Exam 1 Reading Guides

Question 1

How do the authors differentiate between a syndrome, disorder, and disease?
What category do psychiatric diagnoses predominantly fall into?

Answer 1

These 3 concepts are distinguished by our level of understanding of their pathology (physiological causes/effects) and etiology (causation/origin)
Most psychiatric disorders are considered syndromes (disorders in rare cases)

Question 2

Syndrome

Answer 2

Constellation of signs (observations) and symptoms (reported experiences) that seem to co-occur but their pathology and etiology are not well understood

Question 3

What are the 3 primary functions of psychiatric diagnosis?
According to Robins and Guze (1970), what types of surplus information does a valid diagnosis offer?

Answer 3

• Summarize distinctive features and allow for more clear communication of problems
• Places a patient’s problems within the context of related diagnoses (organized in categories)
• Offers researchers surplus information about clinical descriptions (symptomatology, demographics, etc.), laboratory research, natural history, and family history

Question 4

Why does Szasz (1960) believe that mental illnesses are myths (Misconception #1)? Why are they invalid (Misconception #4)?

Answer 4

He believed they were only attributed to societal nonconformists that “jeopardize the status quo” and that treatment is only aimed at forcing them to comply with social norms
He also thought they were invalid because they didn’t provide us with any new information, making them useless labels for behaviors we don’t like

Question 5

What evidence led Rosenhan (1973) to conclude that psychiatric labels obstruct people’s ability to differentiate between illness and normality?

Answer 5

When posing as a pseudopatient, he noted that the staff often interpreted unrelated behaviors or parts of their life histories as being consistent with their “illnesses” despite showing no other symptoms

Question 6

What evidence do the authors use to refute the criticism that psychiatric diagnoses engender stigma (in other words, challenge Rosenhan’s findings)?

Answer 6

The pseudopatients in Rosenhan’s study were deemed as in remission or showing no signs of illness (a rare judgment for psychotic patients), meaning staff were able to distinguish normal from abnormal behavior
Studies also show that correct diagnoses may actually decrease stigma by providing a partial explanation for behavior

Question 7

What is the biological model, as defined by Kendell (1975)?
What counterexamples do the authors provide to this notion?

Answer 7

Says that a disorder is something that leads to a biological or evolutionary disadvantage for the organism, such as reduced lifespan
BUT:
- a deployed soldier has less longevity
- a priest has less evolutionary fitness
- phobias are uncorrelated with longevity

Question 8

What are the major tenets of the harmful dysfunction account of mental illness?
In what ways do the authors challenge the logic of the harmful dysfunction account?

Answer 8

Disorders are harmful dysfunctions, meaning they are socially devalued and characterized by a breakdown in some biological or evolutionary system
BUT:
- many medical disorders are adaptive defenses against threats (like the flu)

Question 9

What is a Roschian construct and how does it pertain to the notion of mental illness?

Answer 9

Mental disorders lack defining features and have naturally fuzzy boundaries, meaning they are undefinable
The idea of mental illness is organized around a prototype, making some more “disorder-like” than others

Question 10

According to the authors, what were 3 main criticisms of the DSM-I and DSM-II?
In what ways did the DSM-III and its successors differ with respect to these shortcomings?
What specific benefits were conferred by these changes?

Answer 10

• Vague descriptions of disorders leads to lots of subjectivity in diagnosis
• Was based on Freudian theories and not widely used by non-psychoanalytic circles
• Didn’t consider context

New versions: more detailed and standardized diagnosis criteria, categorized, hierarchal exclusion rules, agnostic
Benefits: decreased subjectivity of diagnostic decision-making and facilitated scientific progress (not just Freudian use)

Question 11

What is the difference between a polythetic and monothetic approach to diagnosis?
What are the relative strengths and weaknesses of these approaches?

Answer 11

Monothetic: symptoms are individually necessary and altogether sufficient for diagnosis
- disagreement about symptoms leads to disagreement about diagnosis
- stricter but more objective

Polythetic: symptoms are neither necessary nor sufficient
- high interrater reliability
- symptomatic heterogeneity

Question 12

What is comorbidity and why is the application of this term to mental disorders potentially misleading?
Why is extensive comorbidity a problem for a classification system of mental disorders?

Answer 12

More than one diagnosis occurring at the same time
Misleading because people assume it implies overlapping etiology rather than different variants the same underlying condition

Extensive comorbidity leads to diagnostic overshadowing (assuming it’s the more complicated/florid disorder) and gives it a reputation as a less ideal classification system (which should have mutually exclusive categories with little overlap)

Question 13

In what to ways do critics suggest that the DSM-5 has overmedicalized normality?

