Psychological Disorders

Essentials of Psychology : Psychological Disorders

Lesson 5 Overview

The objective of this lesson

is to give you an overview

of psychological disorders

and approaches to their

treatment. It isn’t meant to

make you a clinical

psychologist. Two

points should be stressed

from the very beginning. First, the labels that have been applied to

mental disorders have changed over the years. For example, at one

time, excessive masturbation was considered pathological in males,

and it was sufficient to have a woman confined to an asylum.

Homosexuality was finally eliminated from the official manual

of mental disorders in only the past couple of decades.

Second, mental disorders and approaches to their treatment are, to

some extent, social products. As societies change over time, so do

ideas about mental disorders. For that matter, as society changes,

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different kinds of mental disorders are likely to become more common.

For example, eating disorders, which certainly have psychological

components, were all but unknown in the sixteenth century. Getting

enough to eat was a sufficient problem for most people. Conclusion:

One should apply labels to people with extreme caution. Just as

personalities vary, every disorder has commonalities and differences.

5.1 Differentiate a healthy personality from a disordered personality in the context of mental health and stress management Psychological Disorders

READING ASSIGNMENT

Read this assignment. Then read Chapter 10 in your textbook.

Normal versus Abnormal

Let’s say that you’re among an isolated tribe of people in the

Venezuelan rain forest. In your society, it’s normal for males to prize

shrunken heads as trophies with great power. Headhunting is normal

for these people. Let’s say you’re a sociologist studying American

divorce statistics. You find that for every two marriages, one will end in

divorce. Does that make divorce normal or abnormal? For a

psychologist, statistical normality simply refers to the distribution of

some variable in a population. For example, 100 is the mean score on

an IQ test, and normal or average ranges from about 80 to 120. On

the other hand, when someone says that Justin’s compulsion to wash

his hands 40 or 50 times a day “isn’t normal,” you may agree with that

observation. Yet, you should keep in mind that in social worlds, when

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people refer to normal behavior they’re often simply making a

judgment about behavior that they prefer.

Psychologists must use some approach other than “normal” versus

“abnormal” to identify abnormal behavior. For psychologists, behavior

is considered abnormal if people experience distress and if that

distress prevents them from functioning in their daily life. Given that

general definition, it’s also best to think of normal and abnormal as two

ends of a continuum. Thus, social nonconformity, such as wearing

nose rings and having tattoos, might not have anything to do with a

psychological disorder at all. Further, you must consider the

situational context. Behavior expected and allowed during New

Orleans Mardi Gras, for example, would be unacceptable at a New

England wedding reception.

Perspectives on Abnormality: From Superstition to Science

Your text discusses six perspectives on abnormality:

1. Medical—Biological causes underlie abnormal behavior and are

best treated as medical disorders or diseases.

2. Psychoanalytic—Abnormal behavior stems from childhood

conflicts such as those identified in Freud’s psychoanalytic

theory.

3. Behavioral—Abnormal behaviors are symptoms of underlying

learning dysfunctions. Both the shortcomings and the strengths of

this perspective result from an exclusive focus on observable

behaviors.

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4. Cognitive—How people think affects how they act. If you’re

persuaded that your life is hopeless, you may adopt the

behaviors of a powerless victim.

5. Humanistic—People can take responsibility for not only how they

think, but how they choose to act. Healing is, in the end, an

“inside job.” You can be the “best you can be,” but it’s up to you

to do the work, walk the walk, and acquire self-knowledge.

6. Sociocultural—Behavior is shaped by such things as family

relationships, social class, and accepted norms within particular

ethnic groups. In this perspective, family or group therapy may

accompany other kinds of therapy.

Classifying Abnormal Behavior: The ABCs of DSM

Disorders are classified to facilitate diagnosis and keep therapists on

the same page. The basic diagnostic manual used by psychologists is

the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

(DSM-5). The DSM is updated and revised regularly because

understandings change as science changes. Science is an ongoing

process.

