Disorders Flashcards
What are the goals of compulsions
to reduce anxiety or prevent an undesirable situation from happening. Often excessive and not connected in a realistic way to the goal.
Mean age of onset for specific phobia is
10 years old
Most common comorbid disorders with OCD
Anxiety disorders followed by depressive or bipolar disorder, impulse control disorder, and substance use disorder
How long must sxs last for a diagnosis of Separation Anxiety Disorder for children & adolescents and for adults
at least 4 weeks in children and adolescents, at least 6 months in adults
Most prevalent mental disorders worldwide
Anxiety Disorders
_____% of people with OCD have co-morbid disorders
90
Specifiers for specific phobia include
Animal, natural environment (lighting, heights), blood-injection-injury (seeing blood, having invasive medical procedure), situational (bridges, elevators), other (vomiting, choking, catching illness)
Why is combining in vivo exposure with relaxation or cognitive techniques not really effective in significantly improving outcomes for treatment of Agoraphobia
Because the person needs to be exposed and learn to tolerate high levels of fear or anxiety
Lower than normal levels of _______ and elevated activity in _______ ______ ___________ and _________ are linked to OCD
Serotonin; caudate nucleus, orbitofrontal cortex, cingulate gyrus, and thalamus
Deliberately exposing a person to physical sxs associated with panic attacks including having the person run, spin in circle, breath through a straw
interoceptive exposure to treat panic attacks
Used as a treatment for blood-infection-injury phobias
Applied tension—repeatedly tensing and relaxing the body’s large muscle groups to increase pressure and prevent fainting
Mowrer’s 2 Factor Theory explains that the development of phobias is a combination of
Classical conditioning and Operant conditioning
What are treatments for Phobias
Exposure and Response Prevention, flooding, graded/graduated exposure
Repetitive bxs or mental acts that a person feels the drive to perform. Rigid rules typically apply
Compulsions
Preoccupation with a perceived defect or flaw in physical appearance which isn’t observable or appears minor to others
Body Dysmorphic Disorder
Sxs of Agoraphobia must be persistent for at least __________ months
6
First line treatment for Social Anxiety are
CBT and Antidepressants (SSRI and SNRI)
Hyperthyroidism, cardiac arrhythmia, and other conditions should be ruled out before diagnosing this disorder
Panic Disorder
___________ have earlier age of onset for OCD and slightly higher prevalence rates in childhood
males
3 reasons why a person fears or avoids situations when they have agoraphobia
fear that escape will be difficult, that help with be unavailable, fear that it will be embarrassing
Combined ERP and __________ is most effective in circumstances when issues are severe, to help with comorbid sxs, and when treatments haven’t been effective individually
SSRI
Fear or anxiety reactions to at least one social situation in which someone could be exposed to scrutiny
Social Anxiety
Recurrent, unexpected panic attacks with at least one attack being followed by at least _________ month(s) of persistent concern about having an additional attack or maladaptive change in bx related to the attack
1 Month (Panic Disorder)
_________ Conditioning is when a previously neutral object/event becomes a conditioned stimulus and elicits a conditioned response after being paired with an unconditioned stimulus
Classical conditioning
A sxs of this disorder is Delusion of Reference. What is the Disorder and what are delusions of reference?
Body Dysmorphic Disorder; believing others are mocking or taking special notice of physical appearance
Effectiveness of treatment (CBT) for Separation Anxiety Disorder in children is increased by what other intervention
Parent training
Recurrent and persistent thoughts, urges, or images that are intrusive or unwanted
obsessions
Developmentally inappropriate and excessive fear or anxiety about being away from attachment figures
Separation Anxiety Disorder
Specific Phobia is twice as common for ______
girls
________ Conditioning to described the development of a specific phobia and happens when a person learns that avoiding conditioned stimulus allows them to avoid anxiety. So, person’s avoidance bx is negatively reinforced and the conditioned response is not extinguished because the person never has the opportunity to experience the conditioned stimulus without the unconditioned stimulus
Operant Conditioning
Marked fear of anxiety that occurs in at least 2/5 situations:
using public transit
being in open spaces
being in enclosed spaces
standing in line or being in a crowd
being outside the home alone
Agoraphobia
2 Types of Exposure
In vivo and Imaginal (in vivo may be more effective than imaginal and therapist led exposure may be more effective than client led).
Person may perform repetitive bxs such as mirror checking and skin picking with this disorder
Body Dysmorphic Disorder
_________ have slightly higher prevalence rates of OCD in adulthood
Females
____________ and ______________ have been found useful for alleviating panic attacks but are associated with high relapse rates when used alone
Antidepressants and benzidiazepines
Criteria for Specific Phobia
Fear/Anxiety must be out of proportion to actual danger, must be persistent (usually lasting at least 6 months), must cause significant distress or impairment
First line treatment for Agoraphobia
Exposure and Response Prevention
Intense fear or anxiety about a specific object or situation accompanied by avoiding it or enduring it with intense distress
Specific Phobia
Virtual reality exposures may be as effective as in vivo exposures especially for what types of phobias
acrophobia-fear of heights and fear of flying
Preferred treatment for Separation Anxiety Disorder
CBT including psychoeducation, exposure, relaxation techniques and cognitive restructuring
First line treatment for OCD
Exposure and response prevention
Fear or anxiety related to social anxiety must be excessive for the threat or situation, cause significant distress, and avoidance must be persistent for at least how long
6 months
Persistent eating of non-nutritive, non-food substances
Pica
How long must sxs persist for a diagnosis of Pica
1 month
Pica is most common among which populations
kids and pregnant women
What must be present for a diagnosis of Anorexia Nervosa
-Intense fear of gaining weight/becoming fat or engaging in bxs that interfere with weight gain
-Self-evaluations are unduly influenced by weight/shape and lack of awareness about the seriousness of low weight
Specifiers for type of Anorexia
restricting or binge eating/purging types
Severity of Anorexia is determined by what
BMI
Anorexia often co-occurs with what other diagnoses
Depression and Anxiety. Anxiety often precedes Anorexia
Why is Anorexia difficult to treat
Denial of problem and resistance to change
In the short term, the prognosis for Anorexia tends to be _________ than the prognosis for Bulimia. But this changes in the long term.
poorer; over time the prognosis becomes similar to Bulimia
Research supported treatments for Anorexia include
CBT for anorexia
CBT-E (enhanced CBT)
FBT (family based treatment)
Pharmacology
Outpatient treatment for Anorexia and Bulimia that includes parents.
