ANSWERS TO TEST YOURSELF CHAPTER 1 Defining Abnormality (p. 9) 1.

The continuum model of normality suggests that all behavior falls along a continuum from normal to abnormal and that we make subjective judgments of where to draw the line between normality and abnormality. 2. Cultural relativism is a perspective on abnormality that argues that the norms of a society must be used to determine the normality or abnormality of a behavior. While this criterion recognizes cultural values and the fact that abnormality is always influenced by those values, cultural norms also can be used to discriminate against nonconforming people by labeling them as abnormal. . !he unusualness criterion for abnormality suggests that unusual or rare behaviors should be labeled abnormal. " ma#or advantage of this criterion is that only rare behaviors are labeled abnormal. $a#or disadvantages are that cutoffs for rareness are arbitrary and that positive rare behaviors are not labeled abnormal. %. !he distress criterion for abnormality suggests that only behaviors or emotions that an individual finds distressing should be labeled abnormal. !his criterion ac&nowledges the importance of the sub#ective e'perience of the individual. (owever, not all people who are engaging in behaviors that might harm others or themselves are discomforted by these behaviors. ). !he mental illness criterion for abnormality suggests that only behaviors resulting from mental illness are abnormal. "lthough this criterion appears ob#ective, we have no biological tests to indicate illness in people with abnormal behaviors* instead our #udgments are always based on sub#ective symptoms. 6. The four Ds of abnormality are dysfunction, distress, deviance, and dangerousness. Apply It: c. Henrys behaviors violate norms for the culture in which he lives (and most cultures) and are deviant, and he has been diagnosed with mental disorders. He does not seem distressed by his behavior, however. Hi tori!al Per "e!ti#e on Abnormality (p. +,) 1. !he biological theories saw abnormal behavior as similar to physical diseases, caused by the brea&down of systems in the body. !he supernatural theories saw abnormal behavior as being a result of divine intervention, curses, demonic possession, and personal sin. !he psychological theories saw abnormal behavior as being a result of a trauma, such as bereavement or chronic stress. 2. Trephination is the practice of drilling holes in the skull, possibly in order to release evil spirits causing abnormal behavior. 3. "bnormal behaviors were often described as medical disorders in ancient Chinese writings, although there is also evidence that they were viewed as being due to supernatural forces. 4. Greek and Roman philosophers viewed abnormality as being due primarily to medical illness, or possibly to psychological stress.

5. Some people accused as witches may have had mental disorders, but people of those times viewed such people as being possessed by the devil. 6. Psychic epidemics are incidences of groups of people engaging in abnormal behaviors at the same time without an apparent cause. 7. Moral treatment was designed to restore patients- self.restraint by treating them with respect and dignity and encouraging them to e'ercise self.control. /hilippe /inel was an advocate of moral treatment in 0rance, and 1orothea 1i' established many asylums for moral treatment in the 2nited 3tates. Apply It: b. Hippocrates believed that all mental disorders were caused by imbalances in one of the four bodily humors: blood, phlegm, yellow bile, and blac& bile. T$e Emergen!e of %o&ern Per "e!ti#e (p. +9) 1. Kraepelins classification scheme is the basis of our modern diagnostic systems and contributed greatly to the advances in research and treatment of mental disorders. 2. The discovery that syphilis causes general paresis was one of the first clear demonstrations that biological changes in the body could cause psychological symptoms. 3. Mesmers work with hypnosis motivated Jean Charcot, and later Sigmund Freud, to investigate the role of unconscious processes in psychological symptoms. 4. Behavioral theorists believe that all behaviors, normal and abnormal alike, are the result of reinforcements and punishments. 5. Cognitive theorists believe that psychological symptoms are the result of maladaptive thought processes. Apply It: a. 4oy-s therapist most li&ely is ta&ing a behavioral approach, trying to understand the reinforcing and punishing situations that are increasing and decreasing 4oy-s motivation. %o&ern %ental Healt$ Care (p. 22) +. !he goal of the deinstitutionalization movement was to move mental patients from custodial mental health facilities, where they were isolated and received little treatment, to community.based mental health centers. !housands of patients were released from mental institutions. 2nfortunately, community.based mental health centers have never been fully funded or supported, leaving many former mental patients with few resources in the community. 2. $anaged care systems coordinate care from different types of health care providers to provide comprehensive medical care to patients. !his can be a great asset to people with long.term, serious disorders. Coverage for mental health problems tends to be limited, however, and many people have no insurance at all. Apply It: c. 5f the options given, only psychiatrists have the right to prescribe medications.

CHAPTER ' (iologi!al A""roa!$e (p. %6) +. !he biological theories focus on structural or functional abnormalities in the brain, dysfunction in biochemical systems, and genetic factors. 2. 3erotonin, dopamine, norepinephrine, and 7"8". . 7enes can influence the environments we choose* these environments then reinforce our genetic tendencies. 9nvironments can trigger genetic vulnerabilities. !he environment can cause heritable changes in genes through epigenetic processes. %. "ntipsychotics reduce delusions and hallucinations. "ntidepressants reduce symptoms of depression. 8arbiturates and benzodiazepines reduce an'iety. :ithium reduces mania. ). 9lectroconvulsive therapy (9C!), repetitive transcranial magnetic stimulation (r!$3), vagus nerve stimulation, and deep brain stimulation. Apply It: c. !he forebrain contains structures, such as the cerebral corte' and hypothalamus, that influence our ability to control social behavior. !hus, 7age-s symptoms most li&ely are caused by damage to this area. P y!$ologi!al A""roa!$e (p. )2) +. 8ehavioral approaches Classical and operant conditioning 2. Cognitive approaches !houghts and beliefs . /sychodynamic approaches 2nconscious conflicts %. (umanistic approaches /ressure to conform to societal norms ). 0amily systems approaches 1ysfunctional interpersonal dynamics ,. 9motion.focused approaches /oor regulation of emotions Apply It: d. (umanistic therapists might guess that you are feeling social pressure to be more popular, but they would not openly challenge you about this. So!io!)lt)ral A""roa!$e (p. );) 3ocioeconomic disadvantage, upheaval and disintegration of societies and cultures, stigmatization and discrimination, and the norms of a culture for appropriate symptoms. Apply It: c. Culture.bound disorders are disorders that appear to be specific to a culture. Pre#ention Program (p. )<) Apply It: a. /resentations to unselected groups represent efforts at primary prevention. Common Element in Effe!ti#e Treatment (p. )9) Apply It: c. 9'amination of a client-s upbringing is not one of the common elements of effective therapies discussed, while the other three items are.

CHAPTER * A e ment Tool (p. ;%) !he validity of a test is its accuracy in measuring what it is supposed to measure. " test has face validity if the items appear to measure what they are intended to measure. Content validity is an inde' of whether a test assesses all the important aspects of a construct. Concurrent validity indicates whether the test yields the same results as other tests of the same thing. /redictive validity is a measure of whether a test predicts what it should predict. Construct validity indicates whether a test measures what it is supposed to measure and not something else. Reliability is the consistency of a test in measuring what it is supposed to measure. !est.retest reliability indicates how consistent the results of a test are over time. "lternative form reliability is achieved when two forms of a test produce similar results. =nternal reliability measures whether different parts of the same test produce similar results. =nterrater or inter#udge reliability is achieved when two or more raters or #udges get similar results from a test. Apply It: c. /ro#ective tests have low reliability and validity. C$allenge in A e ment (p. ;;) +. 4esistance and inability to provide information are important challenges in assessing adults. 2. Children may have difficulty e'pressing their feelings and symptoms* parents and teachers are used as sources of information but are not always accurate. Apply It: d. "ll the factors listed can interfere with an accurate assessment of the man-s symptoms. Diagno i (p. <)) +. !he Diagnostic and Statistical Manual of Mental Disorders is the set of criteria used in the 2nited 3tates for diagnosing mental disorders. 2. !he first two editions of the DSM had vague criteria for diagnoses based on psychoanalytic theory. :ater editions had much more specific criteria for diagnoses that were descriptive rather than theory.based. . !he DSM criteria are still based on the assumption that there is a clear demarcation between normal and abnormal* there is much overlap in criteria for diagnoses, ma&ing differentiation difficult* some argue that the DSM is culturally biased or does not ta&e into account cultural differences in the e'pression of disorders. Apply It: e. 9thnicity>race is not one of the five a'es. CHAPTER + T$e S!ientifi! %et$o& (p. 92) +. !he scientific method is a set of steps designed to obtain and evaluate information relevant to a problem in a systematic way. 2. " hypothesis is a testable statement of what we e'pect to happen in a research study. " null hypothesis is the statement that the outcome of the study will contradict the primary hypothesis of the study. 2sually, the null hypothesis says

