Exam 3 Flashcards
OCD
Obsessive Compulsive Disorder
What is OCD?
Anxiety disorder characterized by obsessions and compulsions
Obsessions
Recurrent and persistent thoughts, urges, images, cause unwanted anxiety and stress
(contamination, order, losing control, doubt)
Compulsions
Repetitive behaviors/covert mental acts intended to reduce anxiety
(washing hands, ordering, counting, checking)
Negative reinforcement
Removing distress due to an action
DSM-V Criteria for OCD
Presence of obsessions, compulsion, or both
Obsessions and compulsions are extremely time-consuming
Hair Pulling Disorder
Trichotillomania : compulsion to pull hair - there are also skin-picking disorders causing lesion, hoarding disorder, difficulty with parting from things, and body dysmorphic disorder . . .
Body Dysmorphic Disorder
DSM-V : Preoccupation with 1 or more perceived defects, repetitive mirror checking (behavior(s) develop), clinically significant distress
OCD - Neuro Factors
Overregulation in brain systems (dysfunctional connections in frontal lobe, thalamus, and basal ganglia)
Abnormalities in neural communication (too little serotonin SSRIs can work)
Genetics (identical twins 65%, fraternal twins 15%)
OCD - Psych Factors
Operant conditioning: comp: short-term relief: reinforced
Obsessional thinking: OCD: mental or behavioral rituals
OCD - Social Factors
Stress: OCD follows stressor: severity proportional
Culture + Religion: may determine context of obsessions and compulsions
OCD - Treatment - Neuro
Medication (SSRI - Zoloft, Celexa, and Paxil)
TCA Anafranil
Meds + behavioral treatment recommended
OCD - Treatment - Psych
Cognitive methods: reduce irrationality and frequency of intrusive thoughts / accuracy of thoughts
Exposure + response prevention therapy
Exposure and Response Prevention Therapy (ERPT)
face or confront fear until subsiding
refrain from compulsions, avoidance, escape behaviors
graduated exposure based on fear hierarchy
if you challenge with anxiety-provoking tasks, body will habituate anxiety
Trauma
actual or threatened death, serious injury, sex violence
Stress
overwhelmed, worried, run down
General Adaptation Syndrome (GAS)
3 Stages: alarm: fight or flight response to stressor
resistance: way an organism adapts to physical and psychological stressor
exhaustion: effects of long-term stress on emotional and physical well-being
PTSD
Go through traumatic event - can lead to developing PTSD as a stress disorder
Characteristics of PTSD
intrusive re-experiencing event
avoidance
negative thoughts and mood
increased arousal and activity
symptoms can last longer than 1 month
Acute Stress Disorder (ASD)
symptoms within 4 weeks of traumatic event, last less than 1 month
Factors in “What is traumatic?”
Kind of trauma (disaster, accident, injury)
severity of trauma
duration and proximity of trauma
What basic assumptions does PTSD challenge?
1) belief in a fair and just world
2) belief that it’s possible to trust others/safety
3) belief that it’s possible to be effective in this world
4) the sense that life has purpose + meaning
Adjustment Disorder
emotional reactions to milder life circumstances: new job, married, new home, retiring, breakup
PTSD - Historical Perspective
US Civil War: Palpitations, exhaustion, “irritable heart”
Traumatic neurosis: 1880s - central nervous system railway spine
Hysterical neurosis: Variety
War neurasthenia: weak nervous system - can’t handle combat
Shell shock: artillery and exposure to shells (Abram Kardier wrote on shell shock
Emergence of PTSD diagnosis
PTSD debut in 1980s, DSM-III, rape trauma syndrome: sexual assault reaction
Recent!
