This course provides an introduction to the field of adult psychopathology. It is intended to provide students with the tools necessary to comfortably utilize the DSM system of classification while maintaining a coherent case conceptualization that is not bounded by this system. In order to ensure coverage of the range of adult psychopathology, course material will be organized by diagnostic categories. However, students will be encouraged to develop, maintain and expand on their own working models of how maladaptive patterns of adjustment develop, persist, and evolve into newer, more adaptive patterns of functioning across the range of disorders. We will continually explore our own definitions of psychopathology, those of the field, how these definitions are culturally determined, and what implications these definitions have on our practice and our science.

 The field of psychopathology is far too broad and complex to be sufficiently covered in a semester. The goal of this course is to provide an adequate introduction to some of the prevalent theories, diagnostic issues and some representative research from within each of the main diagnostic categories: mood disorders, anxiety disorders, psychotic disorders and personality disorders.  Substance abuse, eating, somatization, and dissociative disorders will also be briefly reviewed.

Student responsibilities:

Readings:  Because the field is so broad, the reading for this course is quite extensive. I would like you to come to class having read all of the assigned material. However, given the constraints on your time, I am aware this may not always be possible. I have put asterisks in front of readings that I would like you all to prioritize. If you are particularly pressed for time, you may choose to only skim the non-asterisked articles, rather than reading them in depth.

Thought papers:   At two points during the semester you will be asked to write a 4-6 page thought paper on the following topic:
 What is your theory of psychopathology? How do you think that psychological difficulties come to pass? How can they be helped? What is the value of labeling and categorizing these difficulties? What are the risks? Is your answer different depending on what diagnostic category you consider? How do you feel personally about giving people these labels? How do you plan to use the DSM system professionally?
For the second paper, I want you to intentionally take a position contrary to or in some way different from the position you took for your first paper. This will help you practice stretching your thinking and understanding diverse perspectives on psychopathology.  Your grade will be based in part on your ability to expand your thinking through this assignment. Obviously, there are no right or wrong answers to these questions. But for both papers do your best to support your claims with whatever clinical or empirical evidence you’re aware of or at least with the reasons behind the positions you hold. There is no need to do outside reading for these assignments but you will need to do the course reading and do some outside thinking.
Due September 21st, November 2nd

Lead class discussion: By the second week of class, each of your should pick an area in which you would like to lead a class discussion. You can choose any focus within this area (e.g. empirical studies of a particular theory, cultural considerations, biological theories, lifespan perspective on the disorder). You may choose one article to have the class read before your presentation (but this is not a requirement). You should read at least 4 additional sources for your presentation and should provide the class with a handout summarizing the main points/questions you’ve come across in your research.

Diagnostic exercises: At several points during the course, we will practice diagnosing using constructed cases.  I will supply the cases throughout the semester. You should come to class familiar with the diagnostic criteria for the appropriate group of disorders (but may use your DSM as you formulate questions and diagnostic hypotheses). Also, we will devote one class period to learning to use the Structured Clinical Interview for DSM-IV (SCID-IV). After practicing on each other in class, you will each do a practice SCID outside of class and audiotape it. You will turn in the audiotape along with a diagnostic summary and I will provide written feedback. This tape is due  November 16th.

Take-home final:   On December 1st, I will distribute a take-home final exam which will consist of several questions that involve integration of class readings and discussion throughout the semester. Your responses will be due on December 16th.

Source of evaluation

Thought papers:         9/29; 11/2      15% each                             30%

Class presentation                                         20%

Class participation                 10%

SCID tape  11/16                10%

Take-home final 12/16                30%
 

Readings:
*Wakefield, J.C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47, 373-388.
*Fromm-Reichmann, F. (1959). Remarks on the philosophy of mental disorder.  In D. Bullard (Ed.) Psychoanalysis and psychotherapy: Selected papers of Frieda Fromm-Reichmann (pp. 3-24). Chicago: University of Chicago Press.