that the variables (such as stress and depression) are unrelated to each other. . " variable is a factor that can vary within individuals or between individuals. %. "ll participants have the right to understand the study, to have their confidentiality maintained, to refuse or withdraw participation, to give informed consent, to be deceived as little as possible, and to be debriefed on the purposes of the study. Apply It: a. !he independent variable is what you e'pect to influence the dependent variable. =n this study, you are predicting rates of mental illness in locales with different population densities. Ca e St)&ie (p. 9%) +. Case studies are in.depth histories of the e'periences of individuals. 2. !he advantages of case studies are their rich detail, their attention to the uni?ue e'periences of individuals, their ability to focus on rare problems, and their ability to generate new ideas. Apply It: d. Case studies may be interesting, but they often are very specific, may reflect biased reporting from the sub#ect and the clinician, and are difficult to replicate. Correlational St)&ie (p. 9<) +. " correlational study e'amines the relationship between two variables without manipulating either variable. 2. " result is said to be statistically significant if it is unli&ely to have happened by chance. !he convention in psychological research is to accept results that have a probability of less than ) in +66 of happening by chance. . Cross.sectional studies assess a sample at one point in time, while longitudinal studies assess a sample at multiple points in time. " longitudinal study assesses a sample that is e'pected to have some future &ey event both before and after the event, then e'amines changes that occurred in the sample. %. 7roup comparison studies evaluate differences between &ey groups, such as a group that e'perienced a specific type of stressor and a comparison group that did not e'perience the stressor but is matched on all important variables. ). /otential problems in correlational studies include the potential for bad timing and the e'pense of longitudinal studies. Apply It: a. =n a positive correlation, when one variable increases, the other does too. Correlation establishes a relationship between variables but does not show that one causes the other. E"i&emiologi!al St)&ie (p. 99) +. 9pidemiology is the study of the fre?uency and distribution of a disorder in a population. 2. !he prevalence of a disorder is the proportion of the population that has the disorder at a given point or period in time. . !he incidence of a disorder is the number of new cases of the disorder that develop during a specific period of time. Apply It: b. "ll we can &now from these results is that female gender is a ris& factor

for depression. E,"erimental St)&ie (p. +6%) +. =n e'perimental studies the independent variable usually is manipulated or controlled, while this is not true in none'perimental studies. 2. =n control groups, participants have all the same e'periences as the group of main interest in the study e'cept that they do not receive the &ey manipulation. . 1emand characteristics are aspects of the e'perimental situation that cause participants to guess the purpose of the study and change their behavior as a result. !he concern about generalizability is that the conditions of an e'perimental study may not mirror the conditions in the real world, so the results of such a study cannot be generalized to the real world. %. !herapy outcome studies assess the impact of an intervention designed to relieve symptoms. 3imple control groups, wait list control groups, and placebo control groups are used to compare the effects of the intervention with other alternatives. 1etermining what aspects of a therapy resulted in changes in participants can be difficult. !herapy outcome studies also can suffer from a lac& of generalizability, and assigning people who need treatment to control groups has ethical implications. ). 3ingle.case e'perimental designs involve the intensive investigation of single individuals or small groups of individuals before and after a manipulation or intervention. =n an "8"8 or reversal design, an intervention is introduced, withdrawn, and then reinstated, and the behavior of a participant on and off the treatment is e'amined. =n multiple baseline designs, an individual is given a treatment in different settings, or multiple individuals are given a treatment at different times across different settings. 3ingle.case e'perimental designs allow for more intensive assessment of participants than might be possible if there were many more participants. !heir results may not be generalizable to the wider population, however. ,. "nimal studies involve e'posing animals to conditions thought to represent the causes of a psychopathology and then measuring changes in the animals- behavior or physiology. "nimal studies allow manipulations that might not be permitted or possible with humans. (owever, the ethics of e'posing animals to conditions to which we would not e'pose humans can be ?uestioned, as can the generalizability of animal studies. Apply It: c. !his study clearly violates the right of participants to give informed consent before participating* in this case, the children-s parents should be as&ed to consent to their children-s participation because the children are young. "lthough this study does include deception and the infliction of psychological distress, these are sometimes allowed if they are #ustifiable given the potential benefits of the study results. !he researcher does appear to debrief the participants after the study is completed.

-eneti! St)&ie (p. +6,)

Apply It: c. 0amily history studies e'amine the prevalence of a disorder within a family. Cro .C)lt)ral Re ear!$ (p. +6;) Apply It: d. Cross.cultural research is not particularly difficult to have funded, but the other difficulties do apply. %eta.Analy i (p. +6<) $eta.analysis is a statistical techni?ue for summarizing results across several studies. =n a meta.analysis, the results of individual studies are standardized into a statistic called the effect size. !hen the magnitude of the effect size and its relationship to characteristics of the study are e'amined. Apply It: b. !he file drawer effect refers to the fact that results in support of a hypothesis are more li&ely to get published. CHAPTER / Po t.tra)mati! Stre Di or&er an& A!)te Stre Di or&er (p. +2%) +. /eople with post.traumatic stress disorder repeatedly ree'perience the traumatic event, avoid situations that might arouse memories of their trauma, and are hypervigilant and chronically aroused. 2. "cute stress disorder has symptoms similar to those of /!31 that arise within + month of a trauma but last no more than % wee&s. 1issociative symptoms are prominent in acute stress disorder. . /eople who e'perience severe and long.lasting traumas, who have lower levels of social support, who e'perience socially stigmatizing traumas, who already were depressed or an'ious before the trauma, or who have maladaptive coping styles may be at increased ris& for /!31. %. Compared to healthy individuals, /!31 sufferers show greater physiological reactivity to stressors but lower resting cortisol levels, greater activity in the amygdala but less activity in the prefrontal corte', and shrin&age of the hippocampus. 7enetic factors may be involved. ). 8enzodiazepines and antidepressant drugs can ?uell some of the symptoms of /!31. Apply It: a. =n systematic desensitization therapy, individuals wor& through a self. created hierarchy of an'iety.provo&ing e'periences. Pani! Di or&er an& Agora"$obia (p. + 6) +. /anic disorder is characterized by sudden bursts of an'iety symptoms, a sense of loss of control or unreality, and the sense that one is dying. "goraphobia develops when individuals avoid a wide range of situations in which they feel an'ious and fear they will have a panic attac&. 2. 3everal neurotransmitters, including norepinephrine, serotonin and 7"8", have been implicated in panic disorder. !he limbic system and the locus ceruleus are areas of the brain that may be malfunctioning in panic disorder. /anic disorder runs in families, and twin studies suggest that genetics plays a role.

. !he cognitive model suggests that people with panic disorder are hypersensitive to bodily symptoms (an'iety sensitivity). 3ymptoms of an'iety that have preceded panic attac&s become signals for new panic attac&s (interoceptive conditioning). /eople with panic attac&s tend to catastrophize these symptoms. %. !ricyclic antidepressants, selective serotonin and serotonin.norepinephrine reupta&e inhibitors, and benzodiazepines can reduce symptoms of panic disorder, but these symptoms tend to recur once the drugs are discontinued. ). !eaching rela'ation e'ercises to reduce an'iety, challenging catastrophizing cognitions, and e'posing clients to situations that produce panic symptoms so they can e'tinguish their an'ious symptoms. Apply It: b. "voidance of situations associated with panic attac&s reduces an'iety and thus is reinforced, potentially leading to agoraphobia. S"e!ifi! P$obia an& So!ial P$obia0So!ial An,iety Di or&er (p. + 9) +. !he specific phobias include animal type phobias, natural environment type phobias, situational type phobias, and blood.in#ection.in#ury type phobias. 2. /eople with social phobia fear social situations in which they might be embarrassed or #udged by others. . 8ehavioral theories of phobias suggest that they develop through classical conditioning and are maintained by operant conditioning. (umans may be evolutionarily prepared to develop some types of phobias more easily than others. Cognitive theories have focused on social phobia and suggest that it develops in people who have e'cessively high standards for their social performance, assume that others are #udging them harshly, and are hypervigilant to signs of re#ection from others. %. 8iological theories of phobias attribute their development to heredity. ). !he most effective treatments for phobias are behavioral treatments, including systematic desensitization, modeling, and flooding. Cognitive techni?ues help clients identify and challenge negative, catastrophizing thoughts they have when they are an'ious. 7roup cognitive therapy has proven highly effective in treating social phobia and in preventing relapse. !he benzodiazepines and antidepressants can help ?uell an'iety symptoms, but people soon relapse into phobias after the drugs are discontinued. Apply It: d. /repared classical conditioning suggests that evolution has prepared us to fear ob#ects and situations that threatened our ancestors. -enerali1e& An,iety Di or&er (p. +%2) +. 7eneralized an'iety disorder is characterized by chronic symptoms of an'iety across most situations. 2. Cognitive theories suggest that some people have maladaptive assumptions that danger is everywhere and they should always be prepared for it. !heir conscious and unconscious thoughts focus on threat. !hey also believe that worrying will help them avoid bad events* worry also may help them avoid processing the negative images and emotions associated with certain situations. . 8iological theories suggest that people with 7"1 have a deficiency in 7"8" or 7"8" receptors. !hey also may have a genetic predisposition to generalized