FBT (Family Based Treatment)
What is a post hospitalization intervention that’s based on the assumption that shape and weight concerns engender dietary restriction and extreme methods of weight control. It uses behavioral strategies to establish regular eating patters and eliminate body checking. It uses cognitive strategies to identify and replace problematic thinking and enhance motivation.
CBT for Anorexia
Transdiagnostic treatment that proposes eating disorders share same core psychopathology—excessive value given to physical appearance and weight. It’s personalized, flexible, and focusus on the factors that are maintaining patient’s sxs.
CBT-E (Enhanced CBT)
What are compensatory bxs related to Bulimia?
vomiting, excessive exercise (things done to prevent weight gain)
There are inconsistent findings about the use of pharmacotherapy to treat Anorexia. Still, some say the antipsychotic drug Olanzapine and the SSRI Fluoxetine are useful for what?
Olanzapine: fostering initial weight gain; Fluoxetine: improving weight maintenance
For a diagnosis of Bulimia, binge eating and compensatory bx must occur at least ___ times per week for at least _____ months
1 x/week for at at least 3 months
Severity of Bulimia is based on what?
The average number of episodes of inappropriate compensatory bx per week
Bulimia frequently is comorbid what what disorders
Depression and/or Anxiety ; Anxiety frequently precedes the dx
Recurrent episodes of binge eating that are accompanied by a sense of lack of control, inappropriate compensatory behavior to prevent weight gain, and self-evaluation that’s excessively influenced by body shape and weight
Bulimia Nervosa
Most people with this disorder are within the normal weight range, overweight or obese
Binge Eating Disorder
Purging can cause
dental erosion and gastroesophageal reflux, dehydration, heart arrhythmias, and death
Research supported treatments for Bulimia include
CBT*
CBT-E*
IPT (interpersonal therapy)
FBT (Family Based Treatment)
* = preferred treatment (takes less time than IPT)
Family Based Treatment for this eating disorder tends to be more collaborative because clients are more motivated to change and see their sxs and ego-dystonic
Bulimia
Which drug treatment has been found effective for alleviating comorbid Depression and for reducing binge eating and purging in patients without Depression
SSRI (especially fluoxetine)
When is comes to Bulimia, some research has found that combined treatment (medication and CBT) is more effective than medication alone. Other studies have found that combined treatment (CBT and medication) is no more effective than _________ alone
CBT is found to be very effective, even without medication
Most effective version of CBT for patients with Bulimia
CBT-E
What are the 4 stages of CBT-E
Stage 1: engaging patients in treatment and developing formulation of what is maintaining problem (bxs, feelings, thoughts, events, etc.)
Stage 2: reviewing progress, identifying new problems, and updating formulation
Stage 3: identifying triggers and addressing patient’s over-evaluation of shape and weight. Addressing perfectionism, low self-esteem, and interpersonal problems
Stage 4: reducing relapse and identifying ways to maintain progress
As far as treatment for Bulimia, does telepsychology and in person treatment yield same results?
Yes. However, those in face to face treatment abstained from purging slightly more and had greater reduction in eating -disordered cognitions than those doing telepsychology
Who is more distressed by their sxs, those with Anorexia or those with Bulimia?
Those with Bulimia are more distressed by sxs and have more autonomous (intrinsic) motivation to reduce sxs which predicts a greater reduction in sxs
What is the diagnostic criteria for Binge-Eating Disorder/ Sxs of Binge Eating Disorder?
Requires recurrent episodes of bing eating that involves eating an amount of food that is larger than what most people would eat during similar period of time and a lack of control over eating during episodes. Also, other sxs including eating more rapidly than usual, eating until uncomfortably full, eating large amounts when not feeling hungry, feeling alone due to embarrassment about binge eating, feeling disgusted, depressed, or very guilty about binge eating
Binge eating episodes must occur on average at least ____ times per week and at least _____ months
1 x week ; 3 months
Severity (mild, moderate, severe, extreme) for Binge Eating Disorder is determined by what?
Number of binge episodes per week
Binge Eating is how many more times common in women than men?
2-3 x more common in women
People with this disorder tend to be of normal weight, overweight, or obese
Binge Eating Disorder
Who tends to have a better response to treatment, those with Bulimia or those with Binge Eating Disorder?
Those with Binge Eating Disorder because they do not engage in compensatory behaviors
Evidenced based treatments of Binge Eating Disorder are
CBT-E
IPT (interpersonal therapy)
Some studies have found CBT-E to be more effective
True of False: Medication alone is less effective than CBT and Medication to treat Binge Eating Disorder?
True
Repeated voiding of urine into the bed or clothing
Enuresis
For a diagnosis of Enuresis, must urinate in bed or clothes at least _____ times per week for at least _____ consecutive months
Must pee in bed/clothes at least 2 times per week for at least 3 consecutive months
For a diagnosis of the Elimination Disorder Enuresis, the person must be at least _____ years old or at the equivalent developmental level
5 years old