Developmental Psychology & Psychopathology Part 2 Flashcards
Acute stress disorder
Display of multiple symptoms from any combination of categories following exposure to a traumatic event; is diagnosed when symptoms arise within 1 month of exposure to the stressor and last no longer than 4 weeks
- dissociative symptoms are common
Specific phobia
Unreasonable or irrational fear of specific object or situation
- persistent: > 6 months
Types of phobias
- animal-type: focus on specific animals
- natural environment type: focus in events or situations in the natural environment
- situational type: usually involve a fear of public transportation, tunnels, bridges, elevators, flying, or diving
- blood-injection-injury type: diagnosed in people who fear seeing blood or an injury
Agoraphobia
Fear of places where one might have trouble escaping or getting help if one becomes anxious
Social Anxiety Disorder
People become anxious in social situations and are so afraid of being rejected, judged, or humiliated in public that they are preoccupied with worries to the point that their lives may become focused on avoiding social situations
Panic attacks
Short but intense periods during which one experiences many symptoms of anxiety: heart palpitations, trembling, a feeling of choking, dizziness, intense dread, etc.
Panic disorder
When the panic attacks are more problematic/become common for the person; often caused due to worrying over a potential panic attack
Interoceptive awareness
Heightened awareness of bodily cues
Generalised Anxiety Disorder (GAD)
Uncontrollable worry; anxious all the Tim, in almost all situations, worry about small issues (e.g. being late), as well as larger issues (e.g. career)
Separation Anxiety Disorder (SAD)
Non age-appropriate and excessive anxiety (or anticipation) of going away from home or leaving attachment figures
- one of the most common childhood anxiety disorders
- normative > up to the age of around 3
- excessive worry that caregivers might be harmed
- frequent nightmares about separation
- recurrent physical complaints when not in close proximity to the attachment figures
Obsessive-Compulsive Disorder (OCD)
Diagnosed when either obsessions, compulsions, or both, are present (to a significant degree)
Disorders related to OCD
- hoarding: compulsive behaviour; people are unable to throw away their possessions, even if it has no value (e.g. take-out containers)
- hair-pulling disorder: recurrent pulling out hair, resulting in hair loss (trichotillomania)
- skin-picking disorder: recurrently pick at their skin, creating lesions that might become infected and produce scars
- body dysmorphic disorder: people believe a part of their body is defective; most often the focus is on a part of their face
Stress
When the demands of the individual exceed their available resources
Coping
Regulatory processes that are activated in response to stress
Allostasis
The process of maintaining stability (homeostasis) by active means, namely, by putting out stress hormones and other mediators
Allostatic load
The wear and tear to the body and the brain by use of allostasis, particularly when the mediators are disregulated, ie. not turned off when the stress is over or not turned on adequately when they are needed
Epigenetics
Environmental regulation of gene expression
Positive stress responses
Brief, mild-to-moderate responses, usually with a supportive caregiver
Tolerable stress responses
Atypical stressors that trigger a more widespread and possibly longer-lasting response
Toxic stress responses
Strong, frequent, or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive, adult relationship
‘Families’ of coping strategies
- problem solving
- information seeking
- helplessness
- escape
- self-reliance
- support seeking
- delegation
- social isolation
- accommodation
- negotiation
- submission
- opposition
Maltreatment
Broad category of behaviour, includes physical abuse, sexual abuse, psychological abuse, and neglect; “the gross violation of the rights of a vulnerable and dependent child”
Post-traumatic stress disorder (PTSD)
Experience of trauma and the display of symptoms from each category; diagnosed when symptoms last for longer than one month
Post-traumatic growth
Positive changes following trauma
Fears
Emotional response to a real/perceived imminent threat
Worries
Anticipation of a future threat
Anxiety disorders