Answer 13

• Increasing the number of diagnoses, including relatively mild problems and potentially normative behavior
• Lowering the diagnostic thresholds makes it easier for people to meet criteria

Question 14

What is the attenuation paradox and what does this have to do with the DSM’s current approach to diagnosis?

Answer 14

When efforts to achieve higher reliability produce decreases in validity

People are concerned that efforts to create diagnoses with overt and easily agreed-upon symptoms may lead to more internal consistency at the cost of validity

Question 15

What does it mean that the DSM employs a categorical approach to classification?
What evidence is there to support a dimensional approach?
What are the concerns with using a dimensional approach?

Answer 15

Categorical approach = all-or-nothing principle (you have it or not)

Dimensional: differs in degrees (centered around the Big Five)
- evidence suggests that many disorders, especially personality, may be dimensional in nature
- may be more supported statistically
- concerns with clinical feasibility
- personality dimensions may not be sufficient to capture personality pathology (don’t address adaptivity or behavioral manifestations)

Question 16

What is a panic attack in terms of possible symptoms, as well as the number of symptoms needed to meet DSM criteria for a full-blown one?

Answer 16

An abrupt surge of intense fear or discomfort characterized by up to 13 symptoms: pounding heart, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, dizziness, chills, numbness/tingling, fear of going crazy, fear of dying, + derealization/depersonalization

A full-blown panic attack requires at least 4 of these symptoms to be present

Question 17

How is a panic attack different than a panic disorder? In other words, what else needs to be present other than a panic attack for someone to be diagnosed with panic disorder?

Answer 17

Panic disorder must include unexpected panic attacks PLUS at least 1 month of persistent concern about the recurrence of panic OR significant maladaptive behavioral change (like avoiding all activities in which one might occur)

Question 18

What is agoraphobia and how does it relate to panic disorder?

Answer 18

Anxiety about situations from which escape might be difficult or help might be unavailable in the event of panic
Fear about public transport, open spaces, enclosed spaces, standing in line, crowds, and/or being in public alone

Considered a separate disorder, but is highly comorbid with panic (not everyone with panic disorder has agoraphobia and vice versa)

Question 19

In general, does panic disorder occur more or less frequently in the US than in other countries?
Other than reflecting true differences in occurrence, what else might account for the different rates of diagnosed cases across countries?

Answer 19

Panic disorder is generally more prevalent in the US than in other countries and has increased over the past two decades

This may reflect differences in diagnostic methodology and criteria rather than occurrence

Question 20

Although panic attacks tend to be similar for children and adolescents, what is the primary differentiating factor, and what may explain this difference?

Answer 20

Adolescents are more likely than children to report a fear of going crazy
This may reflect differences in interpretations of physical symptoms (children tend to have external attributions while adolescents tend to have internal)

Question 21

Panic disorder can lead to agoraphobia in many cases, but this phenomenon is more prevalent in women and those who are unemployed. What might account for this epidemiological difference?

Answer 21

Unemployment: those who are forced to leave their houses to go to work are less likely to have agoraphobia (frequently exposed to public situations)
Gender: societal gender roles may make women less likely to confront fear (avoidance behaviors encouraged)

Question 22

What is interoceptive avoidance?

Answer 22

Sensitivity to and avoidance of the physical manifestations of panic/anxiety (usually by avoiding potential triggers like exercise, sex, scary movies, caffeine, etc.)

Question 23

What are safety behaviors and how can they be differentiated from adaptive coping strategies?
Why might safety behaviors decrease anxiety initially but lead to more chronic anxiety in the long run?

Answer 23

Dysfunctional emotion regulation strategies or behaviors meant to avoid disaster and prevent feared outcomes (by seeking out safety objects, persons, or places)
Different than adaptive coping strategies in that they occur in situations where there is no real threat and the feared outcome is unlikely to occur

These things signal safety to the individual, reducing anxiety in the short term. But in the long term, they may prevent disconfirmation of the catastrophic predictions and/or extinction of the conditioned response

Question 24

What is experiential avoidance and how does it relate to panic disorder?

Answer 24

Avoidance or distraction behaviors (including interoceptive avoidance) used when an individual is unwilling to experience the bodily sensations, thoughts, emotions, or memories associated with anxiety or panic

Maladaptive - may worsen fear among panic disorder patients (it is better to notice and accept symptoms of panic than avoid them)

Question 25

What are the “cognitive features” associated with panic disorder?

