Exam 2 Flashcards
Dissociative Disorders
disruption, disconnection of a person’s consciousness/identity
often triggered by trauma
symptoms can be intense, disruptive, dissociative
Dissociative Identity Disorder description
2 or more distinct personality states
disruption of self and interaction with outside world
recurrent gaps in recall of events, personal info, traumatic events
memories do not transfer between identities
usually a sudden dramatic switch between alters
host and alters aren’t always aware of each other
not always distressing, but usually impairing
different areas of brain and physiology involved in different alters
Dissociative Identity Disorder Prevalence
very rare, controversial
culture-bound to North America
alter personalities may be reinforced by culture
greater in females than males
increased suicide rates
possibly caused by childhood trauma (sex abuse)–cope by taking the mind somewhere else
Dissociative Amnesia
inability to recall important autobiographical info (usually of a stressful/traumatic event)
Dissociative Amnesia–localized
amnesia of a specific time period
“amnestic episode”
Dissociative Amnesia–selective
remember some but not all of th event
Dissociative Amnesia–generalized
forget everything
Dissociative Amnesia–continuous
memory problems begin at a specific time and do not stop
Dissociative Amnesia–Systematized
amnesia of a specific category–family, an activity
Dissociative Fugue
Suddenly move away and forget everything form prior life
person assumes a new identity
duration is variable, ends abruptly, usually only happens once
“amnesia on the run”
Depersonalization/Derealization Disorder
recurrent or persistent episodes of one or both
depersonalization–unusual sense of reality, temporarily feels detached from self and surroundings
Derealization–person perceives realty differently (sense of time is off)
Psychodynamic theory of dissociative disorders
extreme use of repression
push memories and events to unconscious
block memories and emotions from conscious
Social/cognitive theory of dissociative disorders
amnesia is a learned response to distracting self from stress, memories, experiences
DID–switching between alters is learned by observation
Biological theory of dissociative disorders
problems are caused by brain dysfunction–structure, metabolic activity, sleep
diathesis-stress theory of dissociative disorder
predisposition to personality traits x extreme stress
treatment for dissociative disorders
DID–integration of personalities, uncover early trauma
dissociative amnesia and fugue = no treatment, typically end abruptly
Somatic Symptom disorder
experience one or more somatic symptom
severe distress and disruption of daily life
excessive thoughts/behaviors related to somatic symptoms
persistent high anxiety, excessive energy/time spent on concern
persistently seek medical advice and not believing diagnoses
fear that serious illness has gone undetected
“hypochondriasis”
Illness-anxiety disorder
preoccupation with health, but DONT have any symptoms
high anxiety about health, easily alarmed
excessive health-related behaviors–research, medical attention OR avoidance behaviors–avoid doctors because so anxious about it
Conversion Disorder
Functional Neurological Disorder
altered sensory or voluntary motor function (one or more)
no identifiable medical cause, not medically plausible (incompatible)
causes distress and/or impairment
usually sudden, related to extreme stress
transfer of extreme emotional stress to physical problem because emotions are too difficult to process
Factitious Disorder (Self)
Munchausen Syndrome
person intentionally produces or pretends to have symptoms
injury, make self sick, headache (can be physiological or psychological)
use deception even without external rewards (more than just getting attention)
the want or feeling of need to be sick
common among people who were often sick as kids or who have a lot of medical knowledge
Factitious Disorder (other)
Munchausen by Proxy
causes harm or pretends someone else is sick
physical or psychological symptoms
use of deception
usually parent to child or to family member
Malingering
fake symptoms, motivated by external rewards or incentives or avoid obligations (NOT DSM disgnosis)
primary gain = avoid guilt with not having to perform a task
secondary gain = avoid something bad
Psychodynamic view of somatic disorders
primary gains = keep internal conflicts repressed
secondary gains = avoid responsibilities and get support
learning theory of somatic disorders
symptoms are reinforcing behaviors
experience symptoms to avoid unpleasant things
benefit to being in the sick role–get care
potential link to OCD
Cognitive theory of somatic disorders
