary 190
7 Obsessive-Compulsive-Related and Trauma-Related Disorders 192
Clinical Descriptions and Epidemiology of Obsessive-Compulsive and Related Disorders 193
Obsessive-Compulsive Disorder 193
Body Dysmorphic Disorder 196
Hoarding Disorder 197
Prevalence and Comorbidity of Obsessive-Compulsive and Related Disorders 198
Etiology of the Obsessive-Compulsive and Related Disorders 199
Etiology of Obsessive-Compulsive Disorder 200
Etiology of Body Dysmorphic Disorder 201
Etiology of Hoarding Disorder 201
Treatment of the Obsessive-Compulsive and Related Disorders 203
Medications 203
Psychological Treatment 203
Deep Brain Stimulation: A Treatment in Development for OCD 206
Clinical Description and Epidemiology of Posttraumatic Stress Disorder and Acute Stress Disorder 207
Etiology of Posttraumatic Stress Disorder 210
Nature of the Trauma: Severity and the Type of Trauma Matter 211
Neurobiology: The Hippocampus 211
Coping 212
Treatment of Posttraumatic Stress Disorder and Acute Stress Disorder 213
Medication Treatment of PTSD 213
Psychological Treatment of PTSD 214
Psychological Treatment of Acute Stress Disorder 215
Summary 216
8 Dissociative Disorders and Somatic Symptom-Related Disorders 218
Clinical Descriptions and Epidemiology of the Dissociative Disorders 219
Depersonalization/Derealization Disorder 220
Dissociative Amnesia 221
Dissociative Identity Disorder 224
The Epidemiology of Dissociative Disorders: Increases Over Time 225
Etiology of DID 226
The Posttraumatic Model 227
The Sociocognitive Model 227
Treatment of DID 229
Clinical Description of Somatic Symptom and Related Disorders 230
Clinical Description of Somatic Symptom Disorder 231
Clinical Description of Illness Anxiety Disorder 232
Clinical Description of Conversion Disorder 232
Etiology of Somatic Symptom-Related Disorders 236
Neurobiological Factors That Increase Awareness of and Distress Over Somatic Symptoms 236
Cognitive Behavioral Factors That Increase Awareness of and Distress Over Somatic Symptoms 238
Etiology of Conversion Disorder 239
Treatment of Somatic Symptom and Related Disorders 241
Somatic Symptom Disorder and Illness Anxiety Disorder 241
Conversion Disorder 242
Summary 243
9 Schizophrenia 245
Clinical Descriptions of Schizophrenia 246
Positive Symptoms 246
Negative Symptoms 249
Disorganized Symptoms 250
Other Schizophrenia Spectrum Disorders 253
Etiology of Schizophrenia 254
Genetic Factors 254
The Role of Neurotransmitters 259
Connectivity in the Brain 263
Environmental Factors Influencing the Developing Brain 263
Psychological Factors 264
Developmental Factors 267
Treatment of Schizophrenia 269
Medications 270
Psychological Treatments 273
Summary 278
10 Substance Use Disorders 280
Overview: Substance Use and the DSM-5 280
Clinical Descriptions: Alcohol, Tobacco, and Marijuana Use Disorders 282
Alcohol Use Disorder 284
Tobacco Use Disorder 287
Marijuana 290
Clinical Descriptions: Opioid, Stimulant, and Other Drug Use Disorders 294
Opioids 295
Stimulants 298
Hallucinogens, Ecstasy, and PCP 301
Etiology of Substance Use Disorders 303
Genetic Factors 304
Neurobiological Factors 305
Psychological Factors 307
Sociocultural Factors 310
Treatment of Substance Use Disorders 313
Treatment of Alcohol Use Disorder 313
Treatments for Smoking 316
Treatment of Drug Use Disorders 318
Prevention of Substance Use Disorders 323
Summary 324
11 Eating Disorders 326
Clinical Descriptions of Eating Disorders 327
Anorexia Nervosa 327
Bulimia Nervosa 331
Physical Consequences of Bulimia Nervosa 332
Binge Eating Disorder 333
Etiology of Eating Disorders 338
Genetic Factors 338
Neurobiological Factors 338
Cognitive Behavioral Factors 341
Sociocultural Factors 343
Other Factors Contributing to the Etiology of Eating Disorders 347
Treatment of Eating Disorders 349
Medications 349
Psychological Treatment of Anorexia Nervosa 350
Psychological Treatment of Bulimia Nervosa 350
Psychological Treatment of Binge Eating Disorder 352
Preventive Interventions for Eating Disorders 353
Summary 354