Answer 25

- Fear of the bodily sensations that arise from panic attacks, even if they are caused by something else (like exercise) - Respond more intensely to words representing physical threat or catastrophe - Memory and attentional abnormalities - Processing or memory biases towards threat-related information

Question 26

What is neuroticism/negative affectivity and how do they relate to panic disorder? Are these emotional features exclusive to panic? Do you notice a pattern regarding which anxiety disorders seem more or less related to neuroticism/negative affectivity?

Answer 26

Proneness to experience negative emotions in response to stressors/in the absence of stressors - Associated with many anxiety disorders, including (but not limited to) panic - Anxiety that presents in a variety of situations (GAD) is more related to neuroticism than anxiety that presents in limited circumstances (social)

Question 27

Why do you think prediction and control relate to proneness towards anxiety?

Answer 27

If you have a greater sense of prediction (understanding cause-effect) and control (understanding that your actions influence outcomes), you may be less prone to anxiety (in which things may feel unpredictable and out of control)

Question 28

How are early childhood relationships with caregivers relevant to the development of one’s sense of prediction and control? What was Mineka, Gunnar, and Champoux‘s (1986) findings regarding this phenomenon?

Answer 28

When caregivers respond to their child's needs, it gives them a sense of predictability ("if I do this, my parent will respond like this"), which will help them develop a sense of prediction and control (on the other hand, an unresponsive parent may lead to an anxiously attached child) Studies on infant monkeys show that when given more mastery and control over their environment and needs, it can buffer the effects of stressful experiences and lead to more adaptive coping responses

Question 29

Identify how parental overprotectiveness might be a causal factor in the development of panic disorder

Answer 29

Anxious mothers may resort to overprotectiveness, criticism, catastrophizing, and less autonomy granting as a way of soothing their anxiety. This may in turn teach their kids maladaptive coping strategies and poor emotional regulation, leading to anxiety disorders

Question 30

Now assume that there is no causal relationship between panic and overprotective parenting, what might explain why these two variables are correlated with each other?

Answer 30

If a child is shy and anxious, it may compel their parents to be more protective over them (the relationship works the other way around) - Perhaps genetics? Anxiety running in families?

Question 31

How did Schneider et al.’s (2009) study demonstrate that certain behaviors by mothers with panic disorder might be specific to their children’s anxiety status?

Answer 31

"Found that mothers with panic disorder were more verbally controlling and more conflictual with their children, regardless of the children's anxiety status"

Question 32

How did Schwartz et al.’s (2012) findings suggest that certain parental behavior may not be a precursor specific to anxiety?

Answer 32

Demonstrated that higher parental aggression predicted higher adolescent anxiety AND depression (showing that it's not a precursor specific to just anxiety or panic)

Question 33

It is notable that respiratory disease in childhood may be a specific risk for panic disorder over other anxiety disorders (e.g., OCD); why might this be the case? That is, what is it about respiratory problems that might link with panic attacks?

Answer 33

Respiratory abnormalities reflect a state of chronic hyperventilation, which may mean that people with these issues are more prone to shortness of breath characterized by panic attacks

Question 34

The stress-diathesis model posits that neither a life stressor nor a pre-existing vulnerability for a disorder is sufficient cause for a disorder. Rather, both need to be present for problems to develop. How has this model been applied to explain the fact that stressful life events tend to precede panic disorder?

Answer 34

Stressful life events and high anxiety (along with preexisting vulnerabilities) may precede initial panic attacks and contribute to their repeated occurrence, which may eventually develop into panic disorder

Question 35

The experience of panic symptoms is relatively common, yet only a small portion of the population develops panic disorder. Describe why this might be the case with reference to the concept of anxiety sensitivity. How might parental behavior influence anxiety sensitivity and, in turn, the development of panic?

Answer 35

What makes panic disorder different than normal panic symptoms is "fear of fear." That is, people with the belief that anxiety and its physical symptoms are harmful (aka anxiety sensitivity) are more prone to P.D. Parents who model or encourage fearful or distressing responses to anxiety symptoms may instill anxiety sensitivity in their kids, making them more prone to P.D.

Question 36

Briefly describe Eysenk’s (1960) model of interoceptive conditioning and what evidence is there to suggest that it overcomes problems with Clark’s (1986, 1988, 1996) cognitive model for panic disorder?

Answer 36

This model suggests that mild physical symptoms of anxiety may become associated with fear, pain, or distress (turning them into conditioned stimuli) This may occur even without conscious awareness of triggering cues, which would explain why some panic attacks lack conscious cognitive appraisal (ex: nocturnal panic), which was a big criticism of Clark's model

Question 37

According to the DSM-V, what is the central feature of GAD?