SSD is self-handicapping–blame inadequacies on health
misinterpretation of bodily sensations and distorted thinking
brain theory of somatic disorders
potentially issues with neural connections in conversion disorder
Psychodynamic treatment for somatic disorders
bring unresolved conflicts into conscious awareness and work through them
behavioral treatment for somatic disorders
remove secondary gains (help from others and the ability to avoid unpleasant experiences)
cognitive-behavioral treatment of somatic disorders
cognitive restructuring–change how person thinks of symptoms
exposure with response prevention
Major Depressive Disorder
(5 or more in 2 weeks) depressed mood (children may express as irritable) anhedonia (no enjoyment) sigificant weight loss or gain insomnia/hypersomnia physical agitation or slowness poor concentration thoughts of death or suicide
Seasonal Affective Disorder
depressive disorder that correlates with winter months
must have had 2 episodes of seasonal MDD to be diagnosed
full remission o spring
more prevalent in northeast US
probably linked to light
MDD with Peripartum Onset
Peripartum (during pregnancy)
postpartum (after birth)
affects 3-6% of women
may have psychotic featured–our of touch with reality
can affect how mother cares for self and baby
can affect appetite, sleep, self-esteem, concentration
Persistent Depressive Disorder (Dysthymia)
depressed mood for most of the day, more days of the week
must last 2 years to be diagnosed
2 or more symptoms
disturbed appetite, disturbed sleep, low energy or fatigue, low self-esteem, poor concentration, feelings of hopelessness
Bipolar I
At least one MD episode and a Manic Episode
Manic Episode characteristics
abnormal and persistent
elevated, expansive, or irritable mood AND increased goal-directed activity
must last one week
(at least 3 symptoms) high self esteem, perspective, grandiose, pressured speech (quick), less need for sleep, racing thoughts, highly distractible, excessively involved in dangerous activities
Bipolar II
MD episode and a hypomanic episode (less severe, 4 days)
cannot be diagnosed if patient has had a full manic episode
Cyclothymic Disorder
chronic pattern of mood swings–like Bipolar but less severe)
hypomanic and depressive symptoms, but cannot have had a major depressive, manic, or hypomanic episode
Psychodynamic Theory of mood disorders
depression is due to anger directed inward, loss of attachment figure early in life, or self-focused rumination
bipolar is due to shifting of dominance between ego (mania) and superego (depression)
psychodynamic treatment of mood disorders
explore/identify unconscious issues and ambivalent feelings toward lost objects (early caregivers), identify and acknowledge anger
Interpersonal Psychotherapy (IPT)
brief treatment course (7-12 months) explore relationships (mostly current) and how they affect patient, build conflict resolution skills
humanistic theory of mood disorders
lack of meaning in life, no self-fulfillment, low self esteem
behavior theory of mood disorders
emphasis on environmental and situational influences and how things are reinforced
Lewinsohon (behaviorist theory of mood disorders)
social withdrawal reduces reinforcement opportunities–>lack of reinforcement leads to social withdrawal
loss of comfort with social skills
Coyne interactional theory (behavior) mood disorders
“reciprocal interaction” between behavior and reinforcement
depressed person but others feel pressured because they’re giving too much so they withdraw and then the depressed person gets worse
behavior treatment for mood disorders
help patient develop social and interpersonal skills
increase rewarding activities (difficult for depressed people though)
“behavioral activation”–encourage patient to bee more active
Beck cognitive theory of mood disorders
Cognitive triad of depression: negative views of self, environment, and future
automatic self-statements for each–goal is to identify them, challenge them, and replace them
Burns cognitive theory of mood disorders
Cognitive distortions–inaccurate thoughts
overgeneralizing, should thoughts (should excel at something), magnify bad and minimize good
Learned helplessness–Seligman
situational factors enhance attitudes that lead to depression
loss of sense of control so feel helpless
cognitive treatment for mood disorders
identify, challenge, and modify distorted thoughts, get better at dealing with thoughts instead of feelings
genetic theory of mood disorders
closer the genetic relationship to someone with depression, greater chance of becoming depressed (identical twins often both have MDD)
gene-enviro interactions
Biochemical factors for mood disorders
neurotransmitters (5HT and NE)–meds that work on these can reduce depression
