Exam 3 Flashcards
long-term pattern of INNER experience and OUTWARD behavior
Personality
characteristics of personality
consistent (traits)
flexible
disorder with a very rigid pattern of experience of behavior
personality disorder
characteristics of personality disorder
lacking flexible piece
always feel need to act and feel the same way constantly
DSM requirements for diagnosing personality disorder
Must cause impairment in social or occupational functioning, or personal distress
what was personality disorder formerly diagnoses in for DSM-IV
Axis II (not transient problems)
when do personality disorders typically start?
adolescence/early adulthood
Generally, person with personality disorder doesn’t see their personality issues as problematic. What do they tend to do?
Tend to externalize the problem
– its not about them but how the world is reacting to them; think their dysfunction is from others treating them poorly
Problems with DSM Categories for personality disorder
Criteria cannot always be observed directly
-PD is an inner experience
Diagnosis is based on self-report
Differ more in degree than in type of dysfunction
- Can have same symptoms of other personality disorder
- Diagnosis of a certain personality disorder is made by the different levels (mild, severe, etc.) of the symptoms
Criteria change in each DSM up until DSM-V
Often co-morbid with
“Axis I” disorder – depression, bipolar disorder, etc.
Cluster A?
Eccentric or odd behavior
cluster A PD has superficial similarity with what psychological disorder?
mild schizophrenia
cluster for Paranoid Personality Disorder
A
characteristics of Paranoid Personality Disorder
Strong suspicion or mistrust of others
Often avoid relationships
Do not see themselves as needing help
-Think its other people who have the problem
cluster A personality disorders more common in males or females?
males
cluster for schizoid personality disorder
A
what is schizoid PD characterized by
Pervasive indifference to others
-Avoid socialization with anybody; don’t value socialization
Lack desire for social relationships
-Indifference towards relationships
Diminished range of emotions and expressions
-Protective factor
Generally don’t seek treatment.
-Externalize dysfunction/stress/problems
cluster for schizotypal PD
A
what is schizotypal personality disorder characterized by
Odd (but not delusional) ways of thinking and perceiving, and behavioral eccentricities
-Disorganized and eccentric on how they talk about things
Most closely similar to schizophrenia
Most severe cluster A disorder?
schizotypal disorder
why do people with schizotypal disorder have a hard time dealing with it?
because want/value relationships but when they try to form relationships their behavior pushes others away
“dramatic” PD
cluster B
characteristics of cluster B PD
Extremely self-absorbed and prone to exaggerate importance of events
Immense difficulty maintaining close relationships
Most commonly diagnoses cluster?
B
histrionic PD cluster?
B
what is histrionic PD characterized by
excessive emotionality and attention-seeking behavior
what does someone with histrionic disorder seek treatment
Goal = please or seduce therapist
Seek treatment in order to get attention from the therapist
most common gender for histrionic PD
females
Grandiose, need much admiration, and little empathy for others
Convinced of own great success, power, or beauty
-Want people to confirm it
Exaggerate achievements and talents, often appear arrogant
Mostly in males
narcissistic PD
Persistently disregard and/or violate others’ rights for own gain
Likely to lie repeatedly, be reckless, and impulsive
-More likely to engage in criminal behavior – don’t see criminal activity as wrong since it might meet their needs
antisocial PD
cluster for antisocial PD
B
cluster for narcissistic PD
B
How old must someone be to be diagnosed with antisocial PD
18
pre diagnosis for antisocial PD
conduct disorder
Borderline personality disorder cluster?
B
characteristics of borderline personality disorder
Great instability in life
- Major and sudden shifts in mood
- Chronically unstable self-image
Shifts in attitudes towards others
- Dichotomous thinking – idolize certain people or people they meet for first time, but if you do anything to violate idolization you become a horrible person to them
- Either love or hate the person, no in between
Impulsivity
- Do whatever there mood tells them to do
- Reckless behavior
- Self injury
Prone to bouts of anger; can lead to physical aggression or self-harm
What are borderline personality disorder people born with?
strong emotional sensitivity
what is borderline PD linked to?
parental loss/abuse
who is borderline PD more common in?
women
What is the only PD with its own treatment
borderline PD
treatment for borderline PD
dialectical behavior therapy (DBT)
drug therapy can help with severe mood
what theory is dialectical behavior therapy based on?
mindfulness theory (idea of being focused on what is happening in the moment)
what needs to be incorporated when someone with borderline PD experiences an intense mood?
reasonable/rational mind
what is included in the DBT states of mind diagram?
reasonable mind wise mind (middle) emotional mind (borderline personality disorder)
what cluster are the anxious personality disorders
C
characteristics of cluster C?
anxious
fearful
depressed
cluster of avoidant personality disorder
C
PD:
Shy and socially uncomfortable but desire social contact
fear intimacy
Extremely sensitive to negative evaluation
Come to therapy seeking acceptance and affection
Avoidant personality disorder
most treatable cluster C personality disorder?
avoidant personality disorder
cluster of dependent personality disorder?
C
PD:
Pervasive, excessive need to be taken care of
- Clingy, obedient, fