psychology eighth edition

psychology eighth edition

Thomas F.

olTmanns Washington University in St. Louis

RobeRT e.

emeRy University of Virginia

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Library of Congress Cataloging-in-Publication Data

Oltmanns, Thomas F. Abnormal psychology \ Thomas F. Oltmanns, Washington University in St. Louis, Robert E. Emery, University of Virginia.—Eighth edition. pages cm ISBN 978-0-205-97074-2 1. Psychology, Pathological. 2. Mental illness. I. Emery, Robert E. II. Title. RC454.O44 2014 616.89—dc23

2013037915

10 9 8 7 6 5 4 3 2 1

To Gail, Josh, Sara, Billy, Presley, Riley, and Kinley—T.F.O.

To Kimberly, Maggie, Julia, Bobby, Lucy, and John—R.E.E.

brief 1 examples and definitions of abnormal behavior 1 2 causes of abnormal behavior 24 3 treatment of psychological disorders 52 4 classification and assessment of abnormal behavior 77 5 Mood disorders and Suicide 105 6 anxiety disorders and obsessive-compulsive disorder 143 7 acute and posttraumatic Stress disorders, dissociative disorders,

and Somatic Symptom disorders 174

8 Stress and physical health 206 9 personality disorders 231 10 feeding and eating disorders 262 11 Substance-related and addictive disorders 284 12 Sexual dysfunctions, paraphilic disorders, and gender

dysphoria 318

13 Schizophrenia Spectrum and other psychotic disorders 348 14 neurocognitive disorders 379 15 intellectual disabilities and autism Spectrum disorders 404 16 psychological disorders of childhood 435 17 adjustment disorders and life-cycle transitions 465 18 Mental health and the law 489

iii

brief

iv

Preface xii about the authors xix

1 examples and definitions of abnormal behavior 1 Overview 2

Recognizing the Presence of a Disorder 4

Defining Abnormal Behavior 5 Harmful Dysfunction 6

Mental Health Versus Absence of Disorder 7

Culture and Diagnostic Practice 7

THINKING CRITICALLY about DSM-5: Revising an Imperfect manual 7

CRITICAL THINKING matters: Is sexual addiction a meaningful Concept? 9

Who Experiences Abnormal Behavior? 10 Frequency in and Impact on Community Populations 11

Cross-Cultural Comparisons 13

The Mental Health Professions 14

Psychopathology in Historical Context 15 The Greek Tradition in Medicine 15

The Creation of the Asylum 16

Worcester Lunatic Hospital: A Model Institution 16

Lessons from the History of Psychopathology 17

Methods for the Scientific Study of Mental Disorders 18 The Uses and Limitations of Case Studies 18