September 14  Building a conceptual model of psychopathology:
Biopsychosocial factors in psychopathology

Readings:
 *Wachtel, P.L. (1994). Cyclical processes in personality and psychopathology. Journal of Abnormal Psychology, 103, 51-54.
*Lewis-Fernandez, R. & Kleinman, A. (1994) Culture, personality and psychopathology. Journal of Abnormal Psychology, 103, 67-71.
*Fowles, D.C. (1993) Biological variables in psychopathology: A psychobiological perpsective In Sutker, P.B., & Adams, H.E. (Eds) Comprehensive handbook of psychopathology. 2nd edition. (only p57-62)   New York: Plenum Press.
*Reiss, D., Plomin, R., & Hetherington, E.M. (1991). Genetics and psychiatry: An unheralded window on the environment.  The American Journal of Psychiatry, 148, 283-291.
*Hayes, S.C., Wilson, K.G., Gifford, E.V., & Follette, V.M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168.
*Cicchetti, D., Ackerman, B.P., & Izard, C.E.. (1995). Emotions and emotion regulation in developmental psychopathology. Development and Psychopathology, 7, 1-10.
Rosenstein, D.S., & Horowitz, H.A. (1996). Adolescent attachment and psychopathology. Journal of Consulting and Clinical Psychology, 64, 244-253.
Kendall-Tackett, K.A., Williams, L.M. & Finkelhor, D. (1993).  Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164-180.
Nash, M.R., Neimeyer, R.A., Hulsey, T.L., & Lambert, W. (1998)  Psychopathology associated with sexual abuse: The importance of complementary designs and common ground. Journal of Consulting and Clinical Psychology, 66, 568-571.

September 21  Classification systems, use of the DSM-IV
Thought paper #1 due
Readings:
*Blashfield, R., (1991). Models of psychiatric classification. In M. Hersen & S.M. Turner (Eds.) Adult Psychopathology and Diagnosis, 2nd Edition. New York: John Wiley & Sons.
 Shea, S. (1991). Practical use of DSM-III-R. In M. Hersen & S.M. Turner (Eds.) Adult Psychopathology and Diagnosis, 2nd Edition. New York: John Wiley & Sons.
Introduction and Use of this Manual from DSM-IV (xv - xxv; 1-11)
Kessler, R.C., et al. (1994). Lifetime and 12-Month prevalence of DSM-III-R psychiatric disorders in the United States: Results form the National Comorbidity Study. Archives of General Psychiatry, 51, 8-19.
*Thacker, J., & Ward, T. (1998). Culture and classification: The cross-cultural application of the DSM-IV. Clinical Psychology Review, 18, 501-529,
*Butcher, J.N., Tarikiyo, T., & Vitousek, K.B. (1993).Understanding abnormal behavior in a cultural context. 83-105.
*Rothblum, E. (1994). ‘I only read about myself on bathroom walls”: The need for research on the mental health of lesbians and gay men. Journal of Consulting and Clinical Psychology, 62, 213-220.
Garb, H.N. (1997) Race bias, social class bias and gender bias in clinical judgment. Clinical Psychology: Science and Practice, 4, 98-119.

September 28th    Theories of anxiety & anxiety disorders

Readings:
            *DSM (anxiety disorders section)
 Freud, S. (1936). The problem of anxiety.  New York: WW Norton. [pp.69-92].
 *Barlow, D.H. (1988). Anxiety and its disorders. New York: Guilford. [Chapter 2, pp 30-72]
 *Beidel, D.C., & Turner, S.M. (1991). Anxiety disorders. In M. Hersen & S.M. Turner (Eds.) Adult Psychopathology and Diagnosis, 2nd Edition. New York: John Wiley & Sons. (pp.226 -254)
 *Kirmayer, L.J., Young, A., & Hayton, B.C. (1995). The cultural context of anxiety disorders. The Psychiatric Clinics of North America, 18, 503-521.
 
