DSM examples

Question 1

What are phobias?

Answer 1

Excessive or unreasonable fears of objects, places or situations.

The phobic stimulus is avoided or endured with intense anxiety or distress.

Question 2

what is the DSM criteria for a specific phobia?

Answer 2

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

B. The phobic object or situation almost always provokes immediate fear or anxiety.

C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.

D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.

F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

G. The disturbance is not better explained by the symptoms of another mental disorder…

. The disturbance is not better explained by the symptoms of another mental disorder…

Question 3

what are the types of specific phobia?

Answer 3

animal (e.g., spiders, insects, dogs),

natural environment (e.g., heights, storms, water)

blood-injection-injury (e.g., needles, invasive medical procedures).

situational (e.g., airplanes, elevators, enclosed places)

other (e.g., situations that may lead to choking or vomiting).

Question 4

what is the criteria for a social phobia

Answer 4

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.

B. The individual fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated.

C. The social situations almost always provoke fear or anxiety.

D. The social situations are avoided or endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context…

Question 5

what are the types of social phobia

Answer 5

Performance situations (e.g., public speaking)

General (e.g., eating in public)

Question 6

what is the prevelence of phobias

Answer 6

Lifetime prevalence around 12%.

More common in women than men.

Most patients with specific phobia have at least one other excessive specific fear.

Most patients with social phobia suffer from one or more additional anxiety disorders.

Question 7

what are the psychodynamic theories of phobias

Answer 7

Freud (1909): Phobias result when unconscious anxiety is displaced onto a neutral or symbolic object.

Hans’ Oedipal fears of his father – or perhaps of his desire to kill his father – became unbearable and were displaced onto horses

Question 8

what are behavioural theories of phobias

Answer 8

Phobias are conditioned fear responses.

Ost and Hugdahl (1981): 58% of phobic clients cited traumatic conditioning experiences as the source of phobia.

McCabe et al. (2003): 92% socially phobic adults reported a history of severe childhood teasing (cf. 35% OCD sufferers).

Vicarious classical conditioning. Rhesus monkey expts.

Question 9

outline a biological explanation of phobias

Answer 9

Prepared learning: Primates seem evolutionarily prepared to rapidly associate certain objects with frightening or unpleasant events.

Prepared fears are not innate but easily acquired and resistant to extinction.

Ohman et al: Fear conditioned more effectively to snakes and spiders than flowers and mushrooms.

Question 10

give two types of therapy for phobias

Answer 10

Treatment: Exposure Therapy
Toy bug on table in corner of room; gradually approach (10)
Graphic close-up photos of cockroaches (20)
Watching the bug scene in “Temple of Doom” (30)
Hold toy bug in hand (35)
Dead cockroach in glass case; gradually approach (50)
Dead cockroach on table; gradually approach (60)
Live cockroach in glass case; gradually approach (70)
Live cockroach in open glass case; gradually approach (80)
Hold live cockroach in your hand (100)

Treatment: CBT:
Social phobia associated with cognitive distortions, e.g., tendency to interpret ambiguous social info in a negative manner.

CBT effective for social phobia.

Question 11

what does phobia, pilia and paraphilias mean?

Answer 11

Phobia (fear, aversion)  Philia (attraction)

Paraphilias- Unusual sexual interests

Question 12

what are qualities of a paraphilia

Answer 12

Compulsive quality

• Vary in severity
• Mainly male – female paraphiliacs are rare

Paraphilias involve a (sometimes exclusive) focus on a specific object, act or situation for sexual gratification. Need not cause harm

Question 13

what is a paraphillic disorder

Answer 13

Paraphilic disorders: atypical sexual activities/preferences that cause harm to the individual or others.

Question 14

outline fetishism

Answer 14

Sexual arousal from use of nonliving objects or a highly specific focus on nongenital body parts
Common fetishes: 
Shoes 
• Stockings 
• Feet 
• Rubber products 
• Fur garments 
• Underwear 
hair

Question 15

Paraphilias Fetishistic Disorder

Answer 15

A. Over a period of at least six months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviours.

B. The fantasies, sexual urges, or behaviours cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., a vibrator).

Question 16

Outline Voyeurism

Answer 16

• Observing an unsuspecting individual undressing, naked or engaged in sex
• Risk associated with “peeping” is necessary for arousal

Question 17

Outline Exhibitionism

Answer 17

• Element of thrill and risk are necessary for sexual arousal. Derives pleasure by exposing oneself to others.
• Masturbation occurs either during exposure or shortly after

Question 18

Outline Frotteurism

Answer 18

• Involves deriving pleasure from touching a nonconsenting person
May rub penis against woman’s thighs, may fondle breasts or genitals
• Typically occurs in crowded public places, elevators, trains, buses, etc.
• Normally frotteurs tend to be shy, sexually inexperienced and afraid of rejection

Question 19

outline Transvestic Fetishism

Answer 19

• Person is sexually aroused while cross-dressing
• Man will wear women’s underwear or full clothing
• Male still regards himself as a male.
• Is usually heterosexual and family oriented

Question 20

Outline Sadism/Masochism

Answer 20

Sadism: Inflicting pain or humiliation to attain sexual arousal

Masochism: Suffer pain or humiliation to attain sexual gratification

Activities: blindfolding, restraint, whipping, urination, defecation, etc.