Answer 37

Excessive worry about various events, activities, or topics occurring on more days than not (i.e., chronic) Other diagnostic criteria: difficulty controlling worry/concentrating, sleep disruption, restlessness, fatigue, irritability Must cause distress and predate the onset of any other condition

Question 38

In what specific ways are cognitions (thoughts) observed in individuals with GAD different than anxiety-related thought observed in other anxiety disorders, such as panic and social phobia?

Answer 38

Worries in GAD appear to be more future-orientated than anxious thoughts observed in other anxiety disorders

Question 39

Do worries in GAD differ in content from worries observed in non-clinical samples? What features differentiate worries found in GAD from normal worries?

Answer 39

No, worries found in GAD are indistinguishable from worries in non-clinical samples. However, those with GAD experience them with greater intensity and frequency. They also have a perceived inability to control worry

Question 40

What changes were made to the GAD diagnosis in the DSM-III-R and why was this important?

Answer 40

GAD was considered more of a "residual category" with low diagnostic reliability Changes that were made to address these issues included making worry the central feature, increasing the duration from at least 1 month to at least 6, allowing it to be diagnosed in the presence of another disorder

Question 41

What types of life impairment are associated with GAD?

Answer 41

Difficulty with social relationships (especially romantic ones), higher work absences, more health care visits, lower life satisfaction/self-esteem, high rates of relapsing symptoms

Question 42

How did Blazer, Hughes, and George (1987) define a stressful life event and what did they find with respect to their associations with GAD?

Answer 42

An unexpected, negative, and very important life event They're associated with an increased risk of developing GAD (and relapsing if previously remitted)

Question 43

Data suggest that those with GAD have similar problem-solving abilities as those without GAD. In what ways do the problem-solving orientation in GAD differ from normal controls with respect to: (a) negative problem orientation, (b) time management behaviors (inclusive of structure and purpose), and (c) responses to chronic worry?

Answer 43

A) GAD = high negative problem orientation (low confidence about one's ability to problem-solve) B) worry has a negative relationship with time structure and purpose (meaning those with GAD are less present-focused and don't believe that they're using their time for a purpose) C) GAD = great use of worry and self-punishment to cope, as well as less use of distractions and social control strategies

Question 44

Define probability overestimation and catastrophizing as they relate to GAD

Answer 44

GAD = cognitive errors like... Probability overestimation: thinking a feared consequence is more likely to happen than it actually is Catastrophizing: assuming your outcomes will be less manageable than they actually end up being

Question 45

What is the basic premise of the cognitive avoidance theory of worry? How is this theory supported by findings on (a) the verbal nature of worry and (b) worry as distraction?

Answer 45

Worry is an attempt at cognitive avoidance meant to cope with a perceived threat by distracting individuals from the experience of fear A) worry is primarily a verbal activity because imagining fear material would produce more feelings of anxiety than simply recounting it out loud B) Use of worry to distract oneself from emotional topics and avoid confronting deep emotions + anxiety-provoking images

Question 46

What is Newman and Llera’s (2011) extension to the cognitive avoidance theory? According to them, what might be reinforcing about worry?

Answer 46

Worry isn't used to avoid negative emotional experiences, it's used to avoid negative contrast (sharp increases in negative emotions) by preparing the individual for negative events It's a cycle of reinforcement: relief is heightened when the anticipated negative outcome doesn't occur

Question 47

What family and parenting factors have been associated with the development of GAD?

Answer 47

GAD symptoms may be associated with: unpleasant, negative, and rejecting family environments; parental alienation and rejection; insecure parental attachments; and interpersonal problems in general

Question 48

What are the diagnostic criteria for Social Anxiety Disorder (SAD)? Be sure to include criteria A through G.

Answer 48

A) marked fear about one or more social situations in which the individual is exposed to possible scrutiny by others B) fears that they will act in a humiliating or embarrassing way C) social situations almost always evoke anxiety D) social situations are avoided or endured with great distress E) fear is out of proportion to the threat F) lasted 6 months or more G) cause impairment in functioning

Question 49

What is Alden and Taylor’s (2004) notion of a “self-perpetuating interpersonal cycle” with reference to SAD? Identify the two most salient ways in which socially anxious individuals exert “pull” on other people.

Answer 49

Socially anxious people go into social situations with the expectation that they'll be negatively evaluated, so they behave in ways that maintain those assumptions (unintentionally) "Pulling" other people can refer to: 1- safety behaviors, intended to prevent feared outcomes, backfire 2- emotionally distancing themself from others and doing less self-disclosure

Question 50

In what specific ways does SAD impact affected individuals in the work place?

Answer 50

- reduced income, unemployment, or underemployment - poorly rated job performance and productivity - turning down job offers/promotions or giving up on career goals

Question 51

What is one reason why SAD may appear less prevalent in Asian versus Caucasian samples? What shift in diagnostic criteria within the DSM-5 may impact this apparent difference?