Internalising disorders in which anxiety has gone from typical or adaptive to pathological in terms of its intensity, duration, and/or pervasiveness
Anxiety sensitivity
Involves hypervigilance and attention to bodily sensations; a tendency to focus on weak or infrequent sensations, and a disposition to react to somatic sensations with distorted cognitions
Phobic disorders
Excessive and exaggerated fears of particular objects or situations, including intense anxiety and avoidant behaviours; associated with significant impairment
- specific phobias
- social phobia
- agoraphobia
Somatisation
Refers to a variety of processes in which aspects of psychological distress manifest themselves in physical symptoms
Conversion disorder (functional neurological symptom disorder)
Characterised by unexplained deficits in voluntary motor or sensory function that cannot be adequately accounted for by known pathophysiological mechanisms
Homotypic continuity
When a particular psychiatric disorder predicts itself at a later time point
Heterotypic continuity
When a particular psychiatric disorder predicts another disorder at a later time point
Modeling
Treatment based on the impact of observational learning:
- symbolic modeling
- live modeling
- participant modeling
Systematic desensitisation
Teaching an anxious person to relax and how to maintain relaxation when exposed to the feared stimulus
Exposure
Rewarding a child for desired behaviour
Self-talk
Cognitive technique focused on providing positive self-statements (e.g. “I am brave”) to enhance appropriate behaviours
4 Ds
Dysfunction
Distress
Deviance
Danger
Shared characteristics - Anxiety disorders
- excessive fear and anxiety
- related behavioural disturbances (e.g. avoidance)
- not attributable to physiological effects of medication/substances or a medical condition
Differences - Anxiety disorders
- types of feared or avoided objects/situations
- content of associated thoughts or beliefs
DSM-5 Anxiety disorders
- separation anxiety disorder
- selective mutism
- specific phobia
- generalised anxiety disorder
- social anxiety disorder
- panic disorder
- agoraphobia
Typical childhood anxiety disorders
- separation anxiety disorder
- selective mutism
Selective mutism
Child shows consistent failure to speak in specific social situations in which there is an expectation for speaking, despite speaking in other situations
- for at least one month (not the first month of school)
Obsessions
Persistent and recurrent intrusive thoughts, ideas, images, or impulses
Compulsions
Repetitive behaviours, urges, rituals, or mental acts
Anhedonia
Losing interest in everything in life
Persistent depressive disorder
Depressed mood for most of the day, for more days than not, for at least 2 years
- in children and adolescents, 1 year
- 2 to 4 symptoms needed for a diagnosis
Subtypes of Major Depressive Disorder
- with vital characteristics
- with psychotic characteristics
- with catatonic characteristics
- with atypical characteristics
- with postpartum beginning
- with seasonal pattern
Hypomania
Milder episodes & symptoms of mania; found in bipolar II disorder
Cyclothymic disorder
Person alternates between periods of hypomanic symptoms & periods of depressive symptoms, over at least a 2 year period
- symptoms do not meet the criteria for hypomania or a depressive episode
Major Depressive Disorder (MDD)
- one of two come symptoms is present (for more than 2 weeks): depressed mood and/or loss of interests (anhedonia)
- at least 4 other symptoms
- problems with appetite
- problems with sleeping
- agitation or inhibition
- tired, loss of energy
- feelings of worthlessness, self blame
- loss of focus, indecisiveness
- thinking about death
- and significant suffering and/or impairment in social or professional functioning
Personality disorders (DSM-5)
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture
- Part of someone’s character
- Ego syntonic > belonging to the self
- Developmental disorder > usually manifests in early adulthood
- Leads to (severe) dysfunction (suffering for self or others)
3 P’s (personality disorders)
- Pervasive: across situations
- Pathological/problematic: causes suffering and dysfunction
- Persistent: stable since early adulthood
Clusters of personality disorders
a.Strange & bizarre
b.Emotional & impulsive
c.Anxious
Personality disorders: Cluster A
Strange, bizarre, and odd > syndromic counterpart: psychotic disorders