Question 21

What is Paedophilic Disorder

Answer 21

A. Over at least 6 months, recurrent, intense, sexually arousing fantasies, sexual urges, or behaviours involving sexual activity with a prepubescent child or children

B. The person has acted on these urges, or urges or fantasies cause distress or interpersonal difficulties

C. The person is at least 16 and at least 5 years older than child

Question 22

Outline treatment of paraphilias

Answer 22

Modify patterns of sexual arousal/attraction (e.g., aversion therapy)

Modify cognitions and social skills

Reduce sexual drive (e.g., SSRIs, castration)

Question 23

Outline OCD

Answer 23

Occurrence of unwanted and intrusive obsessive thoughts or distressing images

Compulsive behaviours performed to neutralise the obsessive thoughts or images or to prevent some dreaded event or situation

Obsessive-Compulsive Disorder (OCD)

Occurrence of unwanted and intrusive obsessive thoughts or distressing images

Compulsive behaviours performed to neutralise the obsessive thoughts or images or to prevent some dreaded event or situation

Question 24

What does a person with OCD Feel?

Answer 24

Driven to perform a compulsive ritualistic behaviour in response to an obsession
The need to follow very rigid rules regarding how the compulsive behaviour should be performed

Question 25

How do the DSM define it?

Answer 25

Recurrent and persistent thoughts, impulses or images that are experienced as intrusive, disturbing, inappropriate and uncontrollable.

Person attempts to resist, suppress or neutralise them with some other thought or action

Person recognises they are a product of his or her own mind

Question 26

give some frequent types of obsessions

Answer 26

Contamination 
Frequent types
Repeated doubts
Ordering
Aggressive or blasphemous impulses
to shout an obscenity in church to hurt a loved one 
Sexual thoughts and imagery
a recurrent pornographic image
(…that violates one’s morals or runs counter to one’s sexual preferences)

Question 27

DSM compulsion definition

Answer 27

Repetitive behaviours or mental acts the person feels driven to perform in response to an obsession, or according to rigid rules
Behaviours or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation
Not to provide pleasure and/or gratification
Behaviours are excessive or not realistically connected to what they are intended to prevent.

Question 28

outline some behaviours that are compulsions

Answer 28

behaviours:
Hand washing Ordering Checking Cleaning Repeating Hoarding

Acts:
Counting Praying Saying words silently Thinking good thoughts to undo bad thoughts

The person with OCD feels compelled to perform acts repeatedly that often seem pointless and absurd even to them and that they in some sense don’t want to perform

Rituals in eating and dressing
Washing rituals: •Washing hands for about 20 minutes after using the toilet

•Washing hands for hours with disinfectants up to the point of bleeding

Checking: •All the lights, appliances, and locks two or three times before leaving the house

•Going back to a junction where one thinks one may have run over a pedestrian and spending hours checking for any sign of the imagined accident

Question 29

what si the DSM criteria for OD

Answer 29

A. Either Obsessions or Compulsions

B. Obsessions or compulsions are timeconsuming (>1hr/day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C. The O-C symptoms are not attributable to the physiological effects of a substance or another medical condition

D. Disturbance is not better explained by the symptoms of another mental disorder

Question 30

what is an insight specifier?

Answer 30

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. …many

With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true. …some

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. …<4%

Question 31

what are the prevelence of OCD?

Answer 31

Usually begins in late adolescence or early adulthood

Estimated UK prevalence 1-2% of general pop.

Equally common in men and women

In childhood onset the disorder is more common in boys than in girls

At least 50% of sufferers have at least one other psychological disorder

Themes of sexuality, exactness and symmetry more common in men; contamination & cleaning more so in women

Culture may influence the themes of obsessions and compulsions.

E.g., religious obsessions and compulsions more common in cultures that emphasise the importance of religious observance

Question 32

what causes OCD

Answer 32

Unwanted cognitive intrusions are experienced by most people.
(i.e., unpleasant thoughts, images, and impulses that intrude into consciousness)
These intrusions typically have similar contents to clinical obsessions.
BUT it is the Apprasisal or thoughts about the thought that are critical
Misappraisals are due to dysfunctional beliefs, e.g., beliefs about:
(1) inflated personal responsibility over one’s own and other’s safety.
(2) thought-action-fusion (TAF): (1) thinking about an unacceptable or disturbing event makes it more likely to happen. (2) obsessional thoughts are morally equivalent to forbidden actions.
(3) excessive concerns about the importance of controlling one’s thoughts.
The strength of such beliefs affects the risk that a person will develop obsessions and compulsions

Intrusive thought Stabbing one’s child with a carving knife +Dysfunctional belief Thinking of something = having done it=Distress

Question 33

give the psyholgical studies looking into dysfunctional beliefs and OCD

Answer 33

Tolin et al. (2003, 2008): dysfunctional beliefs were associated with OCD symptoms in both clinical and nonclinical samples.
Abramowitz et al. (2006): A prospective study. Scores on a measure of dysfunctional beliefs predicted the later development of obsessions and compulsions.