reduced metabolic activity in PFC–executive functioning and adaptation
structural brain abnomalities
Bio treatment for depressive disorders
Tricyclics–3 molecule structure increase NE and 5HT and interfere with reuptake (tons of side effects)
MAO inhibitors so prevent breakdown of NT’s (lots of side effects and interactions with food/alcohol
SSRI’s–inhibits reuptake of 5HT
SNRI–inhibit reuptake of 5HT and NE
Electroconvulsive Therapy
send electro activity through brain to induce controlled seizure
works because reduced brain activity after seizure
Bipolar medications “mood stabalizing”
Lithium–Lico most common, doesn’t work for everyone
Tegretol and Depakote–originally anticonvulsive meds
Suicide
10th leading cause of death in US
2nd leading in college student
women attempt more often, men complete more often
how professionals assess suicide
ideation–thoughts of suicide, not an alarm
Substance intoxication
reversible syndrome due to recent ingestion of a substance–doesn’t last, stops after person stops taking substance
problematic behaviors or psychological changes
different symptoms based on the drug ingested: belligerence, mood change, focus, perception changes, wakefulness/sleepiness, attention
acute short-term intoxication can have different symptoms than long-term
Substance Withdrawal
due to pattern of repeated intoxication from drug
comes from dependence on substance and then sudden reduction of use
Ex: delirium tremens–hand tremors, sweating, pulse, seizures, hallucinations, and nausea are all withdrawal from alcohol
withdrawal is usually related to substance use disorder
urge to take substance again to treat withdrawal symptoms
Substance Use Disorders overview
pathological pattern of behaviors related to substance use
characterized by impaired control (inability to reduce use, life revolves around it)
social impairment (fail responsibilities, relationship issues, stop involvement)
risky use
pharmacological criteria (tolerance and withdrawal)
physiological dependence (withdrawal), psychological dependence (compulsive use, reduce anxiety)
addiction (not DSM term, but describes habitual use)
Pathway to drug dependence
experimentation –> routine use (structure and denial) –> dependence
Alcohol
depressant
most widely used substance
alcoholism is seen as a disease (Disease Model)
risk factors: males more than females (males have an enzyme that breaks it down and females lack it, so they absorb more alcohol), family history, age (20-40), sociodemographic factors (SES, education, living alone), Antisocial personality disorder, ethnicity and culture
Physiological effects of alcohol
heighten activity of GABA (inhibitory) –> relaxation
Psychological effects of alcohol
impaired judgment, increased risk-taking, varies between people because interaction of physiological effects and interpretation
Physical effects of alcohol
alcoholic hepatitis or cirrhosis (liver), increased risk of cancer ot heart disease, Korsakoff’s syndrome (vitamin D deficiency, confusion, disorientation, Long term memory loss)
Barbiturates
depressant sedatives, sleep medications (hypnotics), antianxiety (anxiolytics) very addictive 4x more powerful when used with alcohol mild euphoria, relaxation
Opioids
narcotics (pain relief)
highly addictive
morphine heroine codeine (natural), Demerol, Darvon (synthetic)
act on natural receptor sites in body (endorphin is a natural NT that acts on these sites)
Morphine
narcotic (pain relief) induces feelings of well-being
introduced to US during civil war to treat soldiers
restricted because super addictive
Heroin
narcotic
derived from morphine–developed after civil war to replace morphine
still very addictive
euphoric, powerful depressant (can shut down respiratory system)
most widely used opiate
Amphetamines
synthetic stimulant, euphoric feeling, psychosis
Ecstasy (MDMA)
stimulant
designer drug
euphoria, hallucinations, anxiety, depression, paranoia, psychosis
Cocaine
stimulant
involves reward center by increasing dopamine
can cause anxiety or depression
increased BP and HR
Nicotine
stimulant
increases EPI release so ANS activity increases, HR increases, reduced appetite
Caffeine
stimulant
Hallucinogens (psycedelics)
LSD (expand consciousness, unpredictable trip)
PCP/angel dust (synthetic, developed in 1950’s, delirium, dissociation)
Marijuana (can cause perceptual distortions
Learning theory of substance use
classical conditioning, operant conditioning (withdrawal is negative reinforcement), observational learning (environment)
Cognitive Theory of substance use
what you expect the substance to do
some drugs increase self esteem
Psychodynamic theory of substance use
oral fixation, dependent personality (seeking gratification)
