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Chapter 14: Health Psychology and Introduction to Psychological Disorders

Summary

This chapter bridges the biology of stress with the clinical science of psychological disorders. The first half covers health psychology: eustress vs. distress, adverse childhood experiences, Selye's General Adaptation Syndrome, the fight-flight-freeze and tend-and-befriend stress responses, problem-focused and emotion-focused coping, and positive psychology (well-being, resilience, gratitude, and signature strengths). The second half introduces the clinical classification framework — DSM and ICD systems, the biopsychosocial model, four explanatory perspectives on disorders, evidence-based psychotherapy — then surveys specific phobia and introduces schizophrenia.

Concepts Covered

This chapter covers the following 23 concepts from the learning graph:

  1. Health Psychology
  2. Positive Psychology
  3. Well-Being and Resilience
  4. Gratitude and Subjective Well-Being
  5. Signature Strengths
  6. Stress and Behavior
  7. Eustress vs. Distress
  8. Adverse Childhood Experiences
  9. General Adaptation Syndrome
  10. Problem-Focused Coping
  11. Emotion-Focused Coping
  12. Fight-Flight-Freeze Response
  13. Tend-and-Befriend Response
  14. Defining Psychological Disorders
  15. DSM Classification System
  16. ICD Classification System
  17. Biopsychosocial Model
  18. Behavioral Perspective on Disorders
  19. Biological Perspective on Disorders
  20. Sociocultural Perspective on Disorders
  21. Evidence-Based Psychotherapy
  22. Schizophrenia
  23. Specific Phobia

Prerequisites

This chapter builds on concepts from:

14.1 Health Psychology

Mascot-welcome

Psy the Owl welcoming you to Chapter 14 Welcome to Chapter 14 — where psychology meets physical health and clinical science!

Did you know that your psychological state directly affects your immune function? That chronic stress shrinks the hippocampus? That counting your blessings — literally writing down what you're grateful for — can measurably improve well-being? And that the way two people with similar symptoms end up with completely different clinical outcomes might come down not to biology alone but to psychology, culture, and social support?

This chapter begins with health psychology and stress — the interface between your psychological life and your physical body. Then it pivots to one of the most important conceptual frameworks in clinical psychology: the biopsychosocial model. By the end, you'll understand how psychologists define, classify, and think about mental disorders — and you'll have a preview of several major disorders we'll explore in the next two chapters.

Let's think about that! 🦉

Health psychology is the subfield of psychology dedicated to understanding and improving physical health through psychological science. Health psychologists study how stress, behavior, emotions, personality, and social factors influence health, illness, and health care. Key concerns include: what makes some people resilient under stress, why some people adopt healthy behaviors and others don't, and how psychological interventions can improve health outcomes.

14.2 Stress and the Body

Stress is the process by which people perceive and respond to events (stressors) that they appraise as threatening or challenging. Stress is not purely physiological — Richard Lazarus's cognitive appraisal model emphasizes that stress involves a two-stage evaluation: primary appraisal (is this threatening?) and secondary appraisal (do I have the resources to cope?). The same event can be stressful to one person and exciting to another depending on their appraisal.

Eustress vs. Distress

Eustress is positive, motivating stress associated with exciting, challenging, or growthful experiences — the stress of a first date, a performance, or a creative deadline. It energizes and focuses. Distress is negative, overwhelming stress that exceeds a person's coping resources and impairs functioning — chronic financial worry, relationship conflict, trauma.

The distinction matters because moderate challenge (eustress) promotes performance and growth (recall the Yerkes-Dodson law), while chronic distress is associated with immune suppression, cardiovascular disease, depression, and cognitive impairment.

Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are traumatic events occurring before age 18, including abuse (physical, emotional, sexual), neglect, and household dysfunction (domestic violence, parental substance abuse, mental illness, incarceration, divorce). The ACE Study (Felitti et al., 1998) found dose-response relationships between ACE scores and adult health outcomes: the more ACEs, the higher the rates of heart disease, diabetes, depression, substance abuse, and early mortality.

ACEs illustrate how early psychological and social stressors become biologically embedded — through altered stress hormone systems, epigenetic modifications, and altered brain development — and persist across decades. They underscore that health is not purely a matter of adult choices and biology; early social environments have lasting biological consequences.

Fight-Flight-Freeze Response

The fight-flight-freeze response is the acute physiological stress response orchestrated by the sympathetic nervous system and adrenal glands. When the brain detects threat, it triggers release of epinephrine (adrenaline) and norepinephrine, producing:

  • Increased heart rate and blood pressure
  • Dilated pupils
  • Redirected blood flow to muscles
  • Decreased digestion
  • Heightened alertness and sensory acuity

The freeze component — immobility in response to overwhelming threat, associated with parasympathetic activity — is often added to the classic "fight or flight" description following recognition that organisms (including humans) sometimes respond to extreme threat with freezing.