ReSeARCH methods: Who must Provide scientific evidence? 19

Clinical Research Methods 20

getting HeLp 21

summary 21 the big picture 22 key terms 23

2 causes of abnormal behavior 24 Overview 25

Brief Historical Perspective 26 The Biological Paradigm 26

The Psychodynamic Paradigm 27

THINKING CRITICALLY about DSM-5: Diagnosis and Causes of mental Disorders 28

The Cognitive-Behavioral Paradigm 29

The Humanistic Paradigm 30

The Problem with Paradigms 30

Systems Theory 31 Holism 31

Causality 31

ReSeARCH methods: 33 Correlations: Does a Psychology major make you smarter? 33

Developmental Psychopathology 33

Biological Factors 34 The Neuron and Neurotransmitters 34

Neurotransmitters and Psychopathology 35

mind–body Dualism 35

Major Brain Structures 36

Cerebral Hemispheres 38

Psychophysiology 38

Behavior Genetics 39

Psychological Factors 42 Human Nature 42

CRITICAL THINKING matters: Do Vaccinations Cause autism? 43

Temperament 44

Emotions 45

Learning and Cognition 45

The Sense of Self 46

Stages of Development 46

Social Factors 48 Close Relationships 48

Gender and Gender Roles 48

Prejudice, Poverty, and Society 49

getting HeLp 50

summary 50 the big picture 51 key terms 51

3 treatment of psychological disorders 52 Overview 53 Four Views of Frances 54

Biological Treatments 55 Psychopharmacology 55

THINKING CRITICALLY about DSM-5: Diagnosis and Treatment 56

Electroconvulsive Therapy 57

Psychosurgery 58

Psychodynamic Psychotherapies 58 Freudian Psychoanalysis 58

ConTenTs v

Ego Analysis 60

Psychodynamic Psychotherapy 60

Cognitive-Behavior Therapy 60 Systematic Desensitization 61

Other Exposure Therapies 61

Aversion Therapy 61

Contingency Management 61

ReSeARCH methods: The experiment: Does Treatment Cause Improvement? 62

Social Skills Training 63

Cognitive Techniques 63

Beck’s Cognitive Therapy 63

Rational–Emotive Therapy 63

“Third-Wave” CBT 64

Humanistic Therapies 64 Client-Centered Therapy 64

A Means, Not an End? 64

Research on Psychotherapy 65 Does Psychotherapy Work? 65

CRITICAL THINKING matters: are all Therapies Created equal? 66

The allegiance effect 68

Psychotherapy Process Research 69

ethnic minorities in Psychotherapy 70

Couple, Family, and Group Therapy 72 Couple Therapy 72

Family Therapy 73

Group Therapy 73

Prevention 74

Specific Treatments for Specific Disorders 74

getting HeLp 75

summary 75 the big picture 76 key terms 76

4 classification and assessment of abnormal behavior 77 Overview 78

Basic Issues in Classification 80 Categories Versus Dimensions 80

From Description to Theory 80

Classifying Abnormal Behavior 81 The DSM-5 System 81

labels and stigma 82

Criteria for obsessive-Compulsive Disorder 83

Culture and Classification 83

Evaluating Classification Systems 85 Reliability 85

ReSeARCH methods: Reliability: agreement Regarding Diagnostic Decisions 85

Validity 86

THINKING CRITICALLY about DSM-5: scientific Progress or Diagnostic Fads? 87

Problems and Limitations of the DSM-5 System 88

Basic Issues in Assessment 90 Purposes of Clinical Assessment 90

Assumptions About Consistency of Behavior 91

Evaluating the Usefulness of Assessment Procedures 91

CRITICAL THINKING matters: The barnum effect and assessment Feedback 92

Psychological Assessment Procedures 92 Interviews 92

Observational Procedures 94

Personality Tests and Self-Report Inventories 96

Projective Personality Tests 99

Biological Assessment Procedures 100 Brain Imaging Techniques 100

getting HeLp 102

summary 103 the big picture 103 key terms 104

5 Mood disorders and Suicide 105 Overview 106

Symptoms 109 Emotional Symptoms 109

Cognitive Symptoms 110

Somatic Symptoms 110

Behavioral Symptoms 111

Other Problems Commonly Associated with Depression 111

Diagnosis 111

THINKING CRITICALLY about DSM-5: Depression or Grief Following a major loss? 112

Criteria for major Depressive episode 113

