1. Family
2. Finance
3. Work
4. Illness 

1. Diagnostic reliability is low.
2. There is significant overlap between GAD and other anxiety and panic disorders. 

1. People with GAD have both positive and negative beliefs for worry.
2. People with GAD have more metaworries relative to patients with other anxiety disorders.
3. People with GAD have negative beliefs that worry is dangerous.

• Measured negative beliefs about anxiety (e.g., anxiety is dangerous).
• People who held negative beliefs at Time 1 were more likely to have developed GAD at Time 2. 

• Subjects who worried before imagining giving a speech did not experience increased heart rate during imagining.
• Worrying about a film for 15 minutes was associated with less anxiety about the film.

What is evidence that intolerance of uncertainty is an important part of the develpoment of GAD?

(Dugas et al., 2005)

• Subjects were presented with word lists, half of which denoted uncertainty.
• Subjects with high intolerance for uncertainty recalled more uncertain words, as though they had a cognitive bias.

An organism is predisposed to form associations between certain stimuli and responses.

It is alsmost impossible to condition a fear to a neutral or "positive" object.

1. Systematic desensitization
2. Flooding
3. Modeling 

• Exposure to feared social situations.
• Direct teaching of social skills. 

1. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, with at least two fo the following areas affected: cognition, affectivity, interpersonal functioning, and impulse control.
2. Extreme inflexibility in one's personality. 
3. Stable and long-lasting.
4. Significant distress or impairment.

Individual is distressed by symptoms.

(Mood, anxiety disorders)

Thoughts and behaviors are acceptable to the individual.  There is little insight.

(Personality disorders)

1. Odd/Eccentric
2. Dramatic/Emotional
3. Anxious/Fearful 

1. Paranoid personality disorder
2. Schizoid personality disorder 
3. Schizotypal personality disorder

• Distrust.
• Suspiciousness.
• Relationship problems. 

• Voluntary detachment from social relationship.
• Restricted range of emotional expression. 
• Similar to Autism Spectrum Disorders.

• Discomfort with close relationships.
• Cogntiive and perceptual distortions.
• Eccentricities.
• Appears to be a milder form of schizophrenia (abbreviation of the schizophrenic phenotype).

• Genetic evidence supports a polygenic threshold model.
• Treatment evidence: both respond to anti-psychotic drugs.
• Biological markers such as eye tracking dysfunction and backward masking. 

1. Antisocial personality disorder
2. Borderline personality disorder
3. Histrionic personality disorder
4. Narcisistic personality disorder 

• Attention-seeking
• Demanding
• Erractic in behavior 

• Excessive emotionality.
• Attention seeking.
• Very self-centered.
• Exaggerate displays of emotion (for the purpose of attracting attention).
• Demanding.
• Constantly seeking approval from others. 
• Behavior is often inappropriate, seductive, or provocative.
• Wants concern.
• More common in women.

• Grandiosity.
• Lack of empathy.
• Self-centered.
• Preoccupied with self.
• Thinking own achievements are better than anyone else's.
• Wants admiration.
• More common in men.

1. Avoidant personality disorder
2. Dependent personality disorder
3. Obsessive-compulsive disorder 

• Extreme nervousness, worry, or anxiety.
• Differ in object of worry and in coping. 

• Socially withdrawn because of fear of rejcetion.
• Feelings of inadequacy.
• Hypersensitive to criticism and to rejection.
• Need constant assurance of other people's affection.
• Difficulty etablishing a relationship.

• Extreme dependence on others.
• Afraid of separating from others; clingy.
• Can establish a relationship but then fear being separated.

• Pervasive pattern of orderliness, perfectionsm, and control.
• Extremely inflexible, inefficient, and closed to new ways of functioning.
• Hung up on little details.
• Set extremely high standards for own performance--setting self up for failure. 
• Excessively conscientious, highly moralistic, highly judgmental.
• OCD has insight and is troubled by behavior; obsessive-compulsive PD has no insight and is not troubled.
• (Hoarding)

• People with OCD are troubled by their symptoms; those with OCPD are not.
• Hoarders do not go seeking help until they face an ultimatum.
• The cognitive explanation for OCD does not extend to hoarding very well. 
• OCD starts with intrusive, troublin thoughts, which is not evidenced in hoarding.

• Difficult to identify reliably.
• Overlap signfiicantly.
• Are the traits really inflexible, pervasive, and long-standing?
• Some criteria cannot be directly observed.
• Etiology is poorly understood - mostly explained via psychodynamic reasoning.
• There is little evidence that they can be treated. 

• They are associated with significant impairment.
• The presence of pathological personality traits is associated wtih increased risk of other disorders.
• The presence of a PD can interfere with the treatemnt of another disorder.