Tend-and-Befriend Response

Shelley Taylor proposed that the fight-or-flight model was developed primarily from male-based research and may not accurately characterize stress responses in females. She proposed the tend-and-befriend response: under stress, females (and some males) are more likely to tend to offspring and form social alliances — which may have been more adaptive for females who could not always fight or flee while caring for young.

The tend-and-befriend response appears to be mediated in part by oxytocin, which promotes social bonding and is released during stress. Social support is a powerful stress buffer in the research literature, consistent with the tend-and-befriend model.

General Adaptation Syndrome

Hans Selye's General Adaptation Syndrome (GAS) describes the three-stage physiological response to prolonged stress:

Diagram: Selye's General Adaptation Syndrome

Explore: What happens to the body during each stage of GAS?

Stage 1 — Alarm Reaction The initial response to a stressor. The sympathetic nervous system activates the fight-flight-freeze response. Resources are mobilized rapidly: stress hormones flood the system, the immune system briefly activates. Resistance to disease is temporarily reduced during this mobilization. Duration: Hours to a few days.

Stage 2 — Resistance The body adapts to the continuing stressor. Stress hormone levels remain elevated, but the organism appears to have recovered. Internal resources (glucose, immune function) are maintained at high cost. The body is defending against the original stressor but becomes more vulnerable to other stressors. Duration: Days to weeks.

Stage 3 — Exhaustion If the stressor persists and adaptation resources are depleted, the body enters exhaustion. Immune function collapses, stress-related illness becomes likely (cardiovascular disease, gastrointestinal problems, depression). In extreme cases, organ failure and death can result. Duration: Variable; depends on severity of stressor and individual resources.

Selye's key contribution: He showed that diverse stressors — physical injury, infection, psychological threat — all produce the same physiological response pattern. The concept of "stress" as a general, non-specific response was Selye's innovation.

14.3 Coping Strategies

How people respond to stress — their coping strategies — powerfully influences whether stress becomes harmful.

Problem-focused coping involves directly addressing the source of stress — changing the situation, removing the stressor, or developing new skills to manage it. Example: If a student is failing a course due to poor study habits, developing a new study schedule is problem-focused coping. Problem-focused coping is most adaptive when the stressor is controllable.

Emotion-focused coping involves regulating one's emotional response to stress without directly changing the stressor. Examples: seeking social support, reappraising the situation more positively, mindfulness practice, expressive writing. Emotion-focused coping is most adaptive when the stressor is uncontrollable (e.g., bereavement, terminal diagnosis).

Neither strategy is universally superior. Effective coping often involves flexible use of both, matching the strategy to the situation. Using problem-focused coping on an uncontrollable stressor produces frustration; using only emotion-focused coping on a controllable stressor allows a solvable problem to persist.

14.4 Positive Psychology

Positive psychology is the scientific study of what makes life worth living — human strengths, well-being, flourishing, and the conditions that enable people to thrive. Martin Seligman and Mihaly Csikszentmihalyi launched the formal movement in 2000 as a counter to psychology's historical focus on pathology.

Well-Being, Resilience, and Gratitude

Well-being encompasses subjective happiness, satisfaction with life, positive affect, and the presence of meaning and engagement. Research by Ed Diener on subjective well-being (SWB) identifies three components: life satisfaction, positive affect, and low negative affect. SWB is influenced by genetics (~50% heritable), circumstances (~10%), and intentional activities (~40%) — suggesting that how we spend our time and attention matters substantially.

Resilience is the ability to adapt well in the face of adversity, trauma, or significant stress. Resilience is not a fixed trait but a dynamic process involving social support, cognitive appraisal skills, problem-solving, and meaning-making. George Bonanno's research found that most people exposed to trauma show resilience (return to baseline function relatively quickly) rather than PTSD.

Gratitude — consciously recognizing and appreciating positive experiences and the contributions of others — is one of the most robustly validated positive psychology interventions. Writing three good things that happened each day (and why), or writing a gratitude letter to someone who helped you, produces measurable increases in well-being and decreases in depression symptoms in randomized controlled trials.

Gratitude and subjective well-being are strongly associated: grateful people report higher life satisfaction, more positive emotions, better relationships, and better physical health. The causal relationship appears bidirectional — gratitude promotes well-being, and well-being promotes gratitude.

Signature Strengths

Martin Seligman and Christopher Peterson's Values in Action (VIA) classification identified 24 signature strengths — character strengths that people possess in varying degrees (creativity, curiosity, bravery, kindness, fairness, leadership, gratitude, humor, etc.). Using one's signature strengths — those felt as most authentic and energizing — in new ways each day is associated with increased well-being and engagement.