12 Sexual Disorders 356
Sexual Norms and Behavior 357
Gender and Sexuality 359
The Sexual Response Cycle 360
Clinical Descriptions of Sexual Dysfunctions 362
Disorders Involving Sexual Interest, Desire, and Arousal 363
Orgasmic Disorders 365
Sexual Pain Disorder 366
Etiology of Sexual Dysfunctions 367
Biological Factors 368
Psychosocial Factors 368
Treatments of Sexual Dysfunctions 370
Psychoeducation 371
Couples Therapy 371
Cognitive Interventions 372
Sensate Focus 372
Treatments for Specific Sexual Dysfunctions 372
Clinical Descriptions of the Paraphilic Disorders 373
Fetishistic Disorder 375
Pedophilic Disorder and Incest 376
Voyeuristic Disorder 378
Exhibitionistic Disorder 378
Frotteuristic Disorder 378
Sexual Sadism and Masochism Disorders 378
Etiology of the Paraphilic Disorders 380
Neurobiological Factors 380
Childhood Sexual Abuse 380
Psychological Factors 380
Treatments and Community Prevention for the Paraphilic Disorders 381
Strategies to Enhance Motivation 382
Cognitive Behavioral Treatment 382
Biological Treatments 382
Balancing Efforts to Protect the Public Against Civil Liberties for Those with Paraphilias 383
Summary 384
13 Disorders of Childhood 386
Classification and Diagnosis of Childhood Disorders 387
Externalizing Disorders: ADHD and Conduct Disorder 388
Attention-Deficit/Hyperactivity Disorder 388
Conduct Disorder 395
Internalizing Disorders: Depression and Anxiety Disorders 403
Depression 403
Anxiety 409
Specific Learning Disorder and Intellectual Disability 413
Dyslexia: A Type of Specific Learning Disorder 413
Intellectual Disability 416
Autism Spectrum Disorder 421
Clinical Descriptions, Prevalence, and Prognosis of Autism Spectrum Disorder 421
Etiology of Autism Spectrum Disorder 425
Treatment of Autism Spectrum Disorder 427
Summary 428
14 Late Life and Neurocognitive Disorders 430
Aging: Myths, Problems, and Methods 431
Myths About Late Life 432
The Problems Experienced in Late Life 433
Research Methods in the Study of Aging 433
Psychological Disorders in Late Life 435
Prevalence Estimates of Psychological Disorders in Late Life 435
Methodological Issues in Estimating the Prevalence of Psychopathology 437
Treatment 437
Dementia 438
Alzheimer's Disease 440
Frontotemporal Dementia 444
Vascular Dementia 445
Dementia with Lewy Bodies 445
Treatments for Dementia 446
Delirium 449
Etiology of Delirium 451
Treatment of Delirium 451
Summary 452
15 Personality Disorders 454
The DSM-5 Approach to Classification 455
Problems with the DSM-5 Approach to Personality Disorders 457
Alternative DSM-5 Model for Personality Disorders 459
Common Risk Factors Across the Personality Disorders 461
Clinical Description and Etiology of the Odd/Eccentric Cluster 463
Paranoid Personality Disorder 463
Schizoid Personality Disorder 464
Schizotypal Personality Disorder 464
Clinical Description and Etiology of the Dramatic/Erratic Cluster 466
Antisocial Personality Disorder and Psychopathy 466
Borderline Personality Disorder 470
Histrionic Personality Disorder 473
Narcissistic Personality Disorder 473
Clinical Description and Etiology of the Anxious/Fearful Cluster 476
Avoidant Personality Disorder 476
Dependent Personality Disorder 477
Obsessive-Compulsive Personality Disorder 478
Treatment of Personality Disorders 479
Treatment of Schizotypal Personality Disorder and Avoidant Personality Disorder 481
Treatment of Borderline Personality Disorder 481
Summary 483
16 Legal and Ethical Issues 485
Criminal Commitment 486
The Insanity Defense 487
Current Insanity Pleas 489
Competency to Stand Trial 492
Insanity, Intellectual Disability, and Capital Punishment 496
Civil Commitment 498
Preventive Detention and Problems in the Prediction of Dangerousness 499
Protection of the Rights of People with Psychological Disorders 500
Ethical Dilemmas in Therapy and Research 505
Ethical Restraints on Research 506
Informed Consent 507
Confidentiality and Privileged Communication 508
Summary 509
Appendix: DSM-5 Diagnoses A-1
Glossary G-1
References R-1
Name Index N-1
Subject Index S-1
