ABNORMAL PSYCHOLOGY Flashcards
DAY 1 BLEPP REVIEW
It is a psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected.
Abnormal Behavior
is a breakdown in cognitive, emotional and behavioral functioning.
Psychological Dysfunction
reason why the person came to the clinic.
Presenting Problem
unique combination of behavior, thoughts and feelings that make up a specific disorder.
Clinical Description
how many in the population as a whole have the disorder
Prevalence
how many new cases during a given period such as a year
Incidence
pattern of the illness over time
Course
which means they tend to last a long time, even a lifetime.
Chronic course
which means the individual is likely to recover within a few months only to suffer a recurrence of the disorder at a later time.
Episodic course
which means that the disorder will improve without treatment in a relatively short period.
Time Limited Course
how a disorder starts or begins
Onset
which means they begin suddenly
Acute onset
which means they develop gradually over an extended period
Insidious onset
the anticipated course of a disorder
Prognosis
means the individual will probably recover
Prognosis is “good”
means the probable outcome doesn’t look good
Prognosis is “guarded”
individuals inherit tendencies to express certain traits and behaviours, which may then be activated under conditions of stress.
Diasthesis-Stress Model:
An approach to describing and explaining how biological, psychological, and social factors combine and interact to influence physical and mental health.
Bio Psycho Social Framework
*Major psychological disorders have existed across time and cultures
*Causes and treatment of abnormal behavior varied widely, depending on context
Historical Conceptions of
Abnormal Behavior
*Deviance = Battle of “Good” vs. “Evil”
*Etiology—devil, witchcraft, sorcery
* Salem witch trials in U.S.
*Demons and witches
*Treatments—exorcism, torture, and crude surgeries
*People were treated for “possession”
The Supernatural Tradition
*Hippocrates (460-377 BC)
*Father of modern Western medicine
*Etiology = physical disease
*Precursor to somatoform disorders
*Hysteria
The Biological Tradition
- Galen (129-198 AD)
- Hippocratic foundation
- Galenic-Hippocratic Tradition
- Humoral theory of mental illness
- Black, blue, yellow and phlegm biles
- Etiology = brain chemical imbalances
- Treatments = environmental regulation
- Heat, dryness, moisture, cold
- Bloodletting, induced vomiting
The Biological Tradition
- Mental Illness = Physical Illness
- The 1930s
* Insulin shock therapy
* Brain surgery - ECT
* Benjamin Franklin (1750s)
* Treatment for depression?The 1950s- Psychotropic medications
* Increasingly available
* Systematically developed - Neuroleptics
* Reserpine and psychosis
- Psychotropic medications
- Tranquilizers
* Benzodiazepines and anxiety
The Development of Biological
Treatments
- John Grey (1850s)
* American proponent of the
biological tradition- Etiology = always physical
- Treatments = as is physically ill
* Rest
* Diet
* Room temperature - Improved hospital conditions
19th Century
Plato, Aristotle, and Greece
*Etiology
* Social and environmental
factors
*Treatment
* Reeducation via discussion
* Therapeutic environments
The Psychological Tradition
- Moral Therapy
- “Moral” = emotional or psychological
- Treating patients normally
- Encouraging social interaction
- Focus on relationships
- Individual attention
- Education
Moral Therapy
is an immediate alarm reaction to danger
Fear
is a future-oriented mood state characterized by apprehension because we cannot predict or control upcoming events.
Anxiety
brief experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pains, shortness of breath, and possibly dizziness.
Panic Attack
if you know that you are afraid of high places, but not anywhere else
Expected (or cued) e.g
if you have no idea when the next attack will come.
Unexpected (or uncued):
- At least 6 months of excessive anxiety and worry, must be ongoing more days than not,
and is difficult to turn off or control. - People with this condition mostly worry about minor, everyday life events, a characteristic that distinguishes it from other anxiety disorders
- For children only one symptom is required for a diagnosis
Generalized Anxiety Disorder
individuals experience severe, unexpected panic attacks; they may think they’re dying or losing control.
Panic Disorder
fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of developing panic symptoms, Most, but not all panic disorder, is accompanied by this condition.
Agoraphobia
In Latin America, this is a disorder characterized by sweating, increased heart rate, and insomnia but not by reports of anxiety and fear even though fright is the cause.
Susto
Among Hispanic-Americans, particularly those from the Carribean, this disorder
presents with symptoms that are similar to panic attack but associated more often with crying uncontrollably and bursting into tears.
Ataque de Nervios
- We inherit a tendency to be tense, uptight and anxious
- Depleted levels of Gammaaminobutyric acid (GABA) is associated with increased anxiety
- Area associated with anxiety is the limbic system (deals
with emotions, memories, arousal)
(Biological) Causes of Anxiety Disorders
→ Parents who are overprotective and intrusive
→ A general “sense of uncontrollability” may
develop due to upbringing and other disruptive or traumatic environmental factors.