The Major Psychological Disorders

Anxiety Disorders

Anxiety disorders are the most common of the anxiety-based

disorders, afflicting millions of Americans each year. For some reason,

women tend to suffer from anxiety disorders more than men do—

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though there are still plenty of anxiety sufferers who are men. This

disorder is so common that social critics have written often about the

“age of anxiety.” Here, you’re introduced to the four major categories

of these sorts of problems.

1. Phobic disorder—Specific phobias get a lot of attention in the

media. The film Arachnophobia is one example (the title means

“fear of spiders.”) Phobias can best be thought of as conditioned

response patterns to specific things. Phobic responses can

include anxiety or panic (or both), but the perceived source of the

phobia is always specific. Name anything at all, and there’s

probably a psychological phobia label for it. Acrophobia is fear of

heights, claustrophobia is fear of being in enclosed spaces,

hematophobia is fear of blood, xenophobia is fear of strangers,

and so on.

2. Panic disorder—Panic disorders come in two varieties: with or

without agoraphobia. Agoraphobics often feel uncomfortable in

crowds or anywhere they can’t detect an escape route to a place

where they feel relatively safe and secure.

Panic disorders without agoraphobia involve panic attacks.

People abruptly feel unreasoned panic. Panic may include

all the general anxiety sensations described below (under

“generalized anxiety disorder”), along with a sense of

impending doom, a sense of suffocation, difficulty swallowing

or breathing, trembling, and feelings of unreality. People who

have panic attacks often end up in emergency rooms, certain

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they’re having a heart attack or that they’re about to die.

Panic disorders with agoraphobia include all of the above,

along with the symptoms of agoraphobia. Agoraphobia can

exist with or without panic attacks. However, it usually begins

with a siege of panic attacks. Agoraphobia is a learned

pattern of avoidance behaviors that forestall panicked states

or panicky feelings. Some agoraphobics are literally

housebound. Others feel they can travel only very short

distances from their homes.

3. Generalized anxiety disorder—Since anxiety is so widespread in

modern societies, a generalized anxiety disorder is said to exist if

symptoms last six months or more. The range of anxiety

symptoms is astonishing. They include a racing heart, clammy

skin, sweating, dizziness, all kinds of digestive problems, shallow

breathing, inability to concentrate, and even itching.

4. Obsessive-compulsive disorders—In this sort of disorder, people

may feel compelled to perform certain behaviors because they’re

obsessed with repetitive thoughts. Obsessions are thoughts or

images that haunt a person’s waking hours. For example, a

woman may have constant thoughts about harming her child,

although she doesn’t want to harm her child and never does.

Compulsions may include avoiding cracks in the sidewalk or

washing one’s hands repeatedly throughout the day. The

television series Monk is about a detective with a variety of

compulsive behaviors.

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Somatoform Disorders

Somatoform disorders take several forms. (The root of this term,

soma, is the Greek word for “flesh.”) Hypochondriasis is a heightened

sensitivity to bodily sensations that are seen as ominous and

threatening. Hypochondriacs will convince themselves that their

accelerated heart rate means an impending heart attack or that a

minor pain is a growing cancer. In short, anxieties are displaced or

projected onto bodily sensations. Pain disorder is marked by ongoing

and sometimes disabling pain that has no known physical origin. The

strangest and least common somatoform disorder is conversion

disorder. One of Freud’s earliest cases was a young woman who was

functionally paralyzed from the waist down. Under hypnosis, however,

Freud was able to cure this disability, which he later called conversion

hysteria. Conversion disorders, such as partial anesthesia of the hand

or temporary blindness, have psychological, not physical, origins.

Dissociative Disorders

Dissociative disorders are actually quite rare. They appear in at least

three forms, but they’re all related to stress or trauma.

Dissociative amnesia affects people who can’t remember their

name or origin. This condition is usually brief.

Dissociative fugue occurs when people simply walk away from

the intolerable anxieties of their lives, even if it means they must

cross the country to do so. Confusion and uncertainty about

one’s identity are typical of the condition.