• Experience intense negative emotions.
• Lack skills for managing emotions. 
• Capable of deep love and profound rage almost simultaneously.
• Powerfully connected yet afriad of being abandoned.
• Often use self-injury as a way of coping.
• Intense mood swings.
• Suicidal attempts.

1. Frantic efforts to avoid abandonment
2. Unstable relationships
3. Unstable self image
4. Impulsivity
5. Recurrent suicidal behavior
6. Mood instability
7. Chronic feelings of emptiness
8. Inappropriate anger
9. Stress related paranoia 

• Requires patient and thearpist to find synthesis in various contradictions, or dialectics.
• Usually consists of both individual and group sessions. 

• Pervasive pattern of disregard for the rights of others. 
• Individual is at least 18 years old.
• Evidence of conduct disorder if onset was before 15 years.

Psychopaths represent a distinct subtype of ASPD.

• True psychopath feels no empathy, has no concern for others, fails to feel genuine remorse.
• ASPD is an inability to experience normal emotions.  They can learn to mimic emotions and to become adept at expressing emotions, but they do not truly feel the emotions.

• Failure to conform to social norms.
• Deceitfulness.
• Impulsivity.
• Irritability and aggressiveness.
• Reckless disregard for safety or self or others.
• Consistent irresponsibility.
• Lack of remorse. 

• Heritability studies show an interaction between genetics and environment. 
• Low stress arousal linked to later criminal activity.
• Deficient functioning in the prefrontal cortex.

• Target: men and women separated from biological ASPD parents.
• Comparison: men and women separated from biological non-ASPD parents.
• Regardless of diathesis, those in favorable home environment committed fewer antisocial behaviors.
• Regardless of home environment, the targets committed more antisocial behaviors than the comparison.
• The adverse home environment is far worse for targets.

• Inept parenting.
• Demographics: income, parent edducation, neighborhood.
• Family stressors: divorce, unemployment, substance abuse. 

• Three groups
1. Convicts who fit description of psychopaths.
2. Prisoners who were not psychopathic.
3. University students.
• Incidental learning task.
• Learn to press levers in a certain sequence.
• Incorrect responses sometimes produced a painful electric shock.
• No difference in terms of which group learned the correct sequence the fastest.
• Students received the fewest shocks.
• Psychopaths received the most shocks.

• Psychopaths vs. nonpsychopaths.
• Receive an electric shock in 10 minutes.
• Psychopathic subjects failed to show anxiety. 

For most people, the magnitude of the startle reflex is increased when experiencing a negative emotional state.

The psychopath's startle reflex doesn't follow this pattern.

• A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated:
• Frequenty bullying or threatening of others.
• Frequent provoking of physical fights.
• Using dangerous weapons.
• Physical cruelty to people.
• Physical cruelty to animals.
• Stealing while confronting a victim.
• Forcing someone into sexual activity.
• Fire-setting.
• Deliberately destroying others' property.
• Breaking into a house, building, or car.
• Frequent manipulation of others.
• Stealing items of nontrivial value withotu confronting a victim.
• Frequent staying out beyond curfews, beginning before the age of 13.
• Running away from home overnight at least twice.
• Frequenty truancy from school, beginning before the age of 13.
• Significant impairment. 

• Inept parenting practices.
• Fail to consistently reinforce prosocial behavior.
• Fail to consistently discipline deviant behavior.
• Coercive interactions.

1. Environmental stress.  Parent personality.  Child temperament.
2. Coercive parental discipline.
3. Coercive give-and-take between parent and child.
4. Conflict resolution.
5. Long-term consequences.

1. (Early Childhood) Conflict-ridden home, lax and inconsistent discipline.
2. (Middle Chidhood) Child conduct problems.  Rejection by normal peers.  Academic failure.  Commitment to deviant peer group.
3. (Adolescence) Deliquency.

• Antisocial parents and grandparents
• Family deographics
• Family stressors 

• Impaired social interaction.
• Impaired communication.
• Restricted, repetitive patterns of behavior. 

• Lack of awareness or interest in other people.
• Lack of social referencing.
• Failure to develop theory of mind. 

• 3-year-olds presented with small remote controlled robot.
• Parent acted terrified or interested and happy.
• Normally developing chidlren picked up on the parent's cues and acted accordingly.
• Autistic chidlren ignored their parents and showed no fear at all. 

• "Refrigerator parents" - completely refuted.
• MMR - completely refuted
• Lack TOM
• Inconclusive biological causes 
• Researchers believe there is a neurological basis.

• Child's failure to control his behavior.
• Most commonly diangosed childhood disorders.
• Examples: ADHD, CD, ODD.

• Primarily affect the child's internal world.
• Children are usually diagnosed based on adult criteria. 
• Anxiety, sadness, fears.
• Examples: depression, anxiety, phobias.

• Inattention.
• Hyperactivity/impulsivity ("disinhibition"). 