(Psychological) Causes of Anxiety Disorders
→ Stressful life events trigger our biological and psychological vulnerabilities to anxiety
(Social) Causes of Anxiety Disorders
are most prescribed for GAD, as well as some antidepressants
Benzodiazepines (Treatment Anxiety)
Patients evoke worry process during therapy sessions and confront anxiety provoking images and thoughts head on.
Cognitive Behavioral Therapy (Treatment Anxiety)
Help patients become more tolerant of distressing thoughts and feelings
Meditational approaches (Treatment Anxiety)
Is an irrational fear of a specific object or situation that markedly interferes with a person’s ability to function.
Four major subtypes:
→ Blood-injection-injury type:
→ Situational type (e.g. planes, elevators, and enclosed spaces)
→Natural environment type (e.g heights, storm and water)
→ Animal type
→Other — for any phobias that don’t fall under the first 4 subtypes
Phobia
- Traumatic conditioning experience play a role
- Fear is most likely to develop if we are “prepared”; that is, we seem to carry an inherited tendency to fear situations that have always been dangerous to the human race such as being threatened by wild animals or an enclosed space
- We also have to be susceptible to developing anxiety about the possibility that the event will happen again.
- Patients with blood phobia probably inherit a strong vasovagal response that makes them susceptible to fainting.
Treatment: Structured and consistent exposure-based exercises
Causes of Phobia
Characterized by children’s unrealistic and persistent worry that something will happen to their parents or other important people in their life or that something will happen to the children themselves that will separate them from their parents.
Separation Anxiety Disorder
- Marked fear or anxiety about one or more social situations in
which the person is exposed to possible scrutiny by others.
Social Anxiety Disorder (Social Phobia)
in which individuals may believe they have horrendous bad breath or body odor and thus avoid social interaction.
Taijin Kyofusho
- We learn quickly to fear angry expressions than other facial expressions
- We could inherit a generalized biological vulnerability to develop anxiety or to be
socially inhibited or both - Real social trauma resulting in true alarm e.g. severe bullying in childhood
- People with SAD also learned growing up that social evaluation can be dangerous
creating a psychological vulnerability to develop anxiety
TREATMENT:
* Cognitive Therapy that emphasize real-life experiences to disprove perception of
danger
(CAUSES) Social Anxiety Disorder (Social Phobia)
- Rare childhood disorder characterized by a lack of speech in one or more
settings in which speaking is socially expected. - Failure to speak is not because of lack of knowledge of speech or any physical
difficulties, nor is it due to another disorder in which speaking is rare or can be impaired such as Autism Spectrum Disorder - Must occur for more than one month and can’t be limited to the first month of
school.
TREATMENT
Cognitive Behavioral Therapy but with emphasis on speech
Selective Mutism
- is the diagnosis given to severe anxiety experienced after exposure to a traumatic event.
- Duration is more than one month
- can occur immediately after a traumatic event, or after a significant time has passed. The latter kind is called with delayed onset.
- Setting is often exposure to a traumatic event during which an individual experiences or witnesses death, actual or threatened serious injury, or actual or threatened sexual violation.
Post Traumatic Stress Disorder
- Precipitating event: someone personally experiences trauma
- A family history of anxiety suggests a generalized biological vulnerability for PTSD
- A generalized psychological vulnerability based on early experiences with unpredictable or uncontrollable events e.g. family instability
- If you have a strong social support around you, it is much less likely you will develop PTSD after trauma
Trauma and Stress-Related Disorders
- Precipitating event: someone personally experiences trauma
- A family history of anxiety suggests a generalized biological vulnerability for PTSD
- A generalized psychological vulnerability based on early experiences with unpredictable or uncontrollable events e.g. family instability
- If you have a strong social support around you, it is much less likely you will develop PTSD after trauma
Trauma and Stress-Related Disorders
- Victims should face the original trauma, process intense emotions and develop effective coping procedures in order to
overcome the debilitating effects of the disorder (catharsis, imaginal exposure) - Structured interventions delivered as soon after the trauma are useful in prevention of PTSD
TREATMENT PTSD
*Diagnosis given to PTSD, or very much like it, occurring within the first month of trauma, but the different name emphasizes the severe reaction that people have Immediately.
*Almost 50% of people with Acute Stress Disorder go on to develop PTSD.
Acute Stress Disorder
*Describe anxious or depressive reactions to life stress that are generally milder than what one would see in Acute Stress
Disorder or PTSD but are nevertheless impairing in terms of interfering with work or school performance, interpersonal
relationships, or other areas of living.