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The most dramatic form of dissociative disorder is dissociative

identity disorder (DID). This condition was formerly called multiple

personality disorder. Individuals respond to severe trauma or

stress by escaping into alternate personalities.

Dissociative identity disorder is controversial and very strange. For

example, if person A has alternate personalities B and C, she will live

her life as A while B and C live parallel lives that are unknown to A.

Personality shifts can be abrupt and startling to a therapist, who might

have to figure out which personality he or she is addressing at any

given moment. Perhaps the strangest thing about this disorder is the

fact that different personalities may have distinctive physiological

profiles. For example, personality A may suffer from allergies that

aren’t present in personality B.

Mood Disorders

Are you generally happy and cheerful, or resigned and gloomy? Either

scenario illustrates a mood. Mood disorders refer to pronounced and

prolonged periods of depressed feelings or manic periods of

animated, unrealistic cheerfulness or agitation. There are two types of

mood disorders. Depressive disorders, including major depression,

are marked by sadness, poor self-image, disturbed sleep, and suicidal

thoughts. They’re the most common form of mood disorder. Bipolar

disorders are marked by mood swings ranging from sad and

depressed to happy and excited. Major mood disorders cause

considerable suffering and are marked by extreme emotion. In major

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depressive disorders, hopelessness and despair cloud every moment,

causing feelings of worthlessness and suicidal tendencies.

There are a variety of ideas as to the causes of mood disorders.

Research suggests that some mood disorders have a genetic basis.

Behavioral models propose that decline in positive reinforcements

leads to withdrawal, while, at the same time, getting attention for one’s

depression can attract a different kind of “positive reinforcement.”

According to psychologist Martin Seligman, depression is largely

associated with what he called learned helplessness. Feeling they

can’t control their situation, people give up and submit to what they

perceive as a cruel word. For Aaron Beck, depression results from

what is, in effect, negative thinking. Brain research suggests that

depression is associated with a dimming or blunting of emotional

reaction. Depression in women has been associated with hormonal

fluctuations related to the menstrual cycle.

Schizophrenia

In general, what we call psychosis is characterized as a break with

ordinarily shared perceptions of the world and the self. It’s often said

that a person with psychosis “loses touch with reality.” Given that no

one is entirely sure what reality is, it’s important to approach psychosis

with an open mind. Psychosis deserves attention because those who

must cope with it experience intense suffering. The films A Beautiful

Mind and The Soloist can help many to understand that psychosis is a

human condition and that people suffering from psychosis can make

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important contributions in spite of their affliction.

This section focuses on the most severe of the psychotic disorders,

schizophrenia. Schizophrenia is famously difficult to diagnose

accurately. Nevertheless, certain characteristics reliably distinguish

schizophrenia from other disorders:

Decline in functioning—The sufferer can no longer carry on his or

her previous life patterns.

Disturbance of thought and language—Logic slips away.

Inappropriate use of language. Disturbed verbal communication

is common, along with personality disintegration.

Delusions—A delusion is a belief with no reasonable basis in

reality. (For example, “I’m getting alien transmissions through the

fillings in my molars.”)

Hallucinations and perceptual disorders—Sufferers see, hear,

and feel that which can’t be seen, heard, or experienced by way

of ordinary sensory stimuli. (To hallucinate is to see things that

aren’t visible to others, but which, to the sufferer, may seem

entirely real.)

Emotional disturbances—Typical in schizophrenia is an absence

of affect (expressions of feeling). On the other hand, emotional

responses, like laughter at a funeral, may seem to spring out of

nowhere.

Withdrawal—Interest in others fades away. Social interaction is

either one-way or entirely absent.

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What Causes Schizophrenia?

There’s no agreement on what causes schizophrenia. Some research

suggests that anyone can be driven into a psychotic episode under

highly stressful conditions, such as a dysfunctional family environment

or the experiences of combat. However, evidence also suggests that

some individuals are predisposed to schizophrenia due to heredity or

specific patterns of brain chemistry. For example, the presence of

biochemical abnormalities, such as an excess of the neurotransmitter

dopamine, has been linked to schizophrenia.