treated by identifying oral problems
sociocultural theory of substance use
environment, norms, culture, peer pressure
physiological treatment for substance use
detox (supervised)
antidepressants (reduce cravings)
antabuse (old drug that isn’t helpful–causes illness when taken with alcohol, so like negative reinforcement)
nicotine replacements
methadone (for heroine, acts like heroine, but doesn’t produce high, but still addictive)
suboxone (used for opioid, blocks effects, but still habit forming)
naltrexone (used for opioids and alcohol, blocked opioid receptors and euphoric feelings)
naloxone (narcan, gets opioids off receptors, antidote)
Psychological treatments for substance use
AA (12 step program, belief of higher power) inpatient (usually for detox, 28 day goal), relapse prevention (learning how to avoid high risk situations and environmental cues, behavior modification, education)
Gambling Disorder
behavior that disrupts obligations, may not cause individual distress but can affect others, tolerance (increase in betting money), restlessness, negative emotions, lies, relationship and job problems
treatment for gambling disorder
harm reduction (learn to limit exposure and make it less problematic), CBT, medication, inpatient, outpatient, group therapy
Anorexia Nervosa
restricting food intake to significantly lower body weight (much lower than normal)
intense fear and anxiety about gaining weight or becoming fat
disturbed body image (don’t see self accurately)
onset usually adolescence
low body weight is seen as an achievement
“extreme control”
Anorexia Nervosa Restricting Type
dieting, fasting, excessive exercise to lose weight
Anorexia Nervosa Binge/Purge type
binge eating followed by purging, use of laxatives or diuretics
different from bulimia because severely underweight
Medical Complications from Anorexia
emaciation, amenorrhea (period stops), anemia, low BP, hypothermia, bradycardia (slowed HR), dry cracked yellow skin, lanugo (hair gets straw-like), enlarged salivary glands, suicide risk
Bulimia Nervosa
binge eating to where its uncomfortable in 2 hour period
vomiting, laxatives, diuretics, fasting and exercise to compensate for weight gain
patients are typically normal weight or under weight
Binge/purge behaviors happen at least once a week for 3 months
self-evaluation focused on body weight
not a distorted body image like anorexia
“lack of control”
Medical risks of bulimia
problems with fluid and electrolyte, tearing of esophagus, gastric rupture, heart irregularities, GI problems, mouth/skin irritation, scars on hands, dental problems, suicide risk
Causal factors of eating disorders
social pressure an expectations, refocusing emotional problems on body and not in a constructive manner, phobia of weight gain, negative reinforcement, distorted thinking, family problems, 5HT problems (regulates appetite) antidepressant meds can reduce binge eating
Treatment for eating disorders
hospitalization (first step if patient has severe medical problems)
behavioral modification (get at actions)
CBT (good for bulimia, identify distorted thoughts
IPT (current relationships, conflict, communication)
Insomnia Disorder
can’t fall o stay asleep
Hypersomnolence Disorder
very tired al day, despite sufficient sleep at night
Narcolepsy
sudden irresistible REM sleep during day
cataplexy (sudden loss of muscle tone in response to emotion)
sleep paralysis–when waking up and getting out of rem
hypnogogic hallucinations–can’t tell if it is a dream or real, feels conscious
Obstructive Sleep Apnea Hypopnea
snorting, gasping, shallow breathing during sleep
more common in overweight people
links to depressive symptoms
Central Sleep Apnea
5 or more breathing episodes per hour
Sleep-related Hypoventilation
lowered respiration, co-occurs with other disorders
Circadian Rhythm Sleep-wake disorder
severe recurrent jet lag, mismatch of body’s rhythm and environament
Sleepwalking disorder
occurs during deep sleep, patient usually doesn’t remember
Sleep terrors
almost always kids
wake up screaming and terrified, occur in lighter stages of sleep
usually occurs when kid is experiencing life stress
Nightmare disorder
repeated dysphoric (very emotional) dreams usually can remember
Gender Dysphoria
incongruence between one’s expressed/experienced gender and assigned gender
must cause distress and impairment for at least 6 months
(2+) strong desire to not have their sex characteristics, have the other gender’s characteristics, be the other gender, be treated as the other gender, feeling they have typical feelings as the other gender
discontent with your assigned gender–cognitive and affective issues
“gender affirming” surgery may occur
all caused by societal views?