PTSD - Neuro Factors
Brain structure and function: smaller hippocampi
high amygdala activity
the under-responsive medial prefrontal cortex
dysregulated HPA-axis
- hyperactive at first
- inhibited in later stages of PTSD
neural communication: serotonin: help treat disorder, moderate stress
genetics: small role, 20-30%, heritability 30-40% variance
PTSD - Biological Treatment
Drugs prescribed: anti-depressants (SSRIs) most effective
PTSD - Psych Factors
History of depression and other disorders
lower IQ - severe symptoms
negative emotionality - tendency to mood swings
PTSD - Psych Factors - Cognitive
Cognitive: unable to control stressors, the conviction of the world is a dangerous place
PTSD - Psych Factors - Behavioral
Behavioral: classical + operant conditioning - may explain avoidance. Avoidant symptoms + self-medicate - negatively reinforced
PTSD - Psych Factors - Psychodynamic Concepts
Freud + Breuer - 1800s: trauma primary cause of the difficulty. Recall can be helpful
PTSD - Psychodynamic Treatment
Short-term dynamic therapy of stress syndrome
12 session therapy
1-4: trust building, safely recounting trauma
5-8: work through conflicts, problematic beliefs
9-12: Integrate strides patients have made - process end of therapy
PTSD - Humanistic
Post-traumatic growth (PTG) - positive changes following crises/trauma/loss
various inventories (PTG, SRGS, BFS)
PTG associated with tendency to think about traumatic event (rumination may be beneficial)
Meaning reconstruction: trauma + loss
constructivist perspective: people invent ways to understand self
trauma + loss often invalidate construct self-narratives
complicated grief - unable to construct meaningful story
too theoretical?
PTSD - Social Factors
1) Socioeconomic stress - less access to treatment resources
2) social support - immediately after trauma - lower risk for PTSD
3) cultural patterns - teach one coping style over another
PTSD - Treatment - Social
1) Psychodynamic PTSD Group - make trauma memories conscious
2) Interpersonal PTSD Group - gain awareness of feelings and patterns that relate to others
3) Supportive PTSD Group - members provide emotional support for each other (cope)
4) Trauma-focused cog./behavioral Group - structural groups educate about trauma, anxiety addressed via exposure
PTSD - Treatment - Psych Factors
1) Psychoeducation - first step is to educate about condition
2) Relaxation, exposure, breathing, retraining (avoidance unhelpful)
3) Cognitive methods - help patients understand the meaning of their traumatic experiences and the misattributions they make about there experiences and the aftermath
4) Eye movement desensitization and reprocessing (EMDR) treatment
5) Cognitive Processing Therapy (CPT)
EMDR
Widely used but debated treatment
similar to exposure therapy - think about a troubling image then move the eyes left and right for 15 seconds
symptoms of trauma from the inability to process images and cognitions
CPT
Psychoeducation about PTSD
rules/beliefs log
impact statement - safety, trust, power/control, esteem, intimacy
ABC sheets
Writing trauma accounts (read to self each day)
Dissociation
Symptom of PTSD with four primary symptoms
Amnesia
memory loss, generally temporary
Identity problem
not sure who he/she is (assume new identity)
Derealization
external world perceived and experienced as strange and unusual
Depersonalization
feeling like observer/outsider, normal v abnormal dissociation
Dissociative Amnesia
Impaired memory - not explained by forgetfulness, takes several forms
Generalized Amnesia
can’t remember life - RARE
Selective Amnesia
only remember parts of forgotten time period
Localized Amnesia
memory gap for specific period of time, often before traumatic events
Dissociation - Neuro Factors
after brain injury - not dissociative amnesia
damage to hippocampus after prolonged stress (recovered memories)
Dissociation - Psych Factors
Dissociation Theory (1907) strong emotions impair cognitive processes
Dissociation - Social Factors
Combat + Abuse
Depersonalization - Derealization Disorder
Persistent feeling of being detached from one’s mental processes, body, surroundings
DDD - Neuro Factors
disrupted emotional processing - emotional detachment
frontal lobe activity unusually high
low norepinephrine production
DDD - Psych Factors
Cognitive deficits
short term memory impairment
difficult sustaining attention
DDD - Social Factors
Childhood emotional abuse
Dissociative Identity Disorder
Used to be MPD
2 or more distinct alters (own histories)
most people have 10 or fewer alters