• Adult diagnostic criteria is used.
• Childhood depression is easily overlooked, especially because it manifests itself differently.
• Irritability (rather than depressed mood).
• More psycosomatic complaints.
• Social withdrawal is common.
• Discrepancies between child, parent, and teacher reports of depression.

• Combination of antidepressants and cognitive therapy was by far the best.
• Antidepressants better than cognitive therapy.
• Cognitive therapy was minimally effective. 

• Irritability, temper tantrums, poor frustration tolerance, impulsivity, aggressive behavior, hyperactivity.
• Mixed states or rapid cycling are more common.
• Appear "out of sync."
• Extreme temper tantrums. 

1. Deviance (behavior that is different, extreme, or unusual).
2. Distress (troubled by the disorder).
3. Dysfunction (difficult to fulfill the everyday tasks of life).
4. Danger (to self or to others; evident risk).

• Presence of a pathological excess.
• Delusions
• Hallucinations
• Disorganized speech (loose associations, neologisms, perseveration, clang, word salad)
• Disorganized behavior

• Pathological deficit or absence of normal behavior.
• Alogia (poverty of speech).
• Blunted affect.
• Avolition (apathy).
• Social withdrawal.

1. Enlarged ventricals. 
2. Limbic system.
3. Excessive dopaminergic activity.
4. Glutamate disruption.

Genetic factors are essential as a diathesis (predisposition) but are insufficient by themselves for the development of a disorder.

No environmental factor alone can cause the disorder without a genetic diathesis.

1. Intense cultural pressures to be thin.
2. Unrealistic ideals about what is considered "thin." 

• Three minutes of exposure to "thin-ideal" models.
• Produced feelings of guilt, shame, depression, and body dissatisfaction. 

• Two conditions: pressure or neutral.
• In pressure, talk about how dissatisfied with weight, new diet, etc.
• In neutral, talk about classes and plans for weekend.
• Talking with a body-dissatsified woman produced negative emotions.
• Pressure from other peole is a powerful risk factor. 

• Prisoners double caloric intake for 6 months.
• Most men gained up to 10% of body weight fairly easily.
• They then became hyperbolic, resisting additional weight gain.
• Most gradually returned to original weight levels.
• They burned excess food through increased metabolic activity. 

• For first three months, ate regulary to establish baseline.
• For next 6 months, restricted to half caloric intake. 
• Men lost about 25% of body weight.
• Changes
• Attitudes and behaviors related to food and eating.
• Binge eating.
• Emotional and personality changes.
• Social changes.
• Physical changes.
• Physical activity.  

• Followed 15 year old girls for a year.
• Those who were dieting were 8 times more likely than nondieters to develop an ED.   

• Experimentally induced binge-eating by reducing caloric intake.
• 62% of normal subjects on a restricted diet reported binge-eating.
• Dieting is a risk factor. 

A struggle for control is the central psycholgoical issue in the development of ED. 

Exceptionally "good" girls never go through the adolescent struggle for autnomy.  Dieting becomes an attempt to wrestle control.

Families of anorexis are "enmeshed."  As a result, they do not have the opporutnity to establish themsleves as independent persons. 

EDs are a battle for control.

1. Self-monitoring
2. Weekly weighing
3. Prescription of regular eating patterns
4. Self-control strategies
5. Exposure and response prevention 

1. Help the patient identify a problematic thought.
2. Evaluate the evidence in support of her thought.
3. Evaluate the evidence against her thought.
4. Come to a "reasoned conclusion" as a result of challenging the problematic thought.

Women with a secure relationship with God experienced less pressure, less thin-ideal internalization, less body dissatisfaction, and less dieting.

A secure relationship with God disrupted the pathways from the sociocultural variables to body dissatisfaction and dieting.

• Exposed women to spiritual, religious, and neutral affirmations.
• Women exposed to religious affirmations improved in how they felt about their appearance. 

1. Body appreciation
2. Body acceptance by others
3. An emphasis on what the body can do rather than how it looks
4. Eating in response to hunger instead of rigid dietary rules or negative emotions 

• A descriptive system that does not give a clear understanding as to why those symptoms are caused.
• Imperfect reliability and validity.
• Categorial system which works best when all members of a class are nearly alike, boundaries between classes are clear, classes are mutually exclusive. 

1. Help patient identify a problematic thought.
2. Evaluate the evidence in support of her thought.
3. Evaluate the evidence against her thought.
4. Come to a "reasoned conclusion" as a result of challenging the problematic thought.

• Self-monitoring
• Self-control strategies 
• Exposure and response prevention

Alloy, Abramson, & Francis, 1999

Prospective study of college students and attributional styles.