October 5th   PTSD, trauma, Dissociative disorders

*Litz, B.T., & Roemer, L. (1996). Post-traumatic stress disorder: An overview. Clinical Psychology and Psychotherapy: An International Journal of Theory and Practice, 3, 153-168.
 *Herman, J. (1992). Trauma and recovery. New York: Basic Books. (chapter 6)
DSM (Dissociative disorders section)
 *Kihlstrom, J.F., Tataryn, D.J., & Hoyt, I.P. (1993). Dissociative disorders. In Sutker, P.B., & Adams, H.E. (Eds) Comprehensive handbook of psychopathology. 2nd edition. (pp 203-234)New York: Plenum Press
Sivec, H.J., & Lynn S.J. (1995). Dissociative and neuropsychological symptoms: The question of differential diagnosis. Clinical Psychology Review, 14, 297-316.

October 12th   Cases, Somatoform, Factitious, Eating disorders
Readings:
 *DSM (Somatoform, Eating disorders, Factitious disorders sections)
*Iezzi, A. & Adams, H.E. (1993) Somatoform and factitious disorders. In Sutker, P.B., & Adams, H.E. (Eds) Comprehensive handbook of psychopathology. 2nd edition. (pp 167-201). New York: Plenum Press
Kirmayer, L.J., Robbins, J.M., Paris, J. (1994). Somatoform disorders: Personality and the social matrix of somatic distress. Journal of Abnormal Psychology, 103, 125-136.
*Williamson, D.A., Barker, S.E., & Norris, L.E. Etiology and management of eating disorders. In Sutker, P.B., & Adams, H.E. (Eds) Comprehensive handbook of psychopathology. 2nd edition. New York: Plenum Press
Striegel-Moore, R.H., Silberstein, L.R., & Rosen, J. (1986). Toward an understanding of risk factors for bulimia. American Psychologist, 41, 246-263.
*Harris, D.J., & Kuba, S.A. (1997). Ethnocultural identity and eating disorders in women of color. Professional Psychology: Research and Practice, 28, 341-347.

October 19  Diagnosis, characteristics and theories of mood disorders
Readings:
 *DSM (mood disorders section)
Karp, D.   (1996). Speaking of sadness: Depression,  disconnection, and the meaning of
illness. New York: Oxford Press. [ch. 2]
Jamison, K.R. (1995). An unquiet mind.  New York: Knopf. [excerpts]
*Grove, W.M., & Andreason, N.C. (1992). Concepts, diagnosis and assessment. In E.S. Paykel (Ed.) Handbook of Affective disorders. New York: Guilford press.
*Blatt, S.J., & Zuroff, D.C. (1992). Interpersonal relatedness and self-definition: two prototypes for depression. Clinical Psychology Review, 12, 527-562.
*Beck, A.T., Rush, A.J., Shaw, B.J., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford. [ch 1]
*Manson, S.M. (1995). Culture and major depression: Current challenges in the diagnosis of mood disorders. The Psychiatric Clinics of North America, 18, 487-602.

Oct 26   Relevant factors in depression, Cases
Readings:
 *Barnett, PA., & Gotlib, I.H. (1988). Psychosocial functioning and depression: Distinguishing among antecedents, concomitants, and consequences. Psychological Bulletin, 104, 97-126.
 *Brown, G.W. & Harris, T.O. (1989).  Depression.  In G.W. Brown & T.O. Harris
(Eds.), Life events and illness (pp. 49-93).  New York:  Guilford.
 Thase, M.E., & Howland, R.H. (1995). Biological processes in depression: An updated review and integration. In E.E. Beckham & W.R., Leber (Eds.) Handbook of depression, 2nd edition. New York: Guilford.
 Weissman, M.M. Wolk, S., Goldstein, R.B., Moreau, D., Adams, Pl, Greenwald, S., Klier, C.M., Ryan, N.D., Dahl, R.E., Wickramaratne, P. (1999). Depressed adolescents grown up. JAMA, 281, 1707-1712.
 *Kovacs, M. (1996). Presentation and course of major depressive disorder during childhood and later years of the lifespan. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 705-715.
 
Nov 2nd   SCID training session
Reaction Paper #2 due
Readings:
SCID
Fennig, S., et al. (1994).  Comparison of facility and research diagnoses in first-admission psychotic patients.  Am J Psychiatry, 151, 1423-1429.

