Unit 5: Mental and Physical Health

🏥 5.1 Introduction to Health Psychology

Health psychology is a subfield of psychology that examines how biological, psychological, and social factors influence health, illness, and health-related behaviors. Rather than viewing health as simply the absence of disease, health psychologists take a holistic approach — studying how our thoughts, emotions, behaviors, and social environments interact to affect our physical well-being.

The Biopsychosocial Model

The biopsychosocial model (George Engel, 1977) is the foundational framework of health psychology. It proposes that health and illness result from the interaction of three factors:

• Biological factors: Genetics, brain chemistry, immune system functioning, hormones, pathogens, and physiological processes.
• Psychological factors: Thoughts, emotions, coping styles, personality traits, stress levels, self-efficacy, and health beliefs.
• Social factors: Socioeconomic status, cultural norms, family relationships, social support networks, access to healthcare, and peer influences.

This model replaced the older biomedical model, which explained disease purely in biological terms and ignored psychological and social contributors.

The Biopsychosocial Model: Health results from the interaction of biological, psychological, and social factors. (Wikimedia Commons, CC BY-SA 4.0)

Stress and Health

Stress is the body's response to perceived threats or challenges. While short-term stress can be adaptive (helping us respond to danger), chronic stress weakens the immune system, increases vulnerability to illness, and contributes to cardiovascular disease, depression, and other conditions.

Types of Stress

• Eustress: Positive, motivating stress that enhances performance (e.g., excitement before a competition).
• Distress: Negative stress that causes anxiety, impairs performance, and harms health.
• Acute Stress: Short-term stress in response to an immediate threat or challenge.
• Chronic Stress: Prolonged, ongoing stress (e.g., poverty, abusive relationships, long-term illness).

Stressors

Stress and the Immune System — Psychoneuroimmunology

Psychoneuroimmunology (PNI) studies the interaction between psychological processes, the nervous system, and the immune system. Key findings include:

• Chronic stress suppresses lymphocyte (white blood cell) activity, making the body more susceptible to infections and disease.
• The HPA axis (hypothalamic-pituitary-adrenal axis) releases cortisol during stress. Prolonged cortisol elevation damages the hippocampus, suppresses immune function, and increases abdominal fat storage.
• Stress can worsen conditions like heart disease, diabetes, and autoimmune disorders.

Coping with Stress

Personality, Behavior, and Health

Health-Promoting and Health-Damaging Behaviors

• Health-promoting: Regular exercise, balanced nutrition, adequate sleep (7–9 hours), avoiding tobacco and excessive alcohol, practicing relaxation techniques, maintaining social connections.
• Health-damaging: Smoking, excessive alcohol consumption, sedentary lifestyle, poor diet, risky sexual behavior, chronic sleep deprivation.
• Perceived Control: People who believe they have control over their health (internal health locus of control) are more likely to engage in health-promoting behaviors.

🌞 5.2 Positive Psychology

Positive psychology is a relatively new branch of psychology founded by Martin Seligman in the late 1990s. Rather than focusing exclusively on mental illness and dysfunction, positive psychology studies the conditions and processes that contribute to human flourishing — optimal well-being, happiness, and the fulfillment of human potential.

Seligman’s PERMA Model

Seligman proposed the PERMA model as a framework for well-being, identifying five core elements that contribute to a flourishing life:

Element	Description
Positive Emotions	Experiencing joy, gratitude, hope, love, and other positive feelings. Goes beyond momentary pleasure to sustained positive affect.
Engagement	Being fully absorbed in activities — achieving a state of flow (Csikszentmihalyi). Occurs when challenge and skill level are well-matched.
Relationships	Positive, meaningful connections with others. Social bonds are among the strongest predictors of well-being and longevity.
Meaning	Having a sense of purpose — belonging to and serving something greater than the self (e.g., religion, community, a cause).
Accomplishment	Pursuing achievement and mastery for its own sake. A sense of competence and progress toward meaningful goals.

