Clinical and Abnormal Psychology
The Clinical and Abnormal domain tests how disordered behavior is defined, classified, and treated: DSM-5-TR criteria, the major disorder categories, theoretical models, and intervention research. Many items hinge on a duration threshold or a symptom count, so learn the numbers.
Classification
- DSM-5-TR is categorical and descriptive: it lists criteria, requires clinically significant distress or impairment, and excludes symptoms better explained by substances or a medical condition.
- Differential diagnosis usually turns on duration, symptom count, and degree of impairment.
Core disorders
- Schizophrenia: positive symptoms (delusions, hallucinations, disorganized speech) and negative symptoms (flat affect, alogia, avolition). Onset is typically late adolescence to early adulthood, earlier and more severe in men. Dopamine hypothesis; enlarged ventricles in some patients.
- Major depressive episode: five of nine symptoms for at least two weeks, including depressed mood or anhedonia. Persistent depressive disorder: depressed mood most days for at least two years.
- Manic episode: at least one week of elevated or irritable mood with increased energy and impairment; hypomanic episode is at least four days without marked impairment. Bipolar II requires hypomania plus depression, never full mania.
- Panic disorder: recurrent unexpected attacks plus worry about further attacks. GAD: excessive worry most days for six months. Specific phobia: marked fear of a circumscribed object, out of proportion to danger.
- OCD: obsessions and/or compulsions that are time-consuming or distressing and ego-dystonic, unlike obsessive-compulsive personality disorder.
- PTSD: trauma exposure followed by intrusion, avoidance, negative cognition, and arousal lasting over one month.
Treatment
- Psychodynamic: insight into conflict. Client-centered (Rogers): unconditional positive regard, genuineness, empathy.
- Behavioral: systematic desensitization (counterconditioning), exposure with response prevention for OCD, token economies.
- CBT: Beck's cognitive triad of self, world, future; identifying and testing distorted thoughts.
- Biomedical: SSRIs for depression and anxiety, lithium for bipolar disorder, antipsychotics with risk of tardive dyskinesia. ECT is effective for severe, treatment-resistant depression.
Worked example
A 26-year-old reports four days of elevated mood, decreased need for sleep, grandiosity, and rapid speech. Friends notice the change, but she keeps working and is not hospitalized. Reasoning: this meets criteria for hypomania (four days, noticeable but no marked impairment), not mania (one week, or hospitalization or marked impairment). With a history of major depression the diagnosis is bipolar II; hypomania alone without depression would suggest cyclothymia. Answering bipolar I ignores the duration criterion.
Traps
- Confusing delusions (false beliefs) with hallucinations (false perceptions).
- Diagnosing OCD when rituals are ego-syntonic and reflect orderliness - that suggests OCPD.
- Applying the two-week depression threshold to persistent depressive disorder, which needs two years.