Question 34

Outline the supression argument for OCD

Answer 34

Distress motivates attempts at suppression

If thought suppression works, it should leave no vestige of the unwanted thought at all.

Try to pose for yourself this task: not to think of a polar bear, and you will see that the cursed thing will come to mind every minute
Wegner et al. (1987): white bear study.
Texan undergraduates.
5-minute suppression session, participants had to ring a bell each time a white bear came to mind.

PPTS thought about bear more than once/ min

Question 35

what is post supression rebound

Answer 35

Post supression rebound :

After suppression task subjects asked to think about the white bear for 5-mins.

These subjects signaled more white bear thoughts than controls who were asked to think about a white bear from the outset.

Paradoxical rebound effect: attempts to suppress thoughts can “rebound” and result in an increased occurrence of the thoughts.

Question 36

outline how thought supression is involved with OCD

Answer 36

Thought suppression attempts result in more rather than less intrusions.

This paradoxical effect of thought suppression may result in full blown obsessions.

There is some evidence that OCD symptoms are associated with a general failure of suppression.

Paradoxical rebound effects may be stronger for patients with OCD.

E.g., Tolin et al. (2002): Participants pressed one button for a word (e.g, “HOUSE”) and a different key for a non-word (e.g., “JWOSE”).

Words: BEAR, VINE, CURB, SCAR, GOWN Non-words: REKM, BLOY, NOFE, POSC, WATI.

“In this experiment, you will be asked to suppress all thoughts of a bear. Do not allow a thought of a bear to enter your mind, and if the thought should come into your mind, please remove it from your mind immediately. Between trials, the computer will remind you to suppress the thought. When you see this, it is very important that you suppress all thoughts of a bear.”

OCD patients showed faster responses to the word BEAR than to other words. This effect was not seen in controls.

Question 37

how does distress produce compulsions?

Answer 37

Attempts to prevent any harmful consequences

(e.g., by avoiding knives and continually asking other people to check on the safety of the child).

Compulsive rituals develop as efforts to remove intrusions and to prevent any perceived harmful consequences.

Compulsions become persistent and excessive because they are negatively reinforced by immediate distress reduction and by the temporary removal of the unwanted thought

Compulsions also prevent people with OCD from learning that their appraisals are unrealistic

(e.g., the affected individual fails to learn that unwanted harm-related images do not lead to acts of harm).

Finally, compulsions can strengthen dysfunctional beliefs about responsibility.

The absence of the feared consequence after performing the compulsion reinforces the belief that the person is responsible for removing the threat

Question 38

what is the cognitive behavioural model of OCD?

Answer 38

intrusive though or image –> misappraisal as important/threatening -> distress –> attempts to supress thought and consequences -> distress reduction –> maladaptive core beliefs

Question 39

Outline CBT treatment for OCD

Answer 39

Exposure and response prevention
Expose the individual to the triggering stimuli (obsession) and block the neutralising behaviour (compulsion)

Exposure Systematic, repeated, and prolonged confrontation with stimuli that provoke anxiety and the urge to perform compulsive rituals.

Response Prevention Person refrains from performing compulsive rituals

The individual learns:
• Anxiety is temporary
• The feared catastrophic consequence never transpires
• Their interpretation of the obsession weakens
• Obsessional thoughts are harmless

Question 40

give an example ofexposure hierarchy for a compulsive washer

Answer 40

Session 1: Walk with therapist through the building touching doorknobs, holding each for several minutes
• Session 2: Repeat above and add contact with sweat by having patient touch armpit and inside of shoe
• Session 3: Repeat above but introduce having patient touch toilet seats
• Session 4: Repeat above but introduce urine by having patient hold a paper towel dampened in her own urine
• Session 5: Repeat above but introduce fecal material by having patient hold toilet paper lightly soiled with her own fecal material
• Sessions 6-15: Daily exposure to the three most fearprovoking activities are repeated.

Question 41

outline CBT effectiveness

Answer 41

RCTs have demonstrated that exposure and response prevention (E/RP) is more effective than other forms of psychotherapy and placebos.
Meta-analyses reveal large effect sizes.
However, E/RP provokes anxiety in patients: approx. 25% drop out of treatment.
For patients who undergo E/RP, effects often last at least 2 years.
CBT also involves challenging the moralistic thoughts and excessive sense of responsibility