an'iety. %. Cognitive.behavioral treatments for people with 7"1 focus on helping them confront their negative thin&ing patterns and e'pectations. ). 1rug therapies have included the use of benzodiazepines and the selective serotonin and serotonin.norepinephrine reupta&e inhibitors. Apply It: c. !he limbic system is thought to be involved in responses to threats. Ob e i#e.Com")l i#e Di or&er (p. +%;) +. 5bsessions are thoughts, images, ideas, or impulses that are persistent, are intrusive, and cause distress* they commonly focus on contamination, se', violence, and repeated doubts. Compulsions are repetitive behaviors or mental acts that the individual feels he or she must perform in order to somehow dispel his or her obsessions. 2. 8iological theories of 5C1 speculate that areas of the brain involved in the e'ecution of primitive patterns of behavior, such as washing rituals, may be impaired in people with 5C1. !hese areas of the brain are rich in the neurotransmitter serotonin, and drugs that regulate serotonin have proven helpful in the treatment of 5C1. . Cognitive.behavioral theories suggest that people with 5C1 are chronically distressed, thin& in rigid and moralistic ways, #udge negative thoughts as more acceptable than other people do, and feel more responsible for their thoughts and behaviors. !his ma&es them unable to turn off the negative, intrusive thoughts that most people occasionally have. Compulsive behaviors develop through operant conditioning. /eople are reinforced for compulsive behaviors by the fact that the behaviors reduce an'iety. %. 1rug treatments for 5C1 affect levels of serotonin and include clomipramine, serotonin reupta&e inhibitors, and possibly atypical antipsychotic medications. ). 9'posure and response prevention therapy repeatedly e'poses the client to the focus of the obsession and prevents compulsive responses to the resulting an'iety. Apply It: c. 3ome individuals e'perience only obsessions, and some compulsions are mental acts. CHAPTER 2 Somatoform Di or&er (p. +,,) +. 3omatoform disorders are a group of disorders whose sufferers e'perience significant physical symptoms for which there is no apparent organic cause. 2. Conversion disorder involves loss of functioning in a part of the body for no organic reason. Conversion symptoms often occur after trauma or stress, perhaps because the person cannot face memories or emotions associated with the trauma. !reatment for conversion disorder focuses on the e'pression of emotions or memories associated with the symptoms. . 3omatization disorder involves a long history of see&ing treatment for multiple physical complaints that have no apparent organic cause. /ain disorder involves only the e'perience of chronic, une'plainable pain. (ypochondriasis is a condition in which people worry chronically about having a dread disease despite

evidence that they do not. !hese disorders may represent acceptable ways of e'pressing emotional pain. Cognitive theories of the disorders hold that they are due to an e'cessive focus on physical symptoms and a tendency to catastrophize symptoms. !reatment for these disorders involves helping people identify the feelings and thoughts behind the symptoms and find more adaptive ways of coping. %. /eople with body dysmorphic disorder are obsessed with some parts of their bodies and ma&e elaborate attempts to change these body parts. !reatments include psychodynamic therapy to reveal underlying concerns, systematic desensitization therapy to reduce obsessions and compulsions about the body, and the use of selective serotonin reupta&e inhibitors. Apply It: d. 5ne clear difference between hypochondriasis and somatization disorder is the amount of time that passes before sufferers see& medical attention. Di o!iati#e Di or&er (p. +;;) +. !he dissociative disorders include dissociative identity disorder (1=1), dissociative fugue, dissociative amnesia, and depersonalization disorder. =n all these disorders, people-s conscious e'periences of themselves become fragmented, they may lac& awareness of core aspects of themselves, and they may e'perience amnesia for important events. 2. !hese disorders may result from the use of dissociation to cope with traumatic e'periences. !herapists often treat these disorders by helping people e'plore past e'periences and feelings they have bloc&ed from consciousness and by supporting them as they develop more integrated e'periences of self and more adaptive ways of coping with stress. . !he distinctive feature of dissociative identity disorder is the development of multiple separate personalities within the same person. !he personalities ta&e turns being in control. %. /eople with dissociative fugue disorder move away from home and assume entirely new identities, with complete amnesia for their previous identities. !hey do not switch bac& and forth between different personalities. /eople with dissociative amnesia lose important memories due to psychological causes. ). /eople with depersonalization disorder have fre?uent e'periences of feeling detached from their mental processes or from their body. Apply It: c. /sychogenic retrograde amnesia usually preserves memory for general information, but organic retrograde amnesia does not. CHAPTER 3 C$ara!teri ti! of Uni"olar De"re ion (p. +<,) +. 1epressed mood or anhedonia, plus four of the following symptoms@ (a) significant weight loss or change in appetite* (b) insomnia or hypersomnia* (c) psychomotor retardation or agitation* (d) fatigue or loss of energy* (e) feelings of worthlessness, or e'cessive or inappropriate guilt* (f) diminished ability to thin& or concentrate, or indecisiveness* (g) recurrent thoughts of death, or a suicide attempt or specific plan. !he symptoms must be present chronically for at least +

wee& and must cause clinically significant distress or impairment. 2. 1epressed mood plus two of the following symptoms for at least 2 years@ (a) poor appetite or overeating, (b) insomnia or hypersomnia, (c) low energy or fatigue, (d) low self.esteem, (e) poor concentration or difficulty ma&ing decisions, (f) feelings of hopelessness. 1uring these 2 years, the person must never have been without the symptoms of depression for longer than a 2.month period. . Aoung adults have the highest rates of depression, followed by middle.aged adults and then older adults. Children have lower rates than adults. Apply It: c. 8randon-s delusion that he is possessed by the devil and his hallucinations of voices telling him to &ill himself indicate that he is e'periencing psychotic depression. C$ara!teri ti! of (i"olar Di or&er (p. +96) +. " distinct period of abnormally and persistently elevated, e'pansive, or irritable mood, lasting at least + wee&. 1uring the period of mood disturbance, three (or more) of the following symptoms (four if the mood is only irritable)@ (a) inflated self.esteem or grandiosity, (b) decreased need for sleep, (c) more tal&ative than usual or pressure to &eep tal&ing, (d) flight of ideas or sub#ective e'perience that thoughts are racing, (e) distractibility, (f) increase in goal.directed activity or psychomotor agitation, (g) e'cessive involvement in pleasurable activities with a high potential for painful conse?uences (e.g., engaging in unrestrained buying sprees, se'ual indiscretions, or foolish business investments). 2. Cyclothymic disorder is characterized by alternating moods of moderate depression and hypomania that do not meet the full criteria for either ma#or depression or a manic episode. !hese moods must be present chronically over at least 2 years. . 8ipolar disorder is rarer than unipolar disorder* there are no consistent age, gender, or racial>ethnic differences in bipolar disorder* bipolar disorder tends to be chronic. Apply It: c. 3teve-s case illustrates the difficulties that can arise in distinguishing between people who are high.energy, ambitious, and driven from those who would ?ualify for a diagnosis of mania. (e clearly is Bgoal.directed,C involved in a business venture that is high ris&* he seems to need little sleep in part because of a rush of ideas* and his phone calls trying to get investors may indicate a pressure to tal&. =t seems that these behaviors have lasted much longer than a wee&. What is unclear, however, is whether 3teve-s activities are dysfunctional or simply typical of what it ta&es to get a new business venture going. T$eorie of Uni"olar De"re ion (p. +9<) +. !he neurotransmitters implicated in depression are serotonin, norepinephrine, and, to a lesser e'tent, dopamine. !he brain areas implicated in depression are the prefrontal corte', anterior cingulate, hippocampus, and amygdala. 2. 1epressed people show chronically elevated levels of cortisol, suggesting an overactive hypothalamic.pituitary.adrenal a'is. . 8ehavioral theorists suggest that reductions in positive reinforcers, often due to negative life events, lead to depression. !he learned helplessness theory says that

uncontrollable events are involved specifically in the development of depression. %. Cognitive theorists suggest that depressed people have a negative view of themselves, the world, and the future and that they engage in pessimistic, hopeless attributions that contribute to depression. 1epressed people also ruminate about their problems and show negative biases in attention and memory. ). =nterpersonal theorists suggest that depression is caused by interpersonal stressors and that depressed people engage in e'cessive reassurance see&ing and are sensitive to re#ection, which leads to conflicts in their relationships and promotes depression. ,. 3ociocultural theories have focused on social conditions that contribute to differences in rates of depression between age groups, between men and women, between racial>ethnic groups, and across cultures. Apply It: c. Aou could conclude only that low caudate activity and depression are related. =t is also possible that answer d is correct and some third variable accounts for the relationship between low caudate activity and depression. T$eorie of (i"olar Di or&er (p. +99) +. 7enetics plays a strong role in bipolar disorder, even more so than in unipolar depression. 2. !he areas of the brain implicated in bipolar disorder include the amygdala, prefrontal corte', and striatum. "bnormalities in white matter connecting the prefrontal corte' with other areas of the brain also have been found in people with bipolar disorder. . 1opamine is implicated in bipolar disorder, as are norepinephrine and serotonin. %. /eople with bipolar disorder may show dysregulation of the reward system, with hypersensitivity to reward during the manic phase and hyposensitivity to reward during the depressed phase. 3tress can trigger new episodes in bipolar disorder, even the stress of changes in sleep or eating patterns. Apply It: a. !he reward sensitivity theories suggest that people with bipolar disorder are more sensitive to reward during the manic phase and thus would be more attracted to gambling during that phase. Treatment of %oo& Di or&er (p. 2+6) +. 3erotonin reupta&e inhibitors, serotonin.norepinephrine reupta&e inhibitors, norepinephrine.dopamine reupta&e inhibitor (bupropion), tricyclic antidepressants, and monoamine o'idase inhibitors. :ithium also can reduce depressive symptoms. 2. :ithium must be ta&en continually to control the symptoms of bipolar disorder. . "nticonvulsants are drugs initially used to treat convulsions that were found to help control the symptoms of bipolar disorder. "ntipsychotic medications reduce manic and psychotic symptoms in people with bipolar disorder. %. 9lectroconvulsive therapy involves passing an electrical current through the brain of a patient to induce a seizure. =t is effective in reducing depressive symptoms but has the potential for negative effects on memory and thin&ing. Dewer methods for stimulating the brain include repetitive transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation.