Mascot-tip

Psy the Owl giving a tip Psy's AP Exam Tip: Positive psychology is relatively recent (post-2000) and may not appear as heavily as the foundational frameworks on earlier AP exams, but questions about gratitude interventions, resilience, and well-being are increasingly common. Know the names Martin Seligman and the three-component SWB model (satisfaction, positive affect, low negative affect).

14.5 Defining and Classifying Psychological Disorders

Defining Psychological Disorders

Defining psychological disorders involves identifying what distinguishes normal variation in mood, thought, and behavior from clinical disorder. The "3Ds" criterion is commonly used:

  • Distress: The person experiences significant subjective suffering.
  • Dysfunction: The symptoms interfere significantly with work, relationships, or daily functioning.
  • Deviance: The behavior is atypical or violates social norms.

A fourth criterion is sometimes added: Danger — risk of harm to self or others. No single criterion is sufficient alone — deviance without distress or dysfunction is not disorder; context always matters. Cultural variation in what counts as distress or deviance requires culturally sensitive assessment.

The Biopsychosocial Model

The biopsychosocial model (George Engel, 1977) proposes that health and illness are determined by the interaction of biological factors (genetics, neurochemistry, brain structure), psychological factors (thoughts, emotions, coping, personality), and social factors (relationships, culture, socioeconomic status, trauma history). This integrative model replaced the purely biomedical model, which treated disease as purely physical.

In psychology, the biopsychosocial model has become the dominant framework for understanding psychological disorders — they arise not from single causes but from the interplay of vulnerability factors (biological, psychological) and environmental stressors (social, cultural, situational). This is formalized in the diathesis-stress model: a disorder develops when a person with a biological or psychological vulnerability (diathesis) encounters sufficient environmental stress to trigger the disorder.

Classification Systems: DSM and ICD

The DSM (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association, is the primary classification system used in the United States. The current edition (DSM-5-TR) classifies over 300 disorders with operational diagnostic criteria. DSM disorders are defined by symptom patterns, duration, and level of impairment.

The ICD (International Classification of Diseases), published by the World Health Organization, is the global standard for all health conditions, including mental disorders. The ICD's chapter on mental disorders (ICD-11) is used internationally and increasingly aligns with DSM criteria, though differences remain.

Both systems use categorical classification (you either meet criteria or you don't), though dimensional approaches (rating severity on a continuum) are increasingly incorporated.

Perspectives on Psychological Disorders

Four major perspectives explain the causes of psychological disorders:

Biological perspective: Disorders result from abnormal brain chemistry, structure, or genetics. Treatment focuses on medications and neurological interventions.

Behavioral perspective: Disorders are learned responses — maladaptive conditioning, reinforcement of problematic behaviors. Treatment focuses on relearning through behavioral techniques (exposure, reinforcement).

Cognitive perspective (covered in Chapter 15): Disorders result from distorted or dysfunctional thought patterns. Treatment focuses on identifying and restructuring maladaptive cognitions.

Sociocultural perspective: Disorders are shaped by social contexts, cultural norms, and structural factors (poverty, discrimination, trauma). Treatment considers family systems, cultural factors, and social inequity.

The biopsychosocial model integrates all four perspectives — recognizing that disorders typically involve biological vulnerability, psychological factors (behavioral/cognitive), and social/cultural context.

14.6 Introduction to Specific Disorders

Specific Phobia

Specific phobia is a marked, persistent, excessive fear of a specific object or situation that causes significant distress or impairment and exceeds the actual danger posed. Common phobia types include: animal (spiders, snakes), natural environment (heights, storms), blood-injection-injury (needles, blood), situational (flying, enclosed spaces), and other.

From a behavioral perspective, specific phobias are acquired through classical conditioning (a neutral stimulus becomes associated with fear through pairing with a threatening experience), maintained through operant conditioning (avoidance reduces fear and is therefore negatively reinforcing), and treated through systematic desensitization or exposure therapy (gradual re-pairing of the feared stimulus with relaxation or neutral experience).

Introduction to Schizophrenia

Schizophrenia is a severe psychotic disorder characterized by a fragmentation of thought, perception, and emotion. It affects roughly 1% of the population worldwide. Full coverage of symptoms (positive and negative) follows in Chapter 15; here we introduce the basic concept.

Schizophrenia involves disturbances in multiple domains: - Positive symptoms (excesses): hallucinations, delusions, disorganized thought - Negative symptoms (deficits): flat affect, social withdrawal, reduced speech, avolition

The dopamine hypothesis — that excess dopamine activity in mesolimbic pathways underlies positive symptoms — is the leading neurochemical account (Chapter 3). Risk factors include genetic vulnerability (10% concordance in first-degree relatives; ~50% in identical twins), prenatal complications, and early cannabis use.