* If symptoms persist for more than six months after the removal of the stress, the adjustment disorder would be considered as chronic
Adjustment Disorders
*Disturbed and developmentally inappropriate behaviors in children, emerging before 5 years of age, in which the child is unable or unwilling to for normal attachment relationships with caregiving adults.
*These seriously maladaptive patterns are due to inadequate or abusive child-rearing practices.
Attachment Disorders
the child will very seldom seek out a caregiver for protection, support, and nurturance and will seldom respond to offers from caregivers to provide this kind of care. Generally they would evidence lack of responsiveness, limited positive affect and additional heightened emotionality such as fearfulness or intense sadness.
Reactive Attachment Disorder
pattern of behavior in which the child shows no inhibitions whatsoever to approaching adults. Child will engage in Inappropriately intimate behavior by showing a willingness to accompany and unfamiliar adult figure somewhere without checking first with caregiver
Disinhibited Social Engagement Disorder
is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions)
that he or she feels the urge to repeat over and over.
Obsessive-Compulsive Disorder (OCD)
intrusive and mostly non-sensical thoughts, images or urges that an individual tries to resist or eliminate.
Obsessions
are the thoughts or actions used to suppress the obsessions and provide relief.
Compulsions
- a) Symmetry (most common)
- b) Forbidden thoughts and actions
- c) Cleaning and Contamination
- d) Hoarding
Four major types of obsessions
- More complex tics with involuntary vocalizations are referred to as
Tourette’s disorder
characterized by involuntary movements (sudden jerking of limbs for example) to co-occur in patients with OCD (particularly
children) or in their families.
Tic Disorder
(e.g believing some thoughts must be suppressed) must be present before development of the disorder
Generalized biological and psychological vulnerability
- Preoccupation with some imagined defect in someone who actually looks reasonably normal.
- Disorder is referred to as “imagined ugliness”
Body Dysmorphic Disorder
The three major characteristics of this problem are excessive acquisition of things, difficulty discarding anything, and living with excessive clutter under conditions characterized as gross disorganization.
Hoarding Disorder
The urge to pull one’s hair from anywhere in the body including the scalp, eyebrows and arms.
Trichotillomania (hair pulling disorder)
Repetitive and compulsive picking of the skin leading to tissue damage.
Excoriation (Skin Picking Disorder)
- formerly called Briquet’s Syndrome and Somatoform Disorder
- Involves having a significant focus on physical symptoms — such as pain or fatigue — to the point that it causes major emotional distress and problems functioning.
- Life revolves around symptom, they are the person’s identity
- The person may or may not have another diagnosed medical
condition.
Somatic Symptom Disorder
- Formerly known as hypochondriasis
- Physical Symptoms are either not experienced at the present time or are very mild but severe anxiety is focused on the possibility of having or developing a serious disease
Illness Anxiety Disorder
belief, accompanied by severe anxiety and sometimes panic, that the genitals are retracting into the abdomen.
Koro
disorders of cognition or perception with strong emotional contributions. Faulty interpretations of physical signs and sensations are central
Somatic Symptom Disorder and Illness Anxiety Disorder
There is a modest genetic contribution, such as a tendency to overrespond to stress
Learned.
Physical malfunctioning such as paralysis, blindness or difficulty speaking (aphonia) without any physical or organic pathology to account for the malfunction.
* Not so easy to distinguish from malingering (faking).
* Conversion symptoms are often seen to be precipitated by marked stress.
* La Belle Indifference was long thought of as a hallmark of conversion reactions but this is not always the case
Conversion Disorder (Functional Neurological Symptom Disorder)
- Falls somewhere between malingering and conversion disorders
- Symptoms are under voluntary control but there is no obvious reasons for voluntarily producing the symptoms except possibly to assume the sick role and receive increase attention.
Factitious Disorder
When an individual deliberately makes someone else sick, the condition is called
factitious disorder imposed on another, previously known as
Manchausen Syndrome by proxy
your perception alters so that you
temporarily lose the sense of your own reality, as if you were in a dream and you were watching yourself.
Depersonalization
your sense of reality of the external world is lost. Things may seem to change shape or size; people may seem dead or mechanical.
Derealization
When feelings are so severe that they dominate an individual’s life and prevent normal functioning.
Depersonalization – Derealization Disorder
The inability to recall important autobiographical information,
usually of a traumatic or stressful nature that is inconsistent with ordinary forgetting
Dissociative Amnesia
unable to remember anything including who they are
Generalized amnesia
failure to recall specific events,
usually traumatic, that occur during a specific period.
Localized or selective amnesia
memory revolves around a particular incident — and an unexpected trip. Usually they leave behind an intolerable situation.