These days, the dominant model for understanding the causes of

schizophrenia is the predispositional model. The basic idea here is

that people are variably predisposed to developing this kind of

psychosis depending on the interaction of genetic and environmental

factors.

Personality Disorders

Personality disorders impair a person’s ability to get along with others.

There are a variety of these disorders, ranging in severity from

dependency disorder, producing excessive dependency on others, to

borderline and schizotypal disorders that approach full-blown

psychosis. As you might expect, the less severe disorders are more

common and are easier to treat. In general, a personality disorder is

characterized by inflexible, maladaptive behavior that cripples one’s

capacity for normal social relationships. Your textbook focuses on

three kinds of personality disorders:

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1. Antisocial personality disorder—People with antisocial

personalities are often called sociopaths or psychopaths. A

common way of thinking of people with antisocial personalities is

that they lack a developed conscience. A psychopath is likely to

be selfish, impulsive, emotionally shallow, and manipulative. The

basic motto of a psychopath might be “My way or the highway,

and I get to decide which highway.”

While psychopathic tendencies are often associated with criminal

or amoral behavior, psychopaths sometimes ascend to positions

of power and responsibility. Even some people in high levels of

government and corporate life are said to have psychopathic

tendencies. The most striking feature of the antisocial personality

is emotional coldness. The fate of others means little or nothing

to them. They may be very clever at expressing sympathy, but

they’re all but incapable of empathy. They fail to identify with the

wants, needs, and suffering of others.

2. Borderline personality disorder—People may have difficulty

developing a secure sense of personal identity. They cope with

this issue by relying on relationships with others to define their

identity. Emotional instability and impulsive, episodic behavior are

common since they simply can’t handle rejection of any kind.

3. Narcissistic personality disorder—A characteristic of this disorder

is an inflated sense of self-importance and a sense of entitlement,

demanding special treatment from others. A major pattern in this

disorder is an inability to experience empathy or compassion for

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others.

Childhood Disorders

“Almost 20 percent of children and 40 percent of adolescents

experience significant emotional or behavioral disorders.” (You should

memorize this line from your text.) Read on for rather startling

statistics related to depression and other problems. Two common

childhood problems get special attention.

Attention-deficit hyperactivity disorder (ADHD) includes inattention,

lots of inappropriate activity, impulsiveness, and a low tolerance for

frustration. Actually, all of these kinds of behavior show up in most

children from time to time. A diagnosis of ADHD, therefore, is one of

degree. Given that fact, ADHD is a controversial disorder. Some feel

that it’s overdiagnosed, possibly with the complicity of pharmaceutical

interests that market the standard treatment—a drug called Ritalin,

which, oddly enough, is chemically related to amphetamines.

Autism is getting a lot of attention these days. That’s because

research indicates that the reported incidence of this disorder in young

children is increasing. Whether that’s because the disorder itself is

increasing or it’s more commonly diagnosed is the subject of vigorous

debate.

Other Disorders

Your text discussion isn’t meant to be exhaustive. It hits important

highlights. Other kinds of disorders with significant public health

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impacts include alcohol and drug abuse, eating disorders, post-

traumatic stress disorder (PTSD), and organic mental disorders such

as Alzheimer’s disease. In this, the age of the Internet, you can learn

more if you’re interested.

Psychological Disorders in Perspective

Prevalence of Psychological Disorders

The essence of this section is an overall view of the incidence and

prevalence of mental and emotional disorders in the United States. It’s

based on an interview sample of 8,000 men and women between the

ages of 15 and 54, drawn so as to represent the US population at

large. The findings are sobering. Of those interviewed, 48 percent had

experienced a disorder at some point in their lives. Additionally, 30

percent had or were experiencing a disorder in the year of the

interview, and the number of persons suffering from more than one

disorder simultaneously (called comorbidity) was significant. By far,

the most common reported disorder was depression. Of course, the

United States isn’t alone in having a high prevalence of psychological

disorders.