Seligman’s PERMA Model: Five pillars of well-being — Positive Emotions, Engagement, Relationships, Meaning, and Accomplishment. (Wikimedia Commons, CC BY-SA 4.0)

Flow (Mihaly Csikszentmihalyi)

Flow is a mental state of complete immersion and focused energy in an activity. Csikszentmihalyi described it as being “in the zone.” Flow occurs when:

• The challenge of the task matches your skill level — not too easy (boredom) and not too hard (anxiety).
• You have clear goals and receive immediate feedback.
• You lose track of time and self-consciousness.

Flow is associated with increased happiness, creativity, and intrinsic motivation. It can occur in work, sports, art, music, or any deeply engaging activity.

Subjective Well-Being (SWB)

Subjective well-being refers to how people evaluate their own lives — their overall life satisfaction and the balance of positive to negative emotions. Research findings include:

• Adaptation-Level Phenomenon: People tend to adapt to both positive and negative events, returning to a baseline level of happiness over time. Lottery winners and accident victims both return close to their original happiness levels (Brickman, Coates, & Janoff-Bulman, 1978).
• Relative Deprivation: Happiness is influenced by comparing ourselves to others. Feeling worse off than those around us decreases well-being, even if our absolute situation is good.
• Set-Point Theory of Happiness: Each person has a genetically influenced baseline level of happiness to which they tend to return after positive or negative experiences.

Character Strengths and Virtues

Seligman and Christopher Peterson developed the VIA (Values in Action) Classification of Strengths — a positive psychology counterpart to the DSM. It identifies 24 character strengths organized under 6 core virtues:

• Wisdom (creativity, curiosity, open-mindedness, love of learning, perspective)
• Courage (bravery, perseverance, honesty, zest)
• Humanity (love, kindness, social intelligence)
• Justice (teamwork, fairness, leadership)
• Temperance (forgiveness, humility, prudence, self-regulation)
• Transcendence (appreciation of beauty, gratitude, hope, humor, spirituality)

Resilience and Growth Mindset

• Resilience: The ability to recover from adversity, trauma, or significant stress. Protective factors include strong social support, optimism, and effective coping strategies.
• Post-Traumatic Growth: Some individuals not only recover from trauma but experience positive psychological changes — greater appreciation for life, improved relationships, increased personal strength, and new possibilities.
• Growth Mindset (Carol Dweck): The belief that abilities and intelligence can be developed through effort and learning. Contrasts with a fixed mindset (believing abilities are innate and unchangeable). Growth mindset promotes resilience, motivation, and academic achievement.

Gratitude, Mindfulness, and Well-Being Interventions

• Gratitude exercises: Keeping a gratitude journal or writing gratitude letters has been shown to increase well-being and decrease depressive symptoms.
• Mindfulness meditation: Paying attention to the present moment without judgment. Reduces stress, anxiety, and depression while increasing emotional regulation and life satisfaction.
• Acts of kindness: Performing intentional acts of kindness for others increases the giver's well-being.

🔍 5.3 Explaining and Classifying Psychological Disorders

A psychological disorder (mental disorder) is a syndrome characterized by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Understanding how disorders are defined, explained, and classified is essential for both diagnosis and treatment.

Defining “Abnormal” Behavior

Psychologists use several criteria to determine whether behavior is abnormal. No single criterion is sufficient on its own — clinicians consider multiple factors:

Perspectives on Psychological Disorders

The Diathesis-Stress Model

The diathesis-stress model proposes that psychological disorders develop when a person has a biological or psychological vulnerability (diathesis) that is triggered by environmental stressors. Neither the vulnerability alone nor the stress alone is sufficient — both are needed. This helps explain why some people develop disorders while others with the same genetic predisposition do not.

The DSM-5-TR: Classification of Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association (2022), is the standard classification system used in the United States for diagnosing psychological disorders.