Criteria for Diagnosis of manic episode 114

Course and Outcome 116 Depressive Disorders 116

Bipolar Disorders 116

Frequency 117 Incidence and Prevalence 117

Risk for Mood Disorders Across the Life Span 117

Gender Differences 118

Cross-Cultural Differences 118

Causes 119 Social Factors 119

Psychological Factors 121

Biological Factors 122

Integration of Social, Psychological, and Biological Factors 127

vi ConTenTs

ReSeARCH methods: analogue studies: Do Rats Get Depressed, and Why? 127

Treatment 128 Depressive Disorders 128

Cognitive Therapy 128

Bipolar Disorders 130

CRITICAL THINKING matters: Do antidepressant Drugs Cause Violent behavior? 131

Electroconvulsive Therapy 132

Seasonal Mood Disorders 132

Suicide 132 Classification of Suicide 133

Frequency of Suicide 135

Causes of Suicide 136

Common elements of suicide 137

Treatment of Suicidal People 138

getting HeLp 139

summary 140 the big picture 141 key terms 141

6 anxiety disorders and obsessive-compulsive disorder 143

Overview 144

Symptoms of Anxiety Disorders 145 Anxiety 145

Excessive Worry 146

Panic Attacks 147

Phobias 147

Diagnosis of Anxiety Disorders 147 Criteria for Panic Disorder 148

THINKING CRITICALLY about DSM-5: splitting Up the anxiety Disorders 149

Course and Outcome 150

Frequency of Anxiety Disorders 151 Prevalence 151

Comorbidity 151

Gender Differences 151

Anxiety Disorders Across the Life Span 151

Cross-Cultural Comparisons 152

Causes of Anxiety Disorders 152 Adaptive and Maladaptive Fears 152

Social Factors 153

Psychological Factors 154

Biological Factors 156

Treatment of Anxiety Disorders 158 Psychological Interventions 158

Biological Interventions 160

ReSeARCH methods: statistical significance: When Differences matter 161

Obsessive-Compulsive and Related Disorders 162 Symptoms of OCD 163

Diagnosis of OCD and Related Disorders 165

Course and Outcome of OCD 167

Frequency of OCD and Related Disorders 168

Causes of OCD 168

Treatment of OCD 169

CRITICAL THINKING matters: Can a strep Infection Trigger oCD in Children? 169

getting HeLp 171

summary 171 the big picture 172 key terms 172

7 acute and posttraumatic Stress disorders, dissociative disorders, and Somatic Symptom disorders 174

Overview 175

Acute and Posttraumatic Stress Disorders 175 Symptoms of ASD and PTSD 176

Diagnosis of ASD and PTSD 177

Criteria for Posttraumatic stress Disorder 178

Criteria for acute stress Disorder 179

The Trauma of sexual assault 180

Frequency of Trauma, PTSD, and ASD 181

Causes of PTSD and ASD 182

Prevention and Treatment of ASD and PTSD 184

Dissociative Disorders 186 Hysteria and the Unconscious 187

CRITICAL THINKING matters: Recovered memories? 188

Symptoms of Dissociative Disorders 189

Diagnosis of Dissociative Disorders 190

Frequency of Dissociative Disorders 192

THINKING CRITICALLY about DSM-5: more on Diagnostic Fads 192

Causes of Dissociative Disorders 194

ReSeARCH methods: Retrospective Reports: Remembering the Past 195

Treatment of Dissociative Disorders 196

Somatic Symptom Disorders 196 Symptoms of Somatic Symptom Disorders 196

Diagnosis of Somatic Symptom Disorders 197

Criteria for Illness anxiety Disorder 198

Frequency of Somatic Symptom Disorders 199

Causes of Somatic Symptom Disorders 200

Treatment of Somatic Symptom Disorders 202

getting HeLp 203

summary 204 the big picture 204 key terms 205

ConTenTs vii

8 Stress and physical health 206 Overview 207

Defining Stress 208 Stress as a Life Event 209

Stress as Appraisal of Life Events 210

Symptoms of Stress 210 Tend and befriend: The Female stress Response? 211

Psychophysiological Responses to Stress 211

Coping 213

Health Behavior 214

CRITICAL THINKING matters: Resilience 214

Illness as a Cause of Stress 217

Diagnosis of Stress and Physical Illness 217

THINKING CRITICALLY about DSM-5: Is the Descriptive approach Too literal sometimes? 217