The Social and Cultural Context of Psychological Disorders

This final topic for the chapter introduces you to some of the

perplexities of classifying psychological disorders in different cultures.

Are patterns of psychological disorders particular to different cultures?

For example, Japan is a collectivist culture. That is, a person’s sense

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of self-worth and identity is strongly intertwined with loyalties to family,

peers, and coworkers. By contrast, the dominant culture of the United

States is individualistic. American identities are based on competition,

personal achievement, and self-reliance. Would the causes of

depression be different in Japan and the United States?

Once you’ve finished studying this section, complete the Evaluate

quizzes and Rethink responses in the Modules 33–35 summaries in

your textbook.

Key Points and Links

READING ASSIGNMENT

Key Points

Psychologists consider behavior to be “abnormal” if it causes

distress and if that distress prevents the person from functioning

in his or her daily life.

Abnormality can be studied from many different perspectives,

such as medical, psychoanalytic, behavioral, cognitive,

humanistic, and sociocultural.

Anxiety disorders are by far the most common psychological

disorders and include categories such as phobias, panic

disorders, generalized anxiety disorders, and obsessive-

compulsive disorders.

Somatoform disorders cause one or more bodily symptoms,

usually including pain. Hypochondriacs, for example, have an

over-exaggerated sensitivity to bodily sensations that are seen as

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threatening.

Dissociative disorders involve disruptions to a person’s memory,

awareness, or identity. Dissociative identity disorder (DID),

formerly called “multiple personality disorder,” is characterized by

a person dealing with severe trauma or stress by escaping into

alternate personalities.

Mood disorders are common, and include ailments such as

depression and bipolar disorder.

Schizophrenia is a severe form of psychotic disorder in which the

patient loses touch with reality. The sufferer generally

experiences a drastically lower functionality, and may experience

disturbing thoughts, delusions, hallucinations, and withdrawal.

A personality disorder is marked by inflexible, maladaptive

behavior that greatly inhibits a person’s capacity to get along with

others and form normal social relationships.

Attention-deficit hyperactivity disorder (ADHD) includes

inattention, impulsiveness, and a low tolerance for frustration.

Because these types of behavior are very common even in

completely normal children, this disorder is controversial, and

some believe it’s over-diagnosed.

Exercise: Psychological Disorders

Fill in the blank.

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1. In disorders once called multiple personality disorders and now

labeled as ________ disorders, a person manifests more than

one personality.

2. In schizophrenia, the symptom called ________ refers to holding

strong beliefs in things that have no basis in reality.

3. For psychologists, ________ behavior is seen as behavior that

produces experiences of distress and prevents people from

functioning as they might wish in their daily lives.

4. The manual that classifies psychological disorders for

psychologists is called the DSM-5. In this acronym, “S” stands for

________.

5. According to research into the prevalence of psychological

disorders, the most common disorder is depression, while the

second most common problem is ________ dependence.

6. ________ personality disorder involves emotional volatility,

impulsive behavior, and relying on relationships to define one’s

identity.

7. ________ is fear of strangers.

8. Hypochondriasis is classified as a/an ________ disorder in which

people are obsessively concerned with their health.

9. In obsessive-compulsive disorder, ________ is the irresistible

urge to behave in repetitive, irrational ways.

10. Alternating depression and ________ characterize bipolar

disorder.

Exercise Answer Key:

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Exercise: Psychological Disorders

1. dissociative

2. delusion

3. abnormal

4. statistical

5. alcohol

6. Borderline

7. Xenophobia

8. somatoform

9. compulsion

10. mania

Link

READING STUDY MATERIAL

Link (register.gotowebinar.com/rt/1719820184845659138)

5.2 Explain therapy approaches to treat varoius psychologocial disorders Treatment of Psychological Disorders

READING ASSIGNMENT

Read this assignment. Then read Chapter 11 in your textbook.

Psychotherapy: Psychodynamic, Behavioral, and Cognitive Approaches to Treatment

Psychodynamic Approaches to Therapy

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The classic psychodynamic approach is the psychoanalytic theory of

Sigmund Freud. The following is a summary of ideas embraced in

Freud’s approach to therapy.