• Contains descriptions, symptoms, and diagnostic criteria for over 300 disorders.
• Organizes disorders into categories (e.g., depressive disorders, anxiety disorders, schizophrenia spectrum).
• Uses a categorical approach — a person either meets criteria for a disorder or does not — though many researchers argue for a dimensional approach (viewing symptoms on a continuum).
• Criticisms: Potential for over-diagnosis, cultural bias, labeling effects (Rosenhan’s “Being Sane in Insane Places” study, 1973), reliability concerns, and the influence of pharmaceutical companies.

Labeling and Stigma

• Rosenhan’s Study (1973): Pseudopatients who reported hearing voices were admitted to psychiatric hospitals and diagnosed with schizophrenia. Once labeled, their normal behaviors were interpreted through the lens of their diagnosis. This demonstrated the power of labeling and the difficulty of distinguishing “sane” from “insane” in institutional settings.
• Stigma: People with mental illness often face discrimination, social rejection, and reduced opportunities. Stigma can prevent people from seeking treatment.
• Self-fulfilling prophecy: Being labeled with a disorder can shape how others treat the person, potentially reinforcing the very behaviors associated with the diagnosis.

📈 5.4 Selection of Categories of Psychological Disorders

The AP Psychology exam requires knowledge of major categories of psychological disorders as classified by the DSM-5-TR. Below is a comprehensive overview of the most commonly tested disorder categories, their symptoms, causes, and key research.

Neurodevelopmental Disorders

Schizophrenia Spectrum Disorders

Schizophrenia is a severe disorder characterized by disturbances in thought, perception, emotion, and behavior. Symptoms are categorized as:

Causes of Schizophrenia

• Dopamine Hypothesis: Excess dopamine activity contributes to positive symptoms. Antipsychotic medications block dopamine receptors.
• Genetics: Strong genetic component — concordance rate is ~48% for identical twins vs. ~17% for fraternal twins. Having a biological relative with schizophrenia significantly increases risk.
• Brain Abnormalities: Enlarged ventricles, reduced cortical gray matter, and abnormalities in the prefrontal cortex and temporal lobes.
• Prenatal Factors: Viral infections during pregnancy, birth complications, and malnutrition increase risk.

Bipolar and Depressive Disorders

Major Depressive Disorder (MDD)

Characterized by persistent depressed mood or loss of interest/pleasure (anhedonia) lasting at least two weeks, along with at least five of the following symptoms:

• Significant weight change or appetite change
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating or making decisions
• Recurrent thoughts of death or suicidal ideation

Causes: Low levels of serotonin and norepinephrine; genetic predisposition; Beck’s cognitive triad (negative views of self, world, and future); learned helplessness (Seligman); stressful life events.

Bipolar Disorder

Characterized by alternating episodes of mania (or hypomania) and depression.

• Manic episodes: Abnormally elevated or irritable mood, grandiosity, decreased need for sleep, pressured speech, racing thoughts, risk-taking behavior, increased goal-directed activity.
• Bipolar I: Full manic episodes (may or may not include depressive episodes).
• Bipolar II: Hypomanic episodes (less severe mania) plus major depressive episodes.

Beck’s Cognitive Triad: Depression involves negative views of the self, the world, and the future. (Wikimedia Commons, CC BY-SA 4.0)

Anxiety Disorders

Anxiety disorders involve excessive fear or anxiety that is disproportionate to the actual threat and interferes with daily functioning.

Obsessive-Compulsive and Related Disorders

• Obsessive-Compulsive Disorder (OCD): Characterized by obsessions (unwanted, intrusive, recurring thoughts that cause anxiety) and compulsions (repetitive behaviors performed to reduce the anxiety caused by obsessions). Example: Fear of contamination (obsession) → excessive handwashing (compulsion).
• Body Dysmorphic Disorder: Preoccupation with perceived flaws in physical appearance that are not observable or appear slight to others.

Trauma- and Stressor-Related Disorders

• Post-Traumatic Stress Disorder (PTSD): Develops after exposure to a traumatic event (combat, assault, disaster). Symptoms include intrusive memories (flashbacks, nightmares), avoidance of trauma-related stimuli, negative changes in cognition and mood, and hyperarousal (exaggerated startle response, hypervigilance, sleep disturbance). Symptoms persist for more than one month.