Psychological Factors and Some Familiar Illnesses 218 Cancer 218

Criteria for Psychological Factors affecting other medical Conditions 218

Acquired Immune Deficiency Syndrome (AIDS) 219

Pain Disorder 220

Sleep-Wake Disorders 220

Cardiovascular Disease 221 Symptoms of CVD 222

Diagnosis of CVD 222

Frequency of CVD 222

Causes of CVD 222

ReSeARCH methods: longitudinal studies: lives over Time 223

Prevention and Treatment of CVD 226

getting HeLp 228

summary 229 the big picture 229 key terms 230

9 personality disorders 231 Overview 232

Symptoms 234 Social Motivation 234

Cognitive Perspectives Regarding Self and Others 235

Temperament and Personality Traits 235

Context and Personality 237

Diagnosis 237 Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders 238

CRITICAL THINKING matters: Can Personality Disorders be adaptive? 238

Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders 239

Cluster C: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders 241

A Dimensional Perspective on Personality Disorders 241

THINKING CRITICALLY about DSM-5: Is a Dimensional model Too Complicated? 243

Frequency 245 Prevalence in Community and Clinical Samples 245

Gender Differences 246

Stability of Personality Disorders over Time 246

Culture and Personality 247

ReSeARCH methods: Cross-Cultural Comparisons: The Importance of Context 248

Schizotypal Personality Disorder (SPD) 249 Symptoms 249

Criteria for schizotypal Personality Disorder 250

Causes 250

Treatment 250

Borderline Personality Disorder (BPD) 251 Impulse Control Disorders 252

Symptoms 252

Criteria for borderline Personality Disorder 253

Causes 253

Treatment 254

Antisocial Personality Disorder (ASPD) 255 Symptoms 256

Criteria for antisocial Personality Disorder 256

Causes 257

Treatment 259

getting HeLp 259

summary 260 the big picture 261 key terms 261

10 feeding and eating disorders 262 Overview 263

eating Disorders in males 264

Symptoms of Anorexia 265 Significantly Low Weight 265

Fear of Gaining Weight 266

Disturbance in Experiencing Weight or Shape 266

Amenorrhea 266

Medical Complications 266

Struggle for Control 266

Comorbid Psychological Disorders 266

viii ConTenTs

Symptoms of Bulimia 267 Binge Eating 268

Inappropriate Compensatory Behavior 268

Excessive Emphasis on Weight and Shape 268

Comorbid Psychological Disorders 269

Medical Complications 269

Diagnosis of Feeding and Eating Disorders 269

THINKING CRITICALLY about DSM-5: Is binge eating a mental Disorder? Is obesity? 269