). 8ehavior therapy begins with a functional analysis of the reinforcers and punishments in an individual-s life* then therapists help clients change their environment to reduce punishments and increase positive events, learn new s&ills that will increase the occurrence of positive events, and learn s&ills for managing stress. ,. Cognitive therapy involves helping individuals identify automatic negative thoughts, learn to challenge those thoughts, and change fundamental negative beliefs. 8ehavioral techni?ues are used to increase s&ills and provide evidence against negative thoughts. ;. =nterpersonal therapy focuses on four themes@ grief, role disputes, role transitions, and interpersonal s&ill deficits. Apply It: d. Controlled studies suggest that psychotherapy and drug therapy combined are effective for the greatest percentage of individuals with unipolar depression. S)i!i&e (p. 2+9) +. 3uicide is death from in#ury, poisoning, or suffocation where there is evidence (either e'plicit or implicit) that the in#ury was self.inflicted and that the decedent intended to &ill him. or herself. 2. $en, 9uropean "mericans, adults over age ,) (especially older men). . $ental disorders, especially mood disorders* previous suicidal intentions or attempts* stressful life events, including loss and childhood abuse* impulsivity* hopelessness* a family history of suicide* possibly low levels of serotonin. %. :ithium and selective serotonin reupta&e inhibitors* psychotherapy, especially dialectical behavior therapy. ). 3creening individuals to find those at high ris& for suicide and then providing mental health referrals* possibly restricting access to guns. Apply It: a. "s&ing your friend directly about his or her possibly suicidal thoughts or behaviors will not give him or her the idea of suicide, and as&ing about them can be the first step to getting help. CHAPTER 4 Sym"tom 5 Diagno i 5 an& Co)r e (p. 2%+) +. !he positive symptoms of schizophrenia are delusions, hallucinations, disorganized thin&ing and speech, and disorganized or catatonic behavior. 2. !he negative symptoms of schizophrenia are affective flattening, poverty of speech, and loss of motivation. . 1elusions are beliefs that are untrue or highly unli&ely* hallucinations are unreal perceptual e'periences* catatonia is behavior that reflects unresponsiveness to the environment. %. /eople with schizophrenia show fundamental deficits in attention and wor&ing memory. ). /rodromal symptoms are more moderate positive and negative symptoms that are present before an individual enters into an acute phase of the illness, and residual symptoms are symptoms present after an acute phase. ,. /eople with paranoid schizophrenia have prominent delusions and hallucinations

that involve themes of persecution and grandiosity, but they often do not show grossly disorganized speech or behavior. /eople with disorganized schizophrenia do not have well.formed delusions or hallucinations, but their thoughts and behaviors are severely disorganized. /eople with catatonic schizophrenia show a variety of motor behaviors and ways of spea&ing that suggest almost complete unresponsiveness to their environment. /eople with undifferentiated schizophrenia have symptoms that meet the criteria for schizophrenia (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms) but do not meet the criteria for paranoid, disorganized, or catatonic schizophrenia. /eople with residual schizophrenia have had at least one acute episode of positive symptoms of schizophrenia but do not currently have any prominent positive symptoms of schizophrenia* they may have negative symptoms, however. ;. =n schizoaffective disorder, schizophrenic symptoms occur in the presence of mood symptoms. 3chizophreniform disorder re?uires that individuals meet Criteria ", 1, and 9 for schizophrenia but have symptoms that last only + to , months. =ndividuals with brief psychotic disorder show a sudden onset of delusions, hallucinations, disorganized speech, and>or disorganized behavior. !he episode lasts only between + day and + month, after which the symptoms vanish completely. =ndividuals with delusional disorder have delusions lasting at least + month regarding situations that occur in real life, such as being followed, being poisoned, being deceived by a spouse, or having a disease. !hey do not show any other schizophrenic symptoms. =ndividuals with shared psychotic disorder (also referred to as folie E deu') have a delusion that develops from a relationship with a delusional person. Apply It: d. Catatonic behavior is a positive symptom of schizophrenia, and blunted affect is a negative symptom. Done of the other combinations are correct. (iologi!al T$eorie (p. 2%<) +. 0amily history studies show that the degree of genetic relationship between an individual and a family member with schizophrenia predicts the individual-s ris& for schizophrenia. !win and adoption studies also indicate that genetics is involved. 9pigenetic processes may play a strong role in schizophrenia. 2. /eople with schizophrenia show low activity in the prefrontal corte' and enlarged ventricles, as well as abnormal hippocampal activity. . /renatal and birth difficulties, including prenatal hypo'ia and e'posure to the influenza or herpes simple' virus during the second trimester of gestation, may interact with a genetic predisposition to increase the ris& for schizophrenia. %. 1opamine clearly plays a role in schizophrenia* new research suggests that serotonin, glutamate, and 7"8" may also be involved. Apply It: b. =maging studies show that e'cess dopamine in the mesolimbic pathways may lead to positive symptoms of schizophrenia, while low levels of dopamine in the prefrontal corte' lead to negative symptoms. P y!$o o!ial Per "e!ti#e (p. 2)+) +. /eople with schizophrenia tend to live in stressful and often impoverished circumstances. $ost theorists see this as social driftFa reduction in the socioeconomic status of the person with schizophrenia resulting from impairment.

!he rate of schizophrenia is higher in urban areas than in rural settings, possibly because of the stress of urban life and the greater ris& of e'posure to viruses in urban settings. 3tress seems to trigger new episodes of schizophrenia but is not a primary cause of the disorder. 2. 0amilies high in e'pressed emotion are overinvolved and overprotective while at the same time being critical and resentful. /eople with schizophrenia who live in families high in e'pressed emotion may be at increased ris& for relapse. . Cognitive theorists see some schizophrenia symptoms as attempts to understand perceptual and attentional disturbances. Apply It: b. 2nli&e families in developed countries, families in developing countries tend not to show high levels of e'pressed emotion. Treatment (p. 2);) +. !he phenothiazines treat schizophrenia by affecting dopamine levels. !hey are more effective in treating the positive symptoms than the negative symptoms, however, and a significant percentage of people do not respond to them at all. 3erious potential side effects include muscle stiffness, freezing of the facial muscles, tremors and spasms in the e'tremities, an agitation that ma&es people unable to sit still, and tardive dys&inesia. 2. !he atypical antipsychotics are new drugs that affect serotonin as well as dopamine and seem to be more effective in treating schizophrenia than the phenothiazines. !heir side effects can include dizziness, nausea, sedation, seizures, hypersalivation, weight gain, tachycardia, and agranulocytosis. . /sychosocial therapies focus on helping people with schizophrenia and their families understand and cope with the conse?uences of the disorder. !hey also help the person with schizophrenia gain access to resources and integrate into the community as much as possible. Apply It: a. "ssertive community treatment is focused not on childhood events but on helping people with schizophrenia live life to their greatest potential and cope with their disorder. CHAPTER 6 O&&.E!!entri! Per onality Di or&er (p. 2;2) +. /eople diagnosed with the odd.eccentric personality disordersFparanoid, schizoid, and schizotypal personality disordersFhave odd thought processes, emotional reactions, and behaviors similar to those of people with schizophrenia, but they retain their grasp on reality. 2. /eople diagnosed with paranoid personality disorder are chronically suspicious of others but retain their grasp on reality. . /eople diagnosed with schizoid personality disorder are emotionally cold and distant from others and have great trouble forming interpersonal relationships. %. /eople diagnosed with schizotypal personality disorder have a variety of odd beliefs and perceptual e'periences but retain their grasp on reality. ). !herapists help clients learn to reality.test their unusual thin&ing. "ntipsychotics may help people with schizotypal personality disorder reduce their odd thin&ing.