Psychodynamic Theory of gender dysphoris
results as being extremely close with parent of opposite sex and/or absence of parent of same sex so you identify with opposite sex parent
learning theory of gender dysphoria
children without parent of same sex don’t have a role model
Biological theory of gender dysphoria
patient may have different sex hormones
Sexual Dysfunction Disorder
distress and impairment caused by recurrent problems with sexual interest, arousal, or response
inability to respond sexually or experience sexual pleasure
lifelong sexual dysfuction
occurs from first sexual encounter and on
Generalized sexual dysfunction
Basically occurs all the time
acquired sexual dysfunction
randomly start having problems even after normal experience
situational sexual dysfunction
can have problems with specific person, specific gender, specific location, specific activity
Potential influences of sexual dysfunction
physical problems of the partner
relationship issues (communication, desire, frequency)
individual vulnerability (body image, history of abuse)
cultural or religious factors (prohibition of behaviors, shame)
medical (side effects form medications)
biological * sociocultural * psychological
Interest desire arousal disorders
Male hypoactive sexual desire disorder
Female sexual interest-arousal disorder
erectile disorder
Orgasmic disorders
female orgasmic disorder
delayed ejaculation
premature ejaculation
Pain/penetration disorders
genito-pelvic pain/penetration disorder–tightening of vagina
Causal factors of sexual disorders
psychological–trauma, anxiety from previous encounter, guilt, performance anxiety, relationship problems, irrational beliefs
biological–testosterone levels (both genders), cardiovascular disease, depressant drugs, other medical issues
sociocultural- taboo, expectations (implicit/explicit)
Paraphilic Disorder
“intense sexual interest other than genital stimulation with a normal, mature, consenting human
basically anything that’s not normal
risk of personal harm (distress), harm to others
Exhibitionism
strong urges fantasies or behaviors of exposing genitals to unsuspecting other
other person’s reaction is arousing
urge/fantasy must have distress/impairment
behavior is non-consent so is a disorder
transvestic fetishism
arousal from cross-dressing, urges and behaviors, need impairment/distress, at least 6 months, mostly men dressing as women
Fetishistic Disorder
arousal from non-living objects or non-genital body parts (feet)
if clothing, have to rule out cross-dressing–goes beyond that
not just sex toys since those are made for sexual pleasure
impairment and distress!!
Voyeuristic Disorder
arousal from watching an unsuspecting person naked, undressing, or engaging in activity
don’t get consent from other
behavior is a crime and disorder
urges need to be paired with distress
Frotteuristic Disorder
arousal from touching or rubbing against an unsuspecting person
no consent
urges must have distress
behavior is crime and disorder
Sexual Masochism Disorder
arousal from being humiliated, beaten, bound
if both partners consent, it is not a disorder
need to have distress
Sexual Sadism Disorder
arousal from physical or psychological suffering of another person
disorder is other person has not consented
urges need distress
Pedophilic Disorder
arousal with kids
urges without behavior is still concerning
individua must be at least 16 years old, and child must be at least 5 years younger