Criteria for anorexia nervosa 270

Criteria for bulimia nervosa 271

Frequency of Anorexia and Bulimia 271 Standards of Beauty 272

CRITICAL THINKING matters: The Pressure to be Thin 273

Age of Onset 273

Causes of Anorexia and Bulimia 274 Social Factors 274

Psychological Factors 275

Biological Factors 277

Integration and Alternative Pathways 277

Treatment of Anorexia 278 Course and Outcome of Anorexia Nervosa 278

Treatment of Bulimia 279 Cognitive Behavior Therapy 279

Interpersonal Psychotherapy 279

Antidepressant Medications 279

ReSeARCH methods: Psychotherapy Placebos 280

Course and Outcome of Bulimia Nervosa 280

Prevention of Eating Disorders 280

getting HeLp 282

summary 282 the big picture 283 key terms 283

11 Substance-related and addictive disorders 284 Overview 285

Symptoms 287 Alcohol 289

Tobacco 290

Amphetamine and Cocaine 291

Opiates 292

Sedatives, Hypnotics, and Anxiolytics 293

Cannabis 294

Hallucinogens and Related Drugs 294

Diagnosis 295 Brief History of Legal and Illegal Substances 295

DSM-5 296

Course and Outcome 297

Criteria for alcohol Use Disorder 297

Other Disorders Commonly Associated with Addictions 298

Frequency 298 Prevalence of Alcohol Use Disorder 299

Prevalence of Drug and Nicotine Use Disorders 300

Risk for Addiction Across the Life Span 301

CRITICAL THINKING matters: should Tobacco Products be Illegal? 301

Causes 302 Social Factors 302

Biological Factors 303

Psychological Factors 306

Integrated Systems 307

ReSeARCH methods: studies of People at Risk for Disorders 307

Treatment 308 Detoxification 308

Medications During Remission 308

Self-Help Groups: Alcoholics Anonymous 309

Cognitive Behavior Therapy 310

Outcome Results and General Conclusions 311

Gambling Disorder 312

THINKING CRITICALLY about DSM-5: Is Pathological Gambling an addiction? 312

Symptoms 313

Diagnosis 314

Frequency 314

getting HeLp 315

summary 315 the big picture 316 key terms 317

12 Sexual dysfunctions, paraphilic disorders, and gender dysphoria 318

Overview 319 Brief Historical Perspective 321

Sexual Dysfunctions 321 Symptoms 321

Diagnosis 323

ReSeARCH methods: hypothetical Constructs: What Is sexual arousal? 325

Frequency 327

Causes 328

Treatment 330

CRITICAL THINKING matters: Does medication Cure sexual Dysfunction? 332

Paraphilic Disorders 332 Symptoms 333

ConTenTs ix

Diagnosis 333

THINKING CRITICALLY about DSM-5: Two sexual Problems That Did not become new mental Disorders 339

Frequency 340

Causes 340

Treatment 341

Gender Dysphoria 343 Symptoms 343

Frequency 344

Causes 344

Treatment 345

getting HeLp 345

summary 346 the big picture 346 key terms 347

13 Schizophrenia Spectrum and other psychotic disorders 348 Overview 349

Symptoms 351 Positive Symptoms 352

Negative Symptoms 353

First-Person account of Delusional beliefs 353

Disorganization 354

Diagnosis 355 DSM-5 355

Criteria for schizophrenia 356

Subtypes 356

CRITICAL THINKING matters: Why Were the symptom-based subtypes of schizophrenia Dropped from DSM-5? 357

Related Psychotic Disorders 357

Course and Outcome 358

Frequency 359 Gender Differences 359

Cross-Cultural Comparisons 360

Causes 360 Biological Factors 360

Social Factors 366

Psychological Factors 367

ReSeARCH methods: Comparison Groups: What Is normal? 369

Interaction of Biological and Environmental Factors 369

The Search for Markers of Vulnerability 370

THINKING CRITICALLY about DSM-5: attenuated Psychosis syndrome Reflects Wishful Rather Than Critical Thinking 370

Treatment 372 Antipsychotic Medication 372

Psychosocial Treatment 374

getting HeLp 376

summary 377 the big picture 378 key terms 378

14 neurocognitive disorders 379 Overview 380

Symptoms 383

Delirium 383

Criteria for Delirium 383

Major Neurocognitive Disorder 384

memory Changes in normal aging 385

Diagnosis 388

Brief Historical Perspective 388

Specific Types of Neurocognitive Disorder 389

Criteria for major neurocognitive Disorder 389

CRITICAL THINKING matters: how Can Clinicians establish an early Diagnosis of alzheimer’s Disease? 390

Frequency of Delirium and Major Neurocognitive Disorders 394

Prevalence of Dementia 394

ReSeARCH methods: Finding Genes That Cause behavioral Problems 395

Prevalence by Subtypes of Neurocognitive Disorder 396

Cross-Cultural Comparisons 396

Causes 396 Delirium 396

Neurocognitive Disorder 396

Treatment and Management 399 Medication 399

THINKING CRITICALLY about DSM-5: Will Patients and Their Families Understand “mild” neurocognitive Disorder? 400

Environmental and Behavioral Management 401

Support for Caregivers 401

getting HeLp 402

summary 402 the big picture 403 key terms 403

15 intellectual disabilities and autism Spectrum disorders 404 Overview 405

Intellectual Disabilities 405 Symptoms of Intellectual Disabilities 407

Criteria for Intellectual Disability (Intellectual Developmental Disorder) 407

ReSeARCH methods: Central Tendency and Variability: What Do IQ scores mean? 408

Diagnosis of Intellectual Disabilities 410

Frequency of Intellectual Disabilities 411

x ConTenTs

Causes of Intellectual Disabilities 411

Treatment: Prevention and Normalization 416

eugenics: our history of shame 417

Autism Spectrum Disorder 419 Symptoms of ASD 420

Diagnosis of ASD 424

Frequency of ASD 425

Criteria for autism spectrum Disorder 425