Apply It: d. 3chizotypal personality disorder is most closely lin&ed to schizophrenia. Dramati!.Emotional Per onality Di or&er (p. 2<%) +. /eople diagnosed with the dramatic.emotional personality disordersFantisocial, borderline, histrionic, and narcissistic personality disordersFhave a history of unstable relationships and emotional e'periences and of dramatic, erratic behavior. 2. /eople with antisocial personality disorder regularly violate the basic rights of others, and many engage in criminal acts. "ntisocial personality disorder may have strong biological roots but also is associated with harsh and nonsupportive parenting. . /eople with borderline personality disorder vacillate between all good and all bad evaluations of themselves and others. !heories of the disorder suggest that it is due to fundamental problems in emotion regulation, poor relationships early in life that affect the development of self.concept, genetic factors, and low levels of serotonin. !reatments include dialectical behavior therapy, cognitive therapy, psychodynamic therapy, and antian'iety, antidepressant, and antipsychotic drugs. %. /eople with histrionic and narcissistic personality disorders act in a flamboyant manner. /eople with histrionic personality disorder are overly dependent on and solicitous of others, whereas people with narcissistic personality disorder are dismissive of others. Apply It: d. !his pattern most fits the criteria for narcissistic personality disorder, although some features also fit antisocial personality disorder. An,io) .Fearf)l Per onality Di or&er (p. 2<9) +. /eople diagnosed with the an'ious.fearful personality disordersFavoidant, dependent, and obsessive.compulsive personality disordersFare chronically fearful or concerned. 2. /eople with avoidant personality disorder worry about being criticized. . /eople with dependent personality disorder worry about being abandoned. %. /eople with obsessive.compulsive personality disorder are loc&ed into rigid routines of behavior and become an'ious when their routines are violated. Apply It: b. 9'cessive reassurance see&ing such as 4ose-s is characteristic of dependent personality disorder. Problem 7it$ t$e DSM-IV-TR Per onality Di or&er (p. 29+) !he diagnostic criteria overlap for several disorders* diagnosing the disorders re?uires information that is difficult to obtain* although personality disorders are conceptualized as stable characteristics, in fact they vary over time, especially when individuals are suffering from an "'is = disorder. Apply It: a. DSM-5 Re!on!e"t)ali1ation of Per onality Di or&er (p. 292) +. Degative emotionality, introversion, antagonism, disinhibition, compulsivity, and schizotypy. 2. "ntisocial>psychopathic, avoidant, borderline, obsessive.compulsive, and

schizotypal. Apply It: c. Whether the DSM-5 dimensional approach will eliminate gender bias in diagnosis is not clear. CHAPTER 18 (e$a#ior Di or&er (p. ++) +. !he diagnostic criteria for "1(1 are si' or more symptoms of inattention (e.g., shows lac& of attention to detail, does not listen or follow instructions, has trouble organizing activities, doesn-t li&e activities that re?uire mental effort, loses things, is easily distracted and forgetful)* si' or more symptoms of hyperactivity (e.g., fidgeting, restlessness, inability to stay seated, trouble doing things ?uietly, being Bon the go,C tal&ing e'cessively) or impulsivity (e.g., blurts answers, can-t wait a turn, interrupts). !hese symptoms must be present for , months or longer and must cause impairment in two or more settings* some symptoms must have been present before age ; ("merican /sychiatric "ssociation, 2666). 2. 8iological factors include unusual activity in the prefrontal corte'* dysfunction in norepinephrine, dopamine, and serotonin systems* genetic factors* and prenatal and birth complications. /sychosocial factors may include a disrupted and dysfunctional family life, although these factors may be conse?uences of the "1(1. . !he most common treatment for "1(1 is stimulant drugs. 8ehavior therapy is also helpful, and the combination of stimulants and behavior therapy may be the most effective treatment. %. !he diagnostic criteria for conduct disorder include a repetitive and persistent pattern of behavior in which the basic rights of others or ma#or age.appropriate societal norms are violated. !he child must show three or more of the following symptoms, at a level that causes significant impairment in functioning@ aggression toward people and>or animals (bullying, fighting, using a weapon, physical cruelty, theft, coerced se'ual activity), destruction of property (fire setting, destroying others- property), deceitfulness or theft (brea&ing into buildings or cars, lying, stealing), or serious violations of rules (stays out at night, runs away, avoids school). Children with oppositional defiant disorder engage in less severe antisocial behaviors that indicate negativity and irritability ("merican /sychiatric "ssociation, 2666). ). 8iological factors include genetics, neurological and physiological deficits that ma&e it more difficult for children with these disorders to learn from reinforcements and punishments and to control their behaviors, dysfunction in serotonin systems, and, to a lesser e'tent, high testosterone levels. 3ocial factors include low socioeconomic status, abusive or neglectful parenting, peer reinforcement, and a bias to interpret situations in hostile ways. ,. 1rug therapies, including stimulants, antipsychotic drugs, and antidepressants, are sometimes used to help children with conduct disorder control their behavior, cognitive.behavioral therapies help them learn to interpret and respond to situations more appropriately. Apply It: a. " component of behavior therapy would be to help the boy learn to

generate possible adaptive actions he could ta&e in such situations. Se"aration An,iety Di or&er (p. +%) +. Children with separation an'iety disorder e'cessively fear separation from their primary caregivers. !hey may become e'tremely agitated or ill when they anticipate separation, and they may curtail their usual activities to avoid separation. 2. 3eparation an'iety disorder appears to be associated with a family history of an'iety disorders. Children who are behaviorally inhibited as infants appear to be at ris& for separation an'iety disorder. . /arents may enhance a vulnerability to separation an'iety disorder by their reactions to their children-s distress. "lso, a history of e'posure to uncontrollable events may contribute to separation an'iety. %. Cognitive.behavioral therapies can help children with separation an'iety disorder ?uiet their an'ieties and resume everyday activities. "ntidepressants, antian'iety drugs, and stimulants are sometimes also used. Apply It: b. Children with separation an'iety disorder often refuse to go to school as a way to avoid separation from their parents but do not show the other problems listed. Elimination Di or&er (p. +)) +. 9nuresis is persistent, uncontrolled wetting by children who have attained bladder control. =t runs in families, and some children may have an unusually small bladder, a lower bladder threshold for involuntary voiding, or a urinary tract infection. 8ehavioral theories attribute it to family disruption or poor toilet training. Children usually are treated by their pediatrician with an antidepressant. !he bell and pad method, a behavioral treatment that teaches children to wa&e when their bladder is full, is most effective. 2. 9ncopresis is persistent, uncontrolled soiling by children who have attained control of defecation. =t typically begins after one or more episodes of constipation, which creates distention in the colon and decreases a child-s ability to detect needed bowel movements. $edical management (including colon. clearing medication, la'atives, increased fiber, and daily toilet use) and behavioral techni?ues (rela'ation e'ercises and rewards) can help reduce encopresis. Apply It: d. !he bell and pad method is the most effective treatment for enuresis. Di or&er of Cogniti#e5 %otor5 an& Comm)ni!ation S9ill (p. +<) +. :earning disorders include reading disorder (inability to read), mathematics disorder (inability to learn math), and disorder of written e'pression (inability to write). 2. 1evelopmental coordination disorder involves deficits in fundamental motor s&ills. . Communication disorders include e'pressive language disorder (an inability to e'press oneself through language), mi'ed receptive.e'pressive language disorder (an inability to e'press oneself through language or to understand the language of others), phonological disorder (the use of speech sounds inappropriate for age and dialect), and stuttering (deficits in word fluency).

%. 7enetic factors are involved. "bnormalities in brain structure and functioning have been implicated in these disorders. 9nvironmental factors, including lead poisoning, birth defects, sensory deprivation, and low socioeconomic status, may contribute to brain dysfunction. !reatment usually focuses on building s&ills in problem areas through specialized training and computerized e'ercises. Apply It: b. 3pecialized training to overcome dysle'ia has been shown to result in changes in the parietotemporal and occipitotemporal systems of the brain. %ental Retar&ation (p. 2 ) +. $ental retardation is defined as subaverage intellectual functioning, as indicated by an =G score under ;6 and deficits in adaptive behavioral functioning. !here are four levels of mental retardation, ranging from mild to profound. 2. 8iological factors implicated in mental retardation include genetic factors* metabolic disorders (/H2, !ay.3achs disease)* chromosomal disorders (1own syndrome, fragile I, trisomy + , and trisomy +<)* prenatal e'posure to rubella, herpes, syphilis, or drugs (especially alcohol)* premature delivery* and head trauma (such as that arising from being violently sha&en). Children with mental retardation are more li&ely to come from lower socioeconomic bac&grounds, which may increase their ris& for some causes of retardation and may not provide an environment conducive to ameliorating their ris&. . 8ehavioral strategies teach children basic social, communication, and cognitive s&ills. Deuroleptic medications, atypical antipsychotics, and antidepressants are used to reduce self.in#urious and aggressive behaviors. Comprehensive interventions involving schools and parents are an important element of treatment. Apply It: c. 9ven children e'posed to low to moderate amounts of alcohol prenatally have been shown to have subtle cognitive deficits. Per#a i#e De#elo"mental Di or&er (p. 6) +. !he pervasive developmental disorders are characterized by severe and lasting impairment in several areas of development, including social interaction, communication, and everyday behaviors, interests, and activities. Children with autism show deficits in all these areas. Children with "sperger-s disorder show deficits in social interactions and interests or activities but not in communication. Children with 4ett-s disorder and childhood disintegrative disorder appear to develop normally for a period and then show declines in functioning. 2. 8iological causes of autism may include a genetic predisposition to cognitive impairment, neurological dysfunction, prenatal complications, and serotonin or dopamine imbalances. . 3erotonin reupta&e inhibitors, atypical antipsychotics, naltre'one (an opiate bloc&er), and some stimulants reduce some behaviors in autism but do not eliminate the core of the disorder. %. 8ehavior therapy is used to reduce inappropriate and self.in#urious behaviors and to encourage prosocial behaviors in children with autism. Apply It: b. 1eficits in intelligence are not re?uired for the diagnosis of autism.