Dissociative Fugue
individuals in this trancelike state often brutally assault or sometimes kill people and animals. If the person is not killed himself, he probably won’t remember the incident
Among people of the arctic, _______ is called “pivloktoq”.
Among Navajo Indians it’s called frenzy witchcraft
Amok
People with this condition may adopt as many as 100 new identities, all simultaneously co-existing, although the average number is closer to 15.
CAUSES:
* Being horribly, often unspeakably, abused as a child
* Suggestibility can also play a role.
- TREATMENTS:
- Identify cues and triggers that provoke memories of trauma and neutralize them
- Confront and relive early trauma to gain control over horrible events
Dissociative Identity Disorder
shorthand term for the different identities or personalities in DID.
Alters
The person who becomes the patient and asks for treatment
* The original person is seldom the person who seeks treatment.
* Memories tend to be different from one alter to the next.
Host
Extremely depressed mood state that last at least two weeks and includes cognitive symptoms (such as feelings of worthlessness or indecisiveness) and disturbed physical functions (such as altered sleeping pattern, significant changes in appetite or weight, or a
notable loss of energy) to the point that even the slightest activity or movement requires an overwhelming amount effort.
Major Depressive Episode
loss of energy or inability to engage in pleasurable activities or have any “fun”
Anhedonia:
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least 1 week and present most of the day, nearly every day or any duration if hospitalization is necessary.
Manic Episode
- Also called clinical depression, this disorder causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with clinical depression, the symptoms must be present for at least two weeks.
- If two or more major depressive episodes occurred and was
separated by at least 2 months during which the individual was
not depressed, the major depressive disorder is being noted as recurrent
Major Depressive Disorder
shares many of the symptoms of major depressive disorder but differs in its course. There may be fewer symptoms but depression remains relatively unchanged over long periods of time, sometimes 20 to 30 years or more.
“Is defined as depressed mood that lasts at least 2 years during which the patient cannot be symptom-free for more than 2 months at a time even though they may
not experience all of the symptoms of a major depressive episode.
Persistent depressive disorder (dysthymia)
the finality of death and its consequences are acknowledged and the individual adjusts to the loss. New, bittersweet, but mostly positive memories of the person that are no longer dominating or interfering with functioning are then
incorporated into memory.
Integrated Grief
Struggles to accept the reality of death, wishes to protest against it. Feeling disconnected from the world. With
somatic distress and pangs of sadness
Complicated Grief:
severe and sometimes incapacitating emotional reactions during the premenstrual period.
Premenstrual Dysphoric Disorder
Used to diagnose children and adolescents who exhibit symptoms usually associated with Bipolar Disorder Not Otherwise Specified. Symptoms include severe irritability or temper tantrums, but no episodes of severe mania.
Disruptive Mood Dysregulation Disorder
Tendency of manic episodes to alternate with Major Depressive episodes in an unending rollercoaster ride from the peaks of elation to the depths of despair.
Bipolar Disorders
major depressive episodes alternate with full manic episodes
Bipolar I Disorder
major depressive episodes alternate with hypomanic episodes instead of full manic episodes.
Bipolar II Disorder:
chronic alteration of mood elevation and depression that does not reach the severity of manic or major depressive episodes.
Cyclothymic Disorder
at least 4 manic or depressive episodes in a year
Rapid Cycling Specifier
Patience cycle between depression and
mania without any break. Associated with higher suicide rates.
Rapid Switching or Rapid Mood Switching:
- Mood disorders are hereditable (as evidenced by twin studies)
- Low levels of serotonin is a cause, but only in relation to other neurotransmitters
like norepinephrine and dopamine. Serotonin’s apparent function is to regulate our emotional reactions - Overactivity in the hypothalamic pituitary-adrenocortical (HPA) axis which
produces stress hormones like cortisol have also been implicated
Causes of Mood Disorders
BIOLOGICAL
- Stressful life events are strongly related to the onset of mood disorders
- [Seligman] Learned helplessness theory of depression: the depressive attributional style is (a) internal, in that the individual attributes negative events to personal failings, (b) stable, in that even after a particular negative event passes, “additional bad things will always be my fault” remains. (c) global, in that attributions extend in a variety of issues.
- [Beck] Depressive Cognitive Triad: negative view of self, world and future
- Although bipolar disorder is equally distributed among males and females, 70% of those with major depressive disorder and dysthymia are women. Source is cultural; men are encouraged to be independent, masterful and assertive while females in contrast are more passive, sensitive and relies on others more than makes do.
Causes of Mood Disorders
PSYCHOLOGICAL
Social support is important in determining
course of mood disorders
Causes of Mood Disorders
SOCIAL