Nov 9th  Addictive disorders
 
Readings:
 *DSM (alcohol and substance abuse disorders sections)
 *Widiger, T.A., & Smith, G.T. (1994) Substance use disorder: Abuse, dependence and dyscontrol. Addiction, 89, 267-282.
 Nathan, P.E. (1991) Substance use disorders in the DSM-IV. Journal of Abnormal Psychology, 100, 356-361.
 *Prochaska, J.O., DiClemente, C.C., Norcross, J.C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102-114.
*Sutton, S. (1996). Can ‘stages of change’ provide guidance in the treatment of addictions? A critical examination of Prochaska and DiClemente’s model. In G.Edwards & C. dare (Eds.) Psychotherapy, psychological treatments and the addictions (pp 189-205). Cambridge: Cambridge University Press.
*Marks, I. (1990) Behavioural (non-chemical) addictions. British Journal of Addiction, 85, 1389-1394.   And commentaries

Nov 16th  Schizophrenia and psychotic disorders
Special guest lecture: Paul Nestor
Readings:
*DSM (psychotic disorders sections)
Sheehan, S. (1995). The last days of Sylvia Frumkin. The New Yorker, February 20.
*Carson, R.C., & Stanislow, C.A.. (1993).  The schizophrenias. 295-333.
Fowles, D.C. (1992). Schizophrenia: Diathesis-stress revisited. Annual Review of Psychology, 43, 303-336.
*Weisman, A.G. (1997). Understanding cross-cultural prognostic variability for schizophrenia. Cultural Diversity and Mental Health, 3, 23-35.
* Heinrichs, R. W. (1993).  Schizophrenia and the brain: Conditions for a neuropsychology of madness. American Psychologist, 48, 221-233.
*Meehl, P.E. (1989) Schizotaxia revisited. Archives of General Psychiatry, 46, 935-944.
*Andreason, N.C. et al(1990) Positive and negative symptoms in schizophrenia: A critical reappraisal. Archives of General Psychiatry, 47, 615-621.
 
 
November 23rd      Cases,     Psychopathology Across the Lifespan
Special Guest lecture: Betty Welch

Readings:
*APA Working Group on the Older Adult. (1998). What practitioners should know about working with older adults. Professional Psychology: Research and Practice, 29, 413-427.
*NIH Consensus Development Panel on Depression in Late Life. (1992). Diagnosis and treatment of depression in late life.  JAMA, 268, 1018-1024.

 Nov 30th   Personality disorders
Readings:
 *DSM  (pp. 629-674)
*Livesley, W.J., Schroeder, M.L., Jackson, D.N. & Lang, K.L. (1994). Categorical distinctions in the study of personality disorder: Implications for classification. Journal of Abnormal Psychology, 103, 6-17.
Bornstein, R.F. (1998) Reconceptualizing personality disorder diagnosis in the DSM-V: The discriminant validity challenge. Clinical Psychology: Science and Practice, 5, 333-343.
*Weston, D. & Shedler, J. (1999). Revising and assessing Axis II, Part I: Developing a clinically and empirically valid assessment method. American Journal of Psychiatry, 156, 258-272.
*Weston, D. & Shedler, J. (1999). Revising and assessing Axis II, Part II: Toward an empirically based and clinically useful classification of personality disorders.. American Journal of Psychiatry, 156, 273-285.
*Sperry, L. (1995). Handbook of diagnosis and treatment of the DSM-IV personality disorders. New York: Brunner/Mazel. [Chs 2-11]  skim this
 Beck Schema of personality disorders appendix

Dec 7th   Theories of personality disorders
Readings:
*Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford. [ch 1].
 *Shapiro, D. Neurotic Styles. (chapters 2-4)
Kohut, H. Forms and transformations of narcissism
   Guntrip (1977). The schizoid personality and the external world. In Schizoid phenomena, object relations, and the self. London: Hogarth Press.
 
 

Take-home final due 12/16