CHAPTER 11 Dementia (p. %,) +. !he five types of cognitive impairment in dementia are memory impairment, aphasia, apra'ia, agnosia, and loss of e'ecutive functioning. 2. !he brains of "lzheimer-s patients show neurofibrillary tangles, pla?ues made up of amyloid protein, and cortical atrophy. . !he gene most consistently associated with "lzheimer-s disease is the apolipoprotein 9 gene ("/59). =n addition, abnormal genes on chromosome 2+ have been implicated. /eople with "lzheimer-s disease show abnormalities in a number of neurotransmitters, including acetylcholine, norepinephrine, serotonin, somatostatin, and peptide A. %. 1ementia can also be caused by cerebrovascular disorder, head in#ury, and progressive disorders such as /ar&inson-s disease, (=J disease, (untington-s disease, and, more rarely, /ic&-s disease, Creutzfeldt.Ka&ob disease, and a number of other medical conditions. 0inally, chronic drug abuse and the nutritional deficiencies that often accompany it can lead to dementia. Apply It: d. Cholinesterase inhibitors, drugs affecting glutamate, and antidepressnt and antian'iety drugs are used to treat dementia. Deliri)m (p. %<) +. 1elirium is characterized by disorientation, recent memory loss, and a clouding of consciousness. 2. !he many causes of delirium include medical diseases, the trauma of surgery, illicit drug use, medications, high fever, and infections. Apply It: a. "ntipsychotic medications may reduce confusion in patients suffering from delirium. Amne ia (p. )6) +. "mnesia can be caused by brain damage due to stro&es, head in#uries, chronic nutritional deficiencies, e'posure to to'ins (such as through carbon mono'ide poisoning), herpes encephalitis, or chronic substance abuse. 2. !he treatment of amnesia can involve removing the agents contributing to the amnesia and helping the person develop memory aids. Apply It: b. 4etrograde amnesia is loss of memory for past events. "nterograde amnesia is the inability to remember new information. 8oth types of amnesia can be caused by biological factors. %ental Di or&er in Later Life (p. ))) +. Common an'iety disorders among older people are generalized an'iety disorder and post.traumatic stress disorder. /anic disorder and obsessive.compulsive disorder are relatively rare. 2. "n'iety disorders can be treated with antian'iety drugs, antidepressants, or psychotherapy. . 1epressed older adults may complain not of sadness but of physical problems.

3ome older people show a depletion syndrome, consisting of loss of interest, loss of energy, hopelessness, helplessness, and psychomotor retardation. %. "lcohol use problems and abuse of and dependence on prescription drugs are significant problems among older people. Apply It: d. "ntidepressant medications and 9C! are commonly used to treat severe depression in older people. /sychological therapies, including behavioral therapy, cognitive.behavioral therapy, interpersonal therapy, problem.solving therapy, brief psychodynamic therapy, and life review therapy have been shown to wor& very well. CHAPTER 1' C$ara!teri ti! of Eating Di or&er (p. ; ) +. "nore'ia nervosa is characterized by self.starvation, a distorted body image, intense fear of getting fat, and amenorrhea. /eople with the restricting type refuse to eat in order to prevent weight gain. /eople with the binge>purge type periodically binge and then purge to prevent weight gain. 2. 8ulimia nervosa is characterized by uncontrolled binge eating followed by behaviors designed to prevent weight gain from the binges. /eople with the purging type of bulimia use self.induced vomiting, diuretics, or la'atives to prevent weight gain. /eople with the nonpurging type use fasting and e'ercise to prevent weight gain. . 8inge.eating disorder is a provisional diagnosis in the DSM-IV-TR. =t is characterized by binge eating in the absence of behaviors designed to prevent weight gain. %. 9ating disorder not otherwise specified (91D53) is the diagnosis given to individuals who have significant symptoms of anore'ia nervosa, bulimia nervosa, or binge.eating disorder but who do not meet the full criteria for any eating disorder. ). 5besity is defined as a body mass inde' of 6 or greater. Apply It: d. $ost obesity treatment e'perts recommend aiming for modest weight loss and increased e'ercise. $edications can lead to an average weight loss of ++ pounds or less* commercial weight.loss programs do lead to weight loss for some people* dieting can wor& but is difficult to maintain.

Un&er tan&ing Eating Di or&er (p. <2) +. !here is evidence that tendencies toward anore'ia nervosa and bulimia nervosa are heritable. 9ating disorders may be tied to dysfunction in the hypothalamus, a part of the brain that helps regulate eating behavior. 3ome studies show abnormalities in levels of the neurotransmitters serotonin and norepinephrine in people with eating disorders. 2. 9ating disorders develop as means of gaining some control or of coping with

negative emotions. =n addition, people with eating disorders tend to show rigid, dichotomous thin&ing and to e'cessively value of thinness. . /eople who develop eating disorders may come from families that are overcontrolling and perfectionistic but that discourage the e'pression of negative emotions. Apply It: b. 9lite athletes, particularly gymnasts and bodybuilders in developed nations, tend to have high rates of eating disorders. Casual athletes have lower rates, but those in the 2nited 3tates still are e'posed to societal pressures to be thin* such pressures are less strong in developing countries li&e 0i#i. Treatment for Eating Di or&er (p. <%) +. Cognitive.behavioral therapy for anore'ia nervosa involves ma&ing rewards contingent on the client-s eating and challenging those thoughts that #ustify self. starvation. Clients may be taught rela'ation techni?ues to handle their an'iety about eating. 2. =n $audsley family therapy, parents are coached to ta&e control over their child-s eating and weight. "s the therapy progresses, the child-s autonomy is e'plicitly lin&ed to the resolution of her eating disorder. . Cognitive.behavioral therapy for bulimia nervosa identifies the cognitions that trigger binge eating and compensatory behaviors and teaches clients to confront them. Clients learn new ways to cope with stress and are encouraged to eat three nutritious meals a day. %. 3elective serotonin reupta&e inhibitors are most often used in the treatment of eating disorders. Apply It: a. Cognitive.behavioral therapy has the most evidence of effectiveness in the treatment of bulimia nervosa. CHAPTER 1* Se,)al Dy f)n!tion (p. %6,) +. /eople with disorders of se'ual desire have little or no desire to engage in se'. !hese disorders include hypoactive se'ual desire disorder and se'ual aversion disorder. 2. /eople with se'ual arousal disorders do not e'perience the physiological changes that ma&e up the e'citement or arousal phase of the se'ual response cycle. !hese disorders include female se'ual arousal disorder and male erectile disorder. . Women with female orgasmic disorder either do not e'perience orgasm or have greatly delayed orgasm after reaching the e'citement phase. $en with premature e#aculation reach e#aculation before they wish to. $en with male orgasmic disorder have a recurrent delay in or an absence of orgasm following se'ual e'citement. %. !he two se'ual pain disorders are dyspareunia, genital pain associated with intercourse* and vaginismus, involuntary contraction of the vaginal muscles. ). !he biological causes of se'ual dysfunctions include undiagnosed diabetes or other medical conditions, prescription or recreational drug use (including alcohol), and hormonal or vascular abnormalities. !he psychological causes

include psychological disorders as well as maladaptive attitudes and cognitions (especially performance concerns). !he sociocultural and interpersonal causes include problems in intimate relationships, traumatic e'periences, and an upbringing or a cultural environment that devalues or degrades se'. ,. When the cause of a se'ual dysfunction is biological, treatments that eradicate the cause can cure the se'ual dysfunction. "lternately, drug therapies or prostheses can be used. 3e' therapy corrects the inade?uate se'ual practices of a client and his or her partner. !he techni?ues of se' therapy include sensate focus therapy, instruction in masturbation, the stop.start and s?ueeze techni?ues, and the deconditioning of vaginal contractions. Couples therapy focuses on decreasing conflicts between partners over their se'ual practices or over other areas of their relationship. =ndividual psychotherapy helps people recognize and resolve conflicts or negative attitudes behind their se'ual dysfunctions. Apply It: d. /erformance an'iety involves focusing on how you are performing in se'ual encounters rather than on pleasurable sensations. Para"$ilia (p. %+,) +. !he paraphilias are a group of disorders in which people-s se'ual activity is focused on (+) nonliving ob#ects, (2) nonconsenting adults, ( ) suffering or the humiliation of oneself or one-s partner, or (%) children. 2. 0etishism involves the use of inanimate ob#ects (e.g., panties or shoes) as the preferred or e'clusive source of se'ual arousal or gratification. !ransvestic fetishism involves a man who is aroused by dressing in women-s clothing. . 3e'ual sadism involves physically harming another, and se'ual masochism involves allowing oneself to be harmed to achieve se'ual arousal. %. Joyeurism involves observing another person nude or engaging in se'ual acts, without that person-s &nowledge or consent, in order to become se'ually aroused. 9'hibitionism involves e'posing oneself to another person, without that person-s consent, in order to become se'ually aroused. 0rotteurism involves rubbing up against another person, without his or her consent, in order to become se'ually aroused. ). /edophilia involves engaging in se'ual acts with a prepubescent child. ,. /edophilia has been lin&ed to alterations in the development of the nervous system. 8ehavioral theories suggest that paraphilias result from an initial classical pairing of intense early se'ual arousal with a particular stimulus followed by intensive operant conditioning in which the stimulus is present during masturbation. Cognitive theories point to distorted beliefs and assumptions as leading to paraphilic behavior. ;. !reatments for the paraphilias include castration and antiandrogen drugs to reduce se'ual drive, behavioral interventions to decondition arousal to paraphilic ob#ects, training in interpersonal and social s&ills, and cognitive therapy to challenge distorted beliefs about se'ual behavior. Apply It: c. 7eorge shows symptoms of voyeurism, while 0red shows symptoms of frotteurism. -en&er :&entity Di or&er (p. %+9)