- Paranoia (distrust)
- Schizotypal (delusions, psychotic fear)
- Schizoid (isolation; no desires or affect)
Personality disorders: Cluster B
Emotional > syndromic counterpart: conduct disorders
- Histrionic (attention)
- Narcissistic (superiority)
- Borderline (instability)
- Antisocial (no empathy; criminal)
Personality disorders: Cluster C
Anxious > syndromic counterpart: affective disorders
- Avoidant (evading)
- Dependent (clinging)
- Obsessive-compulsive (rigidity)
The Alternative Model for Personality Disorders
Criterion A: personality functioning
- Levels of Personality Functioning Scale (LPFS)
- Self-functioning: identity and self-direction
- Interpersonal functioning: empathy and intimacy
Criterion B: personality traits
- Personality inventory for the DSM-5 (PID-5)
- 5 trait domains
- Negative affectivity
- Detachment
- Antagonism
- Disinhibition
- Psychoticism
Other criteria: C: inflexibility, D: stability, E: across time, no other explanatory disorder, F: no effects of substances or medical condition, G: not normative behaviour for the person’s developmental stage or sociocultural environment
Treatment options for personality disorders (based on Dutch treatment guidelines)
CBT based:
- Dialectic Behaviour Therapy (DBT)
- Schema-Focused Therapy (SFT)
Psychodynamic based:
- Transference-Focused Psychotherapy (TFP)
- Mentalisation Based Therapy (MBT)
Feeding and eating disorders
Disturbance of eating or eating-related behaviour that results in:
1. the altered consumption food and
2. significantly impaired health and/or functioning
Feeding disorders
- Pica
- Rumination disorder
- Avoidant/restrictive food intake disorder (ARFID)
Eating disorders
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder
Pica
- Persistent (at least one month) eating of non-nutritious, non-food substances
- Unknown prevalence > very rare
- Can occur in typically developing children, but is often comorbid with ASD/IDD
- Can result in medical complications and emergencies
- No age bounds (lower or upper)
Rumination disorder
Persistent (at least one month) regurgitation of food
- Spontaneous
- Food may be re-chewed, re-swallowed, or spit out
Unknown prevalence > rarity
Associated with malnutrition, especially in infancy
Avoidant/restrictive food intake disorder (ARFID)
Lack of interest in food
- May be based on appearance, smell, taste, texture, brand, presentation of the food, or a past negative experience with the food
More than one of the following symptoms:
- Substantial weight loss or failure of expected weight gain (e.g., developmental milestones)
- Nutritional deficiency
- Dependence on a feeding tube or dietary supplements
- Significant psychosocial interference
Unrelated to body image/shape
Very rare > unknown prevalence
Major features of eating disorders
Weight concerns:
- Feeling overweight much of the time (regardless of actual body health/BMI, etc.)
- Viewing one’s weight negatively
Body dissatisfaction:
- Overall distress with one’s appearance
Eating problems
- Restricted eating or dieting
- Lack of control over eating behaviour
Anorexia Nervosa symptoms
- Restriction of energy intake relative to requirements leading to a significantly low body weight
- Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self- evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Anorexia Nervosa subtypes
- Restricting Type: The person does not regularly engage in binge eating.
a. this is a subtype that is typically associated with the stereotypical view of anorexia nervosa. - Binge-Eating/Purging Type: The person regularly engages in binge eating and purging behaviours, such as self-induced vomiting and/or the misuse of laxatives or diuretics.
a.The binge eating/purging subtype is similar to bulimia nervosa; however,
there is no weight-loss criterion for bulimia nervosa.
Severity of Anorexia Nervosa
Based on BMI
- Mild: > 17
- Moderate: 16 - 16.99
- Severe: 15 - 15.99
- Extreme: < 15
Treatment of Anorexia Nervosa
- Restoring the person to a healthy weight
a. Physical tests
b. Refeeding syndrome > if done too fast, individual may die from refeeding efforts - Reducing, or eliminating behaviours or thoughts that originally led to the disordered eating
a. Slow process > at least 6 months to a few years
b. CBT, exposure, etc. - Treating the psychological disorders related to the illness
a. Anxiety, depression, etc.