significant diagnostic plague DSM-V
DID - Neuro Factors
PET scan reveal brain respond differently for each alter
one alter - trauma activated / other alter - trauma not activated
DID - Psych Factors
Hypnotizability
DID - Social Factors
Early childhood abuse
rarely diagnosed prior to 1976 (Sybil movie)
may be induced in some cultures
Dissociative Disorders - Treatment
DD improve simultaneously w/o treatment
- especially dissociative amnesia, d fugue (travel)
medication not used
DD - Treatment - Psych Factors
1) Coping strategies
2) address the presence of alters
3) reinterpret symptoms (limit stress)
Somatic Symptom Disorder
Physical well-being NOT medically explained
SSD - Patients Report…
muscle, joint, back pain
palpitations
IBS
tension headaches
chronic fatigue
insomnia
chest pain
relatively rare - common psych disorder in medical setting
250 BILLION dollars in medical costs/year
SSD - Two common features
Bodily preoccupation
symptom amplification
SSD - three main disorders
somatic symptom disorder
conversion disorder
illness anxiety disorder
SSD - DSM-V
one or more somatic symptoms distressing or disrupting daily life
excessive thoughts, feelings, behaviors, health concerns
- disproportionate persistent thoughts about the seriousness
- persistently high level of anxiety about health symptoms
- excessive time and energy devoted to health symptoms
typically more than 6 months (being symptomatic) even if any one somatic symptom may not be continuously present
SSD - Neuro
genetics - account for half of variability
SSD - Psych
catastrophic thinking, misinterpretation of bodily signals
SSD - Social
observational learning (ill parent)
operant conditioning (reinforced illness behavior - extreme attention or buying treats when ill)
culture - acceptable way to express helplessness (?)
Conversion Disorder
Sensory or motor symptoms incompatible or inconsistent with medical or neurological condition
patients with CD do not consciously produce the symptoms they experience
diagnosis made after all possible medical causes ruled out
CD - three types of symptoms
1) motor - tremors, tics, jerks, spasms, staggering
2) sensory - blindness, deafness, auditory hallucinations
3) seizures - twitch or jerk part of body, uncontrollable spasms, lose consciousness (non-epileptic)
CD - Neuro
muscle weakness from CD not the same as conscious muscle weakness
fMRI suggest some patients with CD develop sensory deficits limb paralysis
CD - Psych
self-hypnosis
CD - Social
life stressors (combat, abuse)
Illness Anxiety Disorder
Preoccupation with fear or belief of having serious disease, misinterpreting symptoms
patients cling to conviction they have serious disease despite evidence against it
symptoms for at least 6 months
causes significant distress or impairment in functioning
IAD - Neuro
Serotonin not functioning properly
IAD - Psych
biases in reasoning (catastrophic thinking, unpleasant sensation focus
IAD - Social
traumatic sexual experience, physical violence, family upheavel
Treatment - Somatic Disorders
clinicians target all areas
SSRIs or St. John’s Wort
CBT - identify irrational thoughts
support from therapist
psychoeducation
Eating Disorders
Abnormal eating - preoccupied with body image
3 types
Anorexia Nervosa
key feature: low body weight (prevent weight gain)
pursue extreme thinness
high risk of death
Anorexia Nervosa - DSM-V
Must meet 3 criteria:
1) low body weight for age and sex
2) intense fear of becoming fat/gain weight
3) distortions of body image
some symptoms overlap with OCD
obsession over symmetry, hoard, order precisely
AN - Restricting Type
severe undereating or excessive exercise
AN - Binge Eating/Purging
Eat more at once than most, reduce calories already consumed - vomiting, laxatives, diuretics, enemas
AN - Medical Effects
Loss of bone density, low heart rate, heart muscle thins, slow metabolism
AN - Psych + Social Effect
Key Starvation Study: develop depression and anxiety, hoard food and other items, lost sense of humor
Bulimia Nervosa
2x as prevalent than Anorexia Nervosa
Key feature: binge-eating and inappropriate efforts to prevent weight gain (can have a normal weight range)
BN - Purging
Eating so much then vomiting, laxatives, enemas
BN - Non-purging
fasting or excessive exercise
Bulimia Nervosa - DSM-V
recurrent binge eating episodes
-eat discrete period of time (within any 2-hour period) more food than typical
-sense of lack of control over eating during the episode
recurrent inappropriate compensatory behaviors to prevent weight gain