+. 7ender identity disorder (7=1) is diagnosed when individuals believe they were born with the wrong se'-s genitals and fundamentally are persons of the opposite se'. !his disorder in adults is also called transse'ualism. 2. 8iological theories suggest that unusual e'posure to prenatal hormones affects the development of the hypothalamus and other brain structures involved in se'uality, leading to gender identity disorder. . 3ocialization theories suggest that the parents of children (primarily boys) with gender identity disorder do not socialize gender.appropriate behaviors in their children. Apply It: d. "ll the options are part of standard therapy for gender identity disorder e'cept cognitive therapy, in which it is assumed that distorted beliefs led to the desire to change se'. CHAPTER 1+ Defining S)b tan!e.Relate& Di or&er (p. % 2) +. 3ubstance into'ication is a set of behavioral and psychological changes that occur as a result of the physiological effects of a substance on the central nervous system. 2. 3ubstance withdrawal is a set of physiological and behavioral symptoms that result when people who have been using substances heavily for prolonged periods of time stop or greatly reduce their use. . 3ubstance abuse is diagnosed when a person repeatedly shows problems in at least one of four areas over a +2.month period@ fails to fulfill important obligations, uses the substance in situations in which it is physically hazardous to do so, has legal problems as a result of substance use, and continues to use the substance despite repeated social or legal problems as a result of use. %. 3ubstance dependence is diagnosed when an individual shows three or more of the following over a +2.month period@ tolerance, withdrawal, ta&ing the substance over a longer period and in larger amounts than was intended, unsuccessful efforts to cut down or control use, spending a great deal of time obtaining and using the substance, giving up or reducing important activities due to substance use, and continuing use despite physical or psychological problems. Apply It: c. Kennifer most li&ely would meet the criteria for substance abuse. 3he has repeatedly used alcohol in situations in which it is hazardous to do so (driving) and has legal problems as a result of substance use (losing her license). 7iven the information we have, she would not meet the criteria for substance dependence because she does not meet three of the criteria for that disorder. De"re ant (p. % <) +. =n low doses, alcohol causes many people to feel more self.confident, more rela'ed, slightly euphoric, and less inhibited. "t increasing doses, alcohol induces fatigue and lethargy, decreased motivation, sleep disturbances, depressed mood, confusion, poor motor control, and memory loss. "lcohol withdrawal symptoms include an'iety, headaches, nausea, cramps, and profuse perspiration. :ater stages of withdrawal can include seizures, hallucinations and delusions, agitation, fever, and irregular heartbeat.

2. 8enzodiazepines and barbiturates can cause an initial rush plus a loss of inhibitions. !hese pleasurable sensations are followed by depressed mood, lethargy, and physical signs of central nervous system depression. . =nhalants can cause hepatitis, liver and &idney illness, permanent damage to the brain, and death due to respiratory or cardiac failure or accidents. Apply It: b. 4aul-s symptoms, including memory loss, difficulties in problem solving, and poor #udgment, most closely fit alcohol.related dementia. Stim)lant (p. %% ) +. Cocaine, amphetamines, and methamphetamines produce a rush of euphoria, followed by increases in self.esteem, alertness, and energy. With chronic use, however, they can lead to grandiosity, impulsiveness, hyperse'uality, agitation, and paranoia. 2. Withdrawal from cocaine, amphetamines, and methamphetamines causes symptoms of depression, e'haustion, and an intense craving for more of the substances. . Cocaine, amphetamines, and methamphetamines activate the central nervous system and can lead to a number of cardiac, respiratory, and neurological problems. %. Dicotine affects the release of several neurochemicals in the body. Dicotine sub#ectively reduces stress but causes physiological arousal similar to that seen in the fight.or.flight response. 3mo&ing is associated with higher rates of heart disease, lung cancer, emphysema, and chronic bronchitis and substantially increases mortality rates. ). Caffeine into'ication can cause agitation, tremors, heart irregularities, and insomnia. Apply It: c. 8ased on the information available, the best diagnosis for Connie would be amphetamine.induced psychotic disorder. O"ioi& (p. %%%) +. !he opioids include heroin, morphine, codeine, and methadone, as well as the synthetic opioids hydrocodone (:orcet, :ortab, Jicodin) and o'ycodone (/ercodan, /ercocet, 5'ycontin). 2. !he opioids cause an initial rush, or euphoria, followed by a drowsy, dreamli&e state. 3evere into'ication can cause respiratory and cardiovascular failure. . Withdrawal symptoms include dysphoria, an'iety, and agitation* an achy feeling in the bac& and legs* increased sensitivity to pain* and a craving for more opioids. %. 5pioids can suppress the respiratory and cardiovascular systems, and opioid into'ication can lead to unconsciousness, coma, and seizures. 5pioid users who in#ect drugs can contract (=J and a number of other disorders by sharing needles. =ntravenous users also can contract hepatitis, tuberculosis, serious s&in abscesses, and deep infections. Women who use heroin during pregnancy ris& miscarriage and premature delivery, and children born to addicted mothers are at increased ris& for sudden infant death syndrome. Apply It: d. /eople dependent on opioids may appear drowsy and spacey.

Hall)!inogen an& PCP (p. %%,) +. !he hallucinogens create perceptual illusions and distortionsFsometimes fantastic, sometimes frightening. 3ome people feel more sensitive to art, music, and other people. (allucinogens also create mood swings and paranoia. 3ome people e'perience frightening flashbac&s to past e'periences. 2. /C/ causes euphoria or affective dulling, abnormal involuntary movements, tal&ativeness, lac& of concern, slowed reaction time, vertigo, mild hypertension, and wea&ness. "t intermediate doses, it leads to disorganized thin&ing, depersonalization, feelings of unreality, and aggression. "t higher doses, it produces amnesia and coma, analgesia sufficient to allow surgery, seizures, severe respiratory problems, hypothermia, and hyperthermia. Apply It: b. 4esearchers thought the hallucinations and delusions e'perienced by people who ta&e :31 were similar to those seen in schizophrenia. Cannabi (p. %%;) +. Cannabis creates a high feeling, cognitive and motor impairments, and, in some cases, hallucinogenic effects. 2. Cannabis can impair cognition and motor performance and can lead to perceptual distortions, feelings of depersonalization, paranoid thin&ing, and an'iety. Apply It: d. 5f those given, the most li&ely conse?uence is that 7ail-s short.term memory will be impaired, interfering with her ability to answer longer ?uestions. Ot$er Dr)g of Ab) e (p. %%<) +. 9cstasy has the stimulant effects of an amphetamine along with occasional hallucinogenic effects. 9ven short.term use of ecstasy can have long.term negative effects on cognition and health. :ong.term use of ecstasy puts users at ris& for several cardiac problems and liver failure and increased rates of an'iety, depression, psychotic symptoms, and paranoia. 2. 7(8 is an anabolic steroid and a central nervous system depressant. "t low doses, it can relieve an'iety and promote rela'ation. "t higher doses, it can result in sleep, coma, or death. . Hetamine is an anesthetic that produces hallucinogenic effects. :arge doses can produce vomiting, convulsions, and even death. %. 4ohypnol has sedative and hypnotic effects. =t is one of the date.rape drugs, along with 7(8 and &etamine. When it is used in combination with alcohol or other depressants, it can be fatal. Apply It: a. Kerry-s mood and cognitive symptoms may be the result of changes in serotonin levels due to chronic ecstasy use. T$eorie of S)b tan!e U e5 Ab) e5 an& De"en&en!e (p. %)2) +. /sychoactive substances affect levels of dopamine and other neurotransmitters in the Bpleasure pathwayC of the brain, which begins in the midbrain ventral tegmental area and then progresses through the nucleus accumbens and on to the anterior cingulate area of the frontal corte'.