Dissociative Disorders

• Dissociative Identity Disorder (DID): Formerly “multiple personality disorder.” Characterized by the presence of two or more distinct personality states. Often linked to severe childhood trauma. Controversial — some argue it is iatrogenic (therapist-created).
• Dissociative Amnesia: Inability to recall important personal information, usually related to a traumatic event. May include dissociative fugue (sudden, unexpected travel away from home with amnesia for one’s past).

Somatic Symptom and Related Disorders

• Somatic Symptom Disorder: One or more physical symptoms (pain, fatigue) accompanied by excessive thoughts, feelings, or behaviors related to those symptoms. The distress is genuine, even if no medical explanation is found.
• Illness Anxiety Disorder: Formerly “hypochondriasis.” Preoccupation with having or developing a serious illness despite minimal or no symptoms.
• Conversion Disorder: Neurological symptoms (blindness, paralysis, numbness) without a medical cause, often following psychological stress.

Feeding and Eating Disorders

Personality Disorders

Personality disorders are enduring, inflexible patterns of inner experience and behavior that deviate markedly from cultural expectations. The DSM-5-TR organizes them into three clusters:

Substance-Related and Addictive Disorders

• Substance Use Disorder: A pattern of substance use leading to clinically significant impairment or distress. Key criteria include tolerance (needing more of the substance for the same effect), withdrawal (physical/psychological symptoms when stopping), failed attempts to cut down, and continued use despite negative consequences.
• Biological factors: Genetic predisposition, dopamine reward pathway (nucleus accumbens), neurotransmitter changes.
• Psychological factors: Stress, self-medication, comorbid mental disorders.
• Social factors: Peer pressure, socioeconomic stress, family history, cultural attitudes toward substance use.

💊 5.5 Treatment of Psychological Disorders

Treatment approaches for psychological disorders fall into two broad categories: psychotherapy (talk therapy) and biomedical therapy (medications and medical procedures). Many clinicians use an eclectic approach, combining techniques from multiple therapeutic orientations based on the client’s needs.

Psychotherapy Approaches

Group, Family, and Community Approaches

• Group Therapy: A therapist works with multiple clients simultaneously. Benefits include social support, shared experiences, diverse perspectives, and cost-effectiveness. Self-help groups (e.g., Alcoholics Anonymous) provide peer support without a professional therapist.
• Family Therapy: Treats the family as a system. Focuses on improving communication patterns, resolving conflicts, and addressing dysfunctional family dynamics that contribute to individual members’ problems.
• Community Mental Health: The deinstitutionalization movement (1960s–70s) shifted care from psychiatric hospitals to community-based treatment. Community mental health centers provide outpatient therapy, crisis intervention, and preventive services. However, deinstitutionalization also contributed to homelessness among those with severe mental illness who lacked adequate community support.

Evaluating Psychotherapy Effectiveness

• Meta-analyses consistently show that psychotherapy is more effective than no treatment for most disorders.
• Common factors: Regardless of the specific approach, successful therapy shares common elements — a strong therapeutic alliance (trusting relationship between therapist and client), hope and expectation of improvement, and a structured rationale for the treatment.
• Evidence-based practice: Integrating the best available research evidence with clinical expertise and patient preferences. CBT has the strongest evidence base for many disorders.

CBT Framework: Thoughts, feelings, and behaviors influence each other. Cognitive-behavioral therapy targets all three. (Wikimedia Commons, CC BY-SA 3.0)

Biomedical Therapies

Psychopharmacology (Medication)

Brain Stimulation Therapies

Psychosurgery

• Lobotomy: A historical procedure (developed by Egas Moniz in the 1930s; popularized by Walter Freeman) that severed connections to the prefrontal cortex. Caused severe side effects (personality changes, cognitive impairment, death). Now considered unethical and no longer performed.
• Modern psychosurgery is extremely rare, highly precise, and used only as a last resort for severe, treatment-resistant cases.

Therapeutic Approaches Matched to Disorders