To resolve unacceptable impulses and unresolved conflicts of the

unconscious, it’s necessary to get through a person’s defense

mechanisms. The most common of these is repression. People try to

keep issues buried that threaten their ego ideal—their ideas about

how they should think and behave. The techniques for uncovering

unconscious content in the patient include dream interpretation (What

do you think the snake might stand for in that dream?) and free

association (Just say whatever comes to mind as I give you a word.).

The very lengthy process of psychoanalysis (it can easily extend over

a period of years) is a tedious uphill battle against the patient’s

resistance. Meanwhile, the long association between doctor and

patient leads to transference. Transference happens when the

negative or hidden feelings in the patient (usually associated with a

parent or a significant other) are transferred to (projected onto) the

therapist. If all goes well and transference issues are resolved,

patients will gradually accept previously unacceptable unconscious

content—which now becomes more or less conscious—and move on

with their lives.

Time is money, and life is short. In that context, contemporary

psychodynamic approaches focus on immediate issues, take more

control over the direction of therapy, and try to get the whole process

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over within about 20 sessions over, say, three months.

Psychodynamic approaches to therapy get mixed reviews. Overall,

they’re time-consuming and expensive, thus eliminating their feasibility

for most people. On the other hand, they do seem to be useful for

some.

Behavioral Approaches to Therapy

The starting assumption in behavioral therapies is that all behavior—

normal or abnormal—is learned. What has been learned can be

unlearned. What hasn’t been learned can be learned.

Classical conditioning treatments include three standard techniques:

1. Aversive conditioning—A subject’s behavior is modified by

coupling an undesired behavior, like alcohol abuse, with a

decidedly unpleasant stimulus. For example, the patient is

administered a drug that makes him or her violently nauseous

when alcohol is consumed. Problems with aversive conditioning

include its harshness on the one hand, and uncertainty as to how

long the rejection or reduction in the undesired behavior will last

on the other.

2. Systematic desensitization—Let’s say Eric is deathly afraid of

snakes. The approach here is coupling gradual exposure to the

anxiety-producing stimulus with learned techniques for relaxation.

In systematic desensitization, a hierarchy of fears is created. For

Eric, that might mean exposure to a picture of a snake, exposure

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to a snake in a cage, and, finally, immediate up-close-and-

personal exposure to a live, harmless snake for a few seconds,

then a little longer, and so on.

3. Exposure treatment—Here the relaxation technique is put aside,

and the patient is simply exposed to the feared stimulus. The

exposure may be gradual, or it may involve what’s called

“flooding.” The latter technique can work, but it isn’t a whole lot of

fun for the subject of the treatment. Imagine having someone with

a fear of spiders suddenly exposed to a terrarium where live

tarantulas are here, there, and everywhere.

Operant conditioning techniques follow the regimes you learned about

earlier in this course. Reinforce desirable behaviors; don’t reinforce

undesirable behaviors. In some settings involving actual human

beings, say in a classroom or a social-skills class in a prison, desired

behaviors can be reinforced by symbols or tokens, such as chips or

tickets. For example, earn a token each time you turn in your

homework on time. Earn a certain number of tokens in such a token

economy, and you get a reward.

Operant conditioning techniques are pretty much limited to involuntary

audiences in institutional settings. Therefore, a therapist who wants

results may also employ the principles of observational learning. For

example, rowdy children may be exposed to scenarios on film that

model fair play and good manners. The same kinds of techniques can

also be used to model ways to master one’s fears or learn

assertiveness in social situations.

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Overall, behavioral approaches work pretty well in treating some kinds

of specific phobias or compulsions. Remember, compulsions are

observed as habitual behaviors that may be counterproductive, such

as the drive to count steps or avoid stepping on cracks in the

sidewalk. On the other hand, while learning a new behavior may

change CNS responses to some extent, behavioral approaches aren’t

designed to give patients deep insights into their hidden desires or

semiconscious motives.