2. 0amily history, twin, and adoption studies all suggest that substance.use disorders are influenced by genetics, particularly by genes that influence how the brain processes dopamine. . /eople differ in how rewarding they find substances, and reward sensitivity is lin&ed to vulnerability to substance abuse and dependence. %. 8ehavioral theories of alcoholism note that people are reinforced or punished by other people for their alcohol.related behaviors. /eople model their alcohol. related behaviors on the behaviors of parents and important others. Cognitive theories argue that people who develop alcohol.related problems have strong e'pectations that alcohol will help them feel better and cope better when they face stressful events. 5ne personality trait associated with an increased ris& for substance.use disorders is behavioral undercontrol, which in turn appears to be influenced by genetics. ). 3ociocultural theorists note that the use of alcohol and other drugs increases among people who are under severe stress. ,. 7ender differences in substance.use disorders may be due to men having more ris& factors for substance use and women being more sensitive to the negative conse?uences of substance use. Apply It: d. !homas-s alcohol dependence could be due to genetics, to modeling of his parents- alcohol behaviors, and to the stress of growing up in a high.conflict, impoverished family. "ll these factors may reinforce one another. Treatment for S)b tan!e.Relate& Di or&er (p. %)9) +. "ntian'iety and antidepressant drugs can help ease withdrawal symptoms. "ntagonist drugs can bloc& the effects of substances, reduce desire for the drug, or ma&e the ingestion of the drug aversive. $ethadone maintenance programs substitute methadone for heroin in the treatment of heroin addicts. 2. 8ehavioral interventions include aversive classical conditioning and covert sensitization therapy to change individuals- conditioned responses to substances. Contingency management programs provide incentives for reducing substance use. Cognitive treatments focus on training people with substance.use disorders in more adaptive coping s&ills and challenging positive e'pectations about the effects of substances. . $otivational interviewing emphatically elicits and solidifies individualsmotivation and commitment to changing their substance use. %. !he abstinence violation effect is an individual-s feelings of conflict and guilt over violating abstinence and attribution of his or her violation of abstinence to a lac& of self.control. 4elapse prevention programs teach individuals to view relapses as temporary and to develop s&ills to avoid future relapses. ). "lcoholics "nonymous is a self.help group that encourages alcoholics to admit their wea&nesses and to call on a higher power and other group members to help them remain completely abstinent from alcohol. 4elated groups are available for people dependent on other substances. ,. /revention programs based on the harm reduction model aim to teach individuals to use alcohol responsibly. Apply It: b. !he therapist first used motivational interviewing to elicit 4enda-s

motivation for and commitment to change. !he therapist then used cognitive techni?ues to challenge her e'pectations that alcohol would help her cope and to help her develop alternative coping strategies. :m")l e.Control Di or&er (p. %,+) /athological gambling is a chronic pattern of gambling leading to significant social and occupational dysfunction. Hleptomania is a chronic pattern of stealing items not needed for personal use or monetary value. /yromania involves the irresistible urge to set fires. =ntermittent e'plosive disorder is a pattern of acting on aggressive impulses that results in harm to others or in property damage. !richotillomania is compulsive hair pulling. Apply It: d. !richotillomania is the impulse.control disorder that most often is comorbid with 5C1 and responds to some of the same drugs as 5C1. CHAPTER 1/ P y!$ologi!al Fa!tor an& -eneral Healt$ (p. %;%) +. /eople who are chronically pessimistic may show poorer physical health because they appraise more events as uncontrollable or because they engage in poorer health.related behaviors. 2. /eople who engage in avoidance coping deny that they are facing stress, including the stress of medical illness. !hey are at increased ris& for a wide range of health problems. !he negative effects of avoidance coping may be more pronounced in 9uropean "mericans than in "sians or "sian "mericans. . /eople who write about the stresses in their life or who e'press their concerns to others show better immune system functioning and health* similarly, people who receive high.?uality social support have more positive physical health outcomes in stressful situations than do those who have little social support or much social friction. %. (aving a psychological disorder increases the ris& for physical health problems. /ossible mechanisms include shared genetic vulnerabilities and medical diseases directly caused by psychological symptoms. =n addition, many people with psychological disorders have unhealthier behaviors, poorer coping s&ills, greater pessimism, and more stressful lives that lead to medical diseases. Apply It: d. 9eyore-s pessimism could lead to poorer physical health. P y!$o o!ial Fa!tor in S"e!ifi! Di ea e (p. %<2) +. =n the short term, stress increases immune system functioning, but chronic stress can suppress immune system functioning and thus contribute to disease. 3tress and psychological factors such as pessimism have been shown to predict the progression of cancer, but psychosocial interventions have not consistently affected the progression of cancer. 2. 3tress and negative e'pectations have been shown to predict the progression of (=J>"=13. . !he !ype " behavior pattern has been lin&ed to coronary heart disease* this pattern involves a sense of time urgency, easily aroused hostility, and competitive striving for achievement. (ostility is the component that best predicts coronary

heart disease. %. 1epression is a strong predictor of recurrent cardiac events in people with coronary heart disease. /oor health behaviors, particularly lac& of e'ercise, help e'plain the lin& between depression and heart disease. Apply It: b. (ostility is the component of !ype " behavior that best predicts coronary heart disease. :nter#ention to :m"ro#e Healt$.Relate& (e$a#ior (p. %<%) +. 7uided mastery techni?ues provide people with e'plicit information about how to engage in positive health.related behaviors and with opportunities to do so in increasingly challenging situations. 2. !he Web can be used to provide behavior.modification programs to people who otherwise might not have access to such programs. Apply It: a. 3imply providing information about the ris&s of health.related behaviors has less impact than increasing motivation, s&ills, and self.efficacy. Slee" an& Healt$ (p. %9 ) +. !he four categories of sleep disorders are sleep disorders related to another mental disorder, sleep disorders related to a general medical condition, substance.induced sleep disorders, and primary sleep disorders. 2. 1yssomnias are primary sleep disorders involving abnormalities in the amount, ?uality, or timing of sleep. /arasomnias are primary sleep disorders involving unusual behavior during sleep. =n neither type is the sleep disorder due to a general medical condition, another mental disorder, or the misuse of substances. . =nsomnia is difficulty initiating or maintaining sleep or sleep that chronically does not restore energy and alertness. (ypersomnia is chronic e'cessive sleepiness as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily. Darcolepsy involves irresistible attac&s of sleep* people with narcolepsy also have (+) cataple'y or (2) recurrent intrusions of elements of rapid eye movement (49$) sleep into the transition between sleep and wa&efulness. 8reathing.related sleep disorders (central sleep apnea and obstructive sleep apnea) involve numerous brief sleep disturbances due to problems breathing. Circadian rhythm sleep disorders include delayed sleep phase type, #et lag type, and shift wor& type* people with these disorders have a sleep.wa&e cycle that is out of synch with the environment. %. Cognitive.behavioral therapy is the most effective treatment for insomnia, although a variety of medications are also prescribed. 3timulants are prescribed for people with narcolepsy or hypersomnia. Continuous positive airway pressure machines are used to treat breathing.related sleep disorders. 5bstructive sleep disorder is also sometimes treated with weight loss or with serotonin reupta&e inhibitors and stimulants. $elatonin, stimulants, light therapy, and behavioral techni?ues to change sleep habits are used to treat circadian rhythm sleep disorders. ). !he parasomnias include nightmare disorder, sleep terror disorder, and sleepwal&ing disorder. Apply It: c. !he devise used to treat obstructive sleep apnea is the continuous positive

air pressure machine. CHAPTER 12 Ci#il Commitment (p. )6%) +. /eople can be involuntarily committed if they are #udged to have grave disabilities that ma&e it difficult for them to meet their own basic needs, if they pose imminent danger to themselves, or if they pose imminent danger to others. 2. 4esearch shows somewhat higher rates of violence by people with mental disorders, particularly those who also have a history of substance abuse, but the rates are not as high as some stereotypes would suggest. Apply It: b. Kim most clearly meets the criterion of an imminent danger, because he wishes to die and has obtained the means to do so. 7eorge has been surviving on the streets for ) years, so he would not meet the criteria for grave disability. "ccording to research, (arry is the person most li&ely to commit violence, but because the danger is not imminent, he probably could not be involuntarily committed. /hil would not be committed for refusing to ta&e his medications unless his symptoms of bipolar disorder met the criteria for imminent grave disability or dangerousness to himself or others. Patient ; Rig$t (p. )6)) /atients who are committed retain the right to treatment, the right to informed consent, and the right to refuse treatment. Apply It: c. Jic&i-s psychiatrist did not obtain informed consent to administer antipsychotic medications. Com"eten!e to Stan& Trial (p. )6,) =ndividuals are #udged incompetent to stand trial when they do not have an understanding of events in the courtroom and cannot participate in their own defense. Apply It: a. /aul-s trial will be postponed* none of the other options are li&ely or always true.

T$e :n anity Defen e (p. )+6) 0ive rules have been used to evaluate the acceptability of a plea of not guilty by reason of insanity@ the $-Daghten rule, the irresistible impulse rule, the 1urham rule, the ":= rule, and the "merican /sychiatric "ssociation definition of insanity. Apply It: b. /eople #udged guilty but mentally ill are incarcerated with the assumption that they will receive mental health care. %ental Healt$ Care in t$e <) ti!e Sy tem (p. )+2) $ental health courts deal specifically with individuals with mental disorders who have committed crimes* the goal is to get them into treatment and rehabilitative services. 1rug courts do the same specifically for people with substance abuse or

substance dependence. Apply It: d. " #udge in a drug court is most li&ely to re?uire :iz to receive treatment for her addiction as a condition of staying out of #ail.