Binge episode
Eating a large amount of food over a short period of time
- 2000+ calories in <2 hours
A sense of lack of control over the eating
Compensatory behaviour
Inappropriate behaviour that is done in order to prevent weight gain
Classified as ‘purging’ or ‘non-purging’
Purging – removing the ‘substances’ from your body in any way
- Vomiting
- Laxatives
- Diuretics
Non-purging
- Excessive exercising (relative to person)
- Extreme dieting or restrictive dieting
- Fasting
Bulimia Nervosa symptoms
- Recurrent episodes of binge eating
- Recurrent inappropriate compensatory behaviour
- Self-evaluation is unduly influenced by body shape and weight
- The binge eating and inappropriate compensatory behaviours both occur at least once a week for 3 months
- The disturbance does not occur exclusively during episodes of anorexia nervosa
Binge Eating Disorder symptoms
- Recurrent episodes of binge eating
- Binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa
- Marked distress regarding binge eating
- The binge eating occurs at least once a week for 3 months
- Binge eating does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
Severity of Bulimia Nervosa
- Mild: 1-3 episodes of inappropriate compensatory behaviour per week
- Moderate: 4-7 episodes of inappropriate compensatory behaviour per week
- Severe: 8-13 episodes of inappropriate compensatory behaviour per week
- Extreme:14 or more episodes of inappropriate compensatory behaviour per week
Severity of Binge eating disorder
- Mild: 1-3 binge-eating episodes per week
- Moderate: 4-7 binge-eating episodes per week
- Severe: 8-13 binge-eating episodes per week
- Extreme:14 or more binge-eating episodes per week
Treatment of Bulimia Nervosa and Binge eating Disorder
Cognitive Behavioural Therapy
- Break the binge-purge cycle
- Reduce binging and purging behaviours
- Challenge automatic negative thoughts
- Learn adaptive coping strategies
Nutritionists may also help with structured meal plans and exercise regimens
Medication (SSRIs) can help ease impulse control problems and reduce binge eating
Schizophrenia
A chronic mental illness with positive symptoms (delusions, hallucinations, disorganised speech, and behaviour), negative symptoms, and cognitive impairment.
Criterion: two (or more) of the following symptoms need to be present each for a significant portion of time during a 1-month period (at least one symptom must be 1, 2, or 3)
1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms
Psychosis
A collection of symptoms that affect the mind, where there has been some loss of contact with reality
Positive symptoms of schizophrenia
Hallucinations: perceptions without a stimulus
Delusions: fixed false beliefs
- Do not hold within cultural contexts
- Can be bizarre or non-bizarre
Passivity phenomena: someone else is making you do something
Negative symptoms of schizophrenia
- Flat affect
- Anhedonia: lack of pleasure in everyday life
- Avolition: lack of ability to begin and sustain planned activities
- Alogia: speaking little, even when forced to interact
- Social withdrawal
Antisocial Personality Disorder
A pattern of disregarding or violating the rights of others. A person with antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively
Avoidant Personality Disorder
A pattern of extreme shyness, feelings of inadequacy, and extreme sensitivity to criticism. People with avoidant personality disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially inept
Borderline Personality Disorder
A pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity. A person with borderline personality disorder may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger, or have ongoing feelings of emptiness
Dependent Personality Disorder
A pattern of needing to be taken care of and submissive and clingy behavior. People with dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves
Histrionic Personality Disorder
A pattern of excessive emotion and attention-seeking. People with histrionic personality disorder may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated emotions
Narcissistic Personality Disorder
A pattern of need for admiration and lack of empathy for others. A person with narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy
Obsessive-Compulsive Personality Disorder
A pattern of preoccupation with orderliness, perfection and control. A person with obsessive-compulsive personality disorder may be overly focused on details or schedules, may work excessively, not allowing time for leisure or friends, or may be inflexible in their morality and values
Paranoid Personality Disorder
A pattern of being suspicious of others and seeing them as mean or spiteful. People with paranoid personality disorder often assume people will harm or deceive them and don’t confide in others or become close to them
Schizoid Personality Disorder
Being detached from social relationships and expressing little emotion. A person with schizoid personality disorder typically does not seek close relationships, chooses to be alone and seems to not care about praise or criticism from others
Schizotypal Personality Disorder
A pattern of being very uncomfortable in close relationships, having distorted thinking and eccentric behavior. A person with schizotypal personality disorder may have odd beliefs or odd or peculiar behavior or speech or may have excessive social anxiety
Treatment of personality disorders
Commonly used types of psychotherapy include:
- Psychoanalytic/ psychodynamic/ transference-focused therapy
- Dialectical behaviour therapy
- Cognitive behavioural therapy
- Group therapy
-Psychoeducation (teaching the individual and family members about the diagnosis, treatment and ways of coping)