Evidence-Based Psychotherapy

Evidence-based psychotherapy refers to psychological treatments that have been validated through rigorous controlled research. The APA's Division 12 maintains lists of empirically supported treatments — therapies with demonstrated efficacy for specific disorders in randomized controlled trials.

Examples include: - Cognitive-behavioral therapy (CBT): Strong evidence for depression, anxiety, OCD, PTSD, eating disorders - Exposure and Response Prevention (ERP): For OCD - Prolonged Exposure: For PTSD - Behavioral Activation: For depression

The emphasis on evidence-based practice is a response to the proliferation of unvalidated therapies. The distinction matters: "therapy" as a category is not evidence-based; specific, manualized therapies applied to specific disorders with specific techniques can be.

14.7 Chapter Review

Mascot-celebration

Psy the Owl celebrating Wonderful work completing Chapter 14!

You've now covered both sides of the health psychology coin — what damages health (stress, adversity, ACEs) and what builds it (resilience, gratitude, positive psychology) — plus the foundational frameworks for understanding psychological disorders. The biopsychosocial model, the DSM/ICD, and the four explanatory perspectives will be your constant companions through Chapters 15 and 16.

Chapter 15 dives deep into the major psychological disorders: anxiety disorders, OCD, schizophrenia (full coverage), personality disorders, autism, ADHD, and eating disorders. Take a breath — you've earned it.

Let's think about that! 🦉

Key Terms

  • Health psychology: Subfield studying psychological influences on physical health.
  • Stress: The process of perceiving and responding to threatening or challenging events.
  • Eustress vs. distress: Positive stimulating stress vs. negative overwhelming stress.
  • Adverse Childhood Experiences (ACEs): Traumatic early-life events with dose-response effects on adult health.
  • Fight-flight-freeze response: Sympathetic activation in response to threat; prepares organism for action.
  • Tend-and-befriend response: Female-typical stress response involving social bonding and caregiving; mediated by oxytocin.
  • General Adaptation Syndrome (GAS): Selye's three-stage stress response — alarm, resistance, exhaustion.
  • Problem-focused coping: Addressing the source of stress; optimal when stressor is controllable.
  • Emotion-focused coping: Managing emotional response to stress; optimal when stressor is uncontrollable.
  • Positive psychology: Scientific study of human flourishing, strengths, and well-being.
  • Well-being: Subjective satisfaction, positive affect, low negative affect.
  • Resilience: Adaptive functioning after adversity.
  • Gratitude: Conscious appreciation of positive experiences; robustly linked to well-being.
  • Signature strengths: VIA character strengths most authentic and energizing for the individual.
  • Biopsychosocial model: Health and illness as products of biological, psychological, and social factors.
  • Diathesis-stress model: Disorders develop when vulnerability + environmental stress reach threshold.
  • DSM: American Psychiatric Association's diagnostic classification manual.
  • ICD: WHO's international health classification system.
  • Biological perspective: Disorders as abnormal brain chemistry/structure/genetics.
  • Behavioral perspective: Disorders as learned maladaptive responses.
  • Sociocultural perspective: Disorders shaped by social context, culture, structural inequity.
  • Evidence-based psychotherapy: Treatments validated through rigorous controlled research.
  • Specific phobia: Excessive, persistent fear of a specific object/situation causing impairment.
  • Schizophrenia: Severe psychotic disorder with positive and negative symptoms.

Practice Questions

  1. According to Selye's General Adaptation Syndrome, during which stage is the organism most vulnerable to new stressors even though it appears to have recovered from the original stressor?

  2. A student whose father lost his job decides to increase her own hours at work and reduce expenses. This is an example of __ coping.

  3. The biopsychosocial model differs from the purely biomedical model in that it __.

  4. The finding that people who write down three things they are grateful for daily show measurable improvements in well-being is best associated with the subfield of __ psychology.

  5. Why does avoidance of a feared object (like spiders) maintain and worsen a specific phobia rather than reducing it?

Show Answers
  1. Resistance stage — the body has adapted to the original stressor but at high resource cost, leaving it more vulnerable to secondary stressors.
  2. Problem-focused coping (directly addressing the source of the problem — financial stress — by changing behavior).
  3. It incorporates psychological and social factors (not just biological ones) as determinants of health and illness — recognizing that genes and brain chemistry interact with thoughts, behaviors, cultural context, and social support.
  4. Positive psychology (Seligman's gratitude interventions).
  5. Avoidance prevents the feared stimulus from being encountered without negative consequence, so the conditioned fear is never extinguished. Avoidance is negatively reinforced (removes anxiety) — it feels good in the short term but maintains the phobia through operant conditioning.