compensatory behaviors and binge once a week for 3 months
self evaluation unduly influenced by body shape and weight
disturbances not exclusively during anorexia nervosa episdoes
BN - Medical Effects
Heart and muscle problems
eroded tooth enamel from chronic vomiting
loss of intestinal function from laxative use
dehydration and electrolytic imbalance
Binge Eating Disorder
Binge eating without subsequent purging
DIFFERENT from Bulimia
1) do not persistently try to compensate for binges
2) most people with binge eating disorder are obese
Binge Eating Disorder - DSM-V
Binge eating once a month/week? for 3 months
lack of control over eating during episode
eating in discrete period of time (within 2-hour period) amounts of food greater than what people would normally eat in same time
Binge Eating Disorder - Biological
Neurotransmitters: important in weight and feeding
monoamines (dopamine, norepinephrine, serotonin)
GABA - inhibitory NT
glutamate - excitatory NT
Anorexia: lower dopamine and serotonin
Bulimia: lower serotonin, though dopamine important in binge eating
Binge Eating Disorder - Biological - Treatment
eating improvement first
maybe antidepressants and antipsychotics at the same time?
SSRI effective-ish
not enough evidence on this
Binge Eating Disorder - Biological - HPA-Axis
Produces cortisol
hyperactivity in anorexia (elevated cortisol)
hyperactivity in bulimia (elevated cortisol, but less than anorexia)
Less active in binge eating?
response to chronic stress?
STS - greater HPA - greater cortisol
Chronic - less HPA - less cortisol
causal links unknown
Binge Eating Disorder - Biological - Reward
Reward pathway disturbances
eating problem akin to addiction? - same brain systems affected
Anorexic - unresponsive to rewards
Bulimia - binge eating, obesity, too responsive to rewards
Mesolimbic pathway - reward pathway
dysfunction in dopamine transmission
Genetics more likely to have a BED if family member does
Binge Eating Disorder - Psych Perspective
Risk Factors
negative self-evaluation
sexual abuse
comorbidity with anxiety and depression
using avoidant strategies to cope with problems
excessive concerns - overvalue weight
consistent predictors: dieting and bodily dissatisfaction
Abstinence Violation Effect
condition arises when violation of self imposed rule about food restriction, can make one feel out of control w/food
Binge Eating Disorder - Psych Perspective
Learning Theory
Operant Conditioning
- positive reinforcement: restrict behaviors positively reinforced by the person’s sense of power and mastery over appearance
positive reinforcement for “losing control” of appetite and binges
bingeing - endorphin rush
- negative reinforcement: preoccupied with food - distract from problems
binge turns off unpleasant thoughts (- reinforce)
purging - (- reinforced) relieving anxiety and fullness (overeat)
Binge Eating Disorder - Psych Perspective
Personality
Perfectionism
harm avoidance (avoid harmful situations)
neuroticism (anxiety, emotional reactivity)
low self-esteem (food = self-worth)
Binge Eating Disorder - Social Perspective
Culture contributes - promote ideal shape (media propagates it)
1) cultural idea of thin
2) media exposure
3) assimilation of thinness ideal
found in westernized and industrialized western countries
Binge Eating Disorder - Gender Differences
Male less likely to have eating disorder (physical ideals unrealistic however)
They may have another disorder - excessive exercise or steroid use
Objectification Theory
Girls learn to consider their bodies as object and commodities
happens before adulthood
ED encouraged to fit an ideal standard
Men - observers and agents to do tasks and be strong, power issues
Women - be looked at, looks, thinness, body image issues
Treating Eating Disorders - Medical
Reach safe weight medically
in-patient hospitalization
CBT
Treating Eating Disorders - Psych
CBT - effective, change your thoughts
Acceptance and Commitment Therapy (ACT)
mindfulness techniques - commit to change (psych flexibility)
Treating Eating Disorders - Social
Interpersonal Therapy (4-6 months of weekly therapy)
improve relationships with others and the problems within relationships
reduce longstanding IP problems
become hopeful and empowered
Treating Eating Disorders - Social
Family Therapy
Maudsley Approach - parents integrated in the process of their daughters eating habits, making them appropriate
psychiatric hospitalization
- get weight up, normal eating pattern, change irrational thoughts
24-hour community: less intensive treatments failed - do this!