Answer 51

- lack of consideration for cultural and racial differences in the diagnostic criteria - a newly added potential criteria is "fear of offending others", which may take into account unique variants of SAD such as TKS (fear of embarrassing another person), which is common in Asia

Question 52

What is one potential reason why men tend to outnumber women in clinical (i.e., treatment-seeking) samples, despite the fact that women are likelier to develop SAD?

Answer 52

Cultural or societal norms about behavior differ for men and women: - men expected to be more outgoing and assertive, meaning the impact of not pursuing treatment may be greater for them socially - on the other hand, it is more acceptable for women to be seen as shy

Question 53

Does SAD typically come before or after alcohol use problems? What function could alcohol use be serving in SAD patients?

Answer 53

- onset of SAD typically predates onset of alcohol dependence - alcohol may serve as a way of reducing anxiety, post-event processing, and feelings of embarrassment

Question 54

According to cognitive-behavioral models (i.e., theories positing that aspects of both our thoughts and behavior are relevant to the development of psychopathology), what are two critical “structures” that maintain social anxiety disorder?

Answer 54

1- the belief that social situations are inherently dangerous or that people are inherently critical 2- behavioral avoidance (+ psychological symptoms)

Question 55

What does Weeks and colleagues (2008) have to say about the core feature of SAD?

Answer 55

The fear of any evaluation (good or bad), which develops out of the belief that social situations are dangerous and critical

Question 56

What findings suggest that individuals with SAD tend to view social interactions as inherently competitive?

Answer 56

- first, they focus their attention on the audience of a social situation, followed by a prediction that they will fall short of their perceived standards - more likely to report that people are inherently critical - engage in negative self-imagery

Question 57

What does Gilbert (2014) and other (e.g., Gilboa-Schechtman et al., 2014) suggest as to why individuals with SAD tend to avoid drawing attention to themselves and work to maintain low social status?

Answer 57

They want to avoid having to engage in (and potentially lose) a conflict in order to defend their higher social status - fear of positive evaluation

Question 58

What are two differences between Rapee and Heimberg’s (1997) and Clark and Wells’ (1995) models of SAD?

Answer 58

Clark and Wells: 1- attention is largely focused on internal symptoms of anxiety 2- subtle avoidance behavior plays the most central role in maintenance Rapee and H: 1- attention is divided between internal focus and an external search for indicators of evaluation 2- maladaptive anxiety management strategies (both subtle + complex) contribute to maintenance

Question 59

What two types of attentional biases are believed to contribute to SAD?

Answer 59

- hypervigilance for detecting threat - difficulty shifting attention away from the threat once its been detected

Question 60

What do the findings of Price, Tone, and Anderson (2011) suggest about attentional bias in SAD?

Answer 60

Attentional bias is not universal across SAD cases + current treatments are aimed only at helping those with a bias towards threat (while those with a bias away from threat fared worse)

Question 61

In what ways does research support the notion that socially anxious individuals approach social situations expecting negative evaluations from others?

Answer 61

- socially anxious individuals tend to be their own worst critics (and thus assume that others will view them the same or worse) - assume that other people are noticing their physical manifestations of anxiety and attributing it to a disorder

Question 62

How is it that individuals with SAD put themselves in a “no-win” situation?

Answer 62

Almost all social situations (regardless of whether they're good, bad, or neutral) are interpreted as negative and costly, thus reducing the quality of the interaction and leading to avoidance

Question 63

There are two ways in which a person can recall visual memories about social events; what are they and which one is predominant in SAD?

Answer 63

There are two perspectives from which visual memories can be recalled: - Field: the memory is recalled from their eyes - Observer: the memory is recalled from the eyes of others (as if viewing oneself on a videotape); this perspective is predominant in SAD

Question 64

What does research suggest about temperament and SAD?

Answer 64

A "behaviorally inhibited" temperament (tendency to display fearfulness, withdrawal, or restraint when faced with unfamiliar stimuli) is a risk factor the development of SAD

Question 65

What are some ways in which parental anxiety may contribute to the development of SAD in children?

Answer 65

- child does not see their parent participating in strong, positive interpersonal relationships - see parents react anxiously (modeling) = learning or imitation - shy parents are less likely to set up playdates for their kids (lack of social experience at a young age)

Question 66

Research suggests that the association between social anxiety and peer victimization is bidirectional – what does that mean?

Answer 66

Peer victimization or neglect is both a predictor and consequence of social anxiety - anxious children are more likely to have negative peer relations, which maintains the social anxiety