Hopeless attributional style

• 17% first onset
• 27% with history relapsed

Optimistic attributional style

• 1% first onset
• 6% with history relapsed

1. interpersonal loss
2. interpersonal disuptes
3. role transitions
4. interpersonal deficits

1. prefrontal cortex
2. Brodmann area 25
3. hippocampus
4. amygdala 

1. dysphoria
2. anhedonia
3. lack of drive
4. changes in appetite, sleep, and activity levels
5. thoughts of hopelessness, guilty, and worthlessness 

1. recurrent
2. with melancholic features
3. with catatonic features
4. with postpartum onset
5. with seasonal pattern
6. with psychotic features

1. mood
2. thoughts
3. increased self-estseem
4. activity 

1. Refusal to maintain body weight above a minimally normal weight for age and height.
2. Intense fear of gaining weight, even though underweight.
3. Distrubed body perception.
4. Amenorrhea. 

1. Recurrent episodes of binge eating.
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain.
3. Symptoms continuing, on average, at least twice a week for three months.
4. Undue influece of weight or shape on self-evaluation. 

1. Restricting-type anorexia nervosa
2. Binge-eating/purging-type anorexia nervosa
3. Normal-weight bulimia nervosa
4. Bulimic obesity
5. Obesity 

1. Self-evaluation based on weight.
2. Comorbidity.
3. Prevalence among high SES, young White females. 

1. Amount of weight loss (AN: significantly below ideal; BN: below, normal, obese)
2. Distortion of body perception (AN: severe distortion; BN: less severe distortion)
3. View of disorder (AN: proud; BN: ashamed)
4. Feelings of control (An: rigid self-control; BN: lack of self-control) 

1. Homosexuality
2. Obesity as a child
3. Certain sports (e.g., wrestlers, jockeys) 

1. Intrusive
2. Recurrent
3. Unwanted
4. Inappropriate 

1. Behavioral: observable acts
2. Mental 

1. Washing
2. Checking
3. Symmetry
4. Hoarding
5. Requesting reassurances
6. Rubbing, touching, tapping, ordering 

1. Counting
2. Counter-image 

Obsession ("dangerous" thought).

Anxiety.

Compulsion.

Anxiety decreases - compulsions are negatively reinforced; fear of thoughts is increased.

Increase in obsessive thoughts and compulsions.

REPEAT.

1. Conversion disorder
2. Somatization disorder
3. Pain disorder 

1. Hypochondria
2. Body dysmorphic disorder

1. Four different kinds of pain symptoms
2. Two gastrointestinal symptoms
3. One sexual symptom
4. One neurological-type symptom 

1. Obsessive, unshakeable conviction that one has a serious physical disease.
2. Individual misinterprets normal bodily occurrences.
3. Patient is sincere in his conviction that something is really wrong.

1. Obsessive concern over an imagined or trivial defect in one's appearnce.
2. Compulsive behaviors (checking, grooming, seeking reassurance), which take up 3-4 hours of the day, end up reinforcing the concerns. 
3. Poor insight.

Concerns about imagined defect.

Anxiety.

Checking, seeking reassurance.

Anxiety decreases - compulsions and concerns are reinforced.

Increase in concerns and compulsions.

REPEAT.

• Patient is knowingly faking.
• Patient has no ulterior motive but desires to take on the role of the sick person. 

Motivation.

Individuals with factitious disorder have no ulterior motivation.

Individuals with malingering are motivated by gaining rewards or by avoiding something aversive.

1. Dissociative Amnesia
2. Dissociative Fugue
3. Dissociative Identity Disorder
4. Deperesonalization Disorder 

1. Two or more distinct personalties.
2. Control of the person by at least two of these personalities.
3. Inability to remember that is too extensive to be due to forgetfulness. 

1. Localized
2. Selective
3. Generalized
4. Continuous (anterograde) 

• Trauma
• Reexperience of trauma
• Avoidance of reimnders, emotional numbing and detachment
• Hypervigilance and chronic arousal
• Distress or impairment 

1. Present for a significant portion of time during a one-month period:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms
2. Functioning markedly below the level achieved prior to onset. 

• Positive symptoms (delusions, hallucinations, disorganized speech, disorganized behavior)
• Negative symptoms (alogia, blunted affect, avolition, social withdrawal)
• Psychomotor symptoms (awkward movements, catatonia, waxy flexibility)
• Deterioration of functioning
• Symptoms present for at least 6 months.

• Outraged by the realization that many of the prisoners were mentally ill, Dix was instrumental in every state establishing state hospital designed to provide loving care for the mentally ill. 
• Humanitarian care soon became overwhelmed by the need to keep order, so the state hospitals resorted to restraining prisoners in straight jackets or handcuffs to keep order.
• In the 1950s, antipsychotic medications were discovered.  This seemed to alleviate some of the need for public mental hospitals.
• Patients were put on meds and sent home, and the hospitals began empyiting in the 1960's and continued into the 1970's.