Eating Disorders - Reasons for Relapse
Reluctance for treatment
unwillingness to continue change once discharged
patients don’t receive adequate outpatient care after discharge
treatments can cost too much - leave the program(s) early :(
Gender
Attitude, feelings, behaviors that given culture associates with a person’s biological sex
Cisgender
Person’s gender identity and expression align w/social expectations of ones sex
Transgender
Umbrella term or identity that encompasses many different genders and expressions that challenge traditional categories
Gender Dysphoria - DSM-V
incongruence gender one is assigned to at birth/experienced gender
one diagnosis/separate criteria
Dysphoria in children and dysphoria in adolescents and adults
only diagnosed in those who experience conflict
Very rare
Should it be removed? - Yes
incongruent feeling not disordered
reflect questionable beliefs about gender as biological
Should it be removed? - No
Diagnosis - lead to extensive interventions
name changed - remove disorder
Paraphilic Disorder
Unusual sexual interests (Paraphilia)
distress, impair functioning, harm self or others
symptoms for at least 6 months
recurrent fantasies related to nonhuman objects, nonconsent, suffering or humiliation
Pedophilic Disorder
Must be at least 16 years or older, 5 years older than a child
View themselves as less responsible, child responsible
often begins in adolescence (chronic)
Understanding Pedophilic Disorder
Overlap w/OCD (involve obsessions and compulsions)
frontal lobe deficits
SSRIs decrease sexual fantasies and behaviors
most are male
Classical and operant conditioning
Zeignark Effect: recall interrupted activties - try to finish
Paraphilic Disorders - Treatment
Chemical castration (temporary - decrease testosterone levels)
CBT - decrease cognitive distortions
relapse prevention training - assess triggers then avoid
train to empathize w/victims - less likely to reoffend
Sexual Functioning - Dysfunctions
Problem in sexual response cycle
Men: Up and down, fairly standard
Women: could be all over the place
Sexual Dysfunctions - 3 Categories
Sexual desire + arousal disorders
- F: get aroused / M: hypoactive sexual desire
Orgasmic disorders
- delayed ejaculation, premature ejaculation, female orgasm disorder
Sexual pain disorders
- Genito pelvic pain/penetration disorder
Understanding Sexual Dysfunctions - Factors
interruption, disease, medication, stress, sexual trauma, image concerns, conflict in relationship
Sexual Dysfunction - Treatment
Positive trend toward medicalization of sex therapy
educate patients about sexuality - human sex response
counter negative thoughts, beliefs, attitudes that interfere
sensate focus exercises (touch, smell, etc)
sex therapy
Experiential Sex Therapy
Focus on experiential meaning of sex
deemphasize fix broken parts
encourages exploring feelings
awareness of feelings (allow for discovery and growth)
Bibliotherapy
therapy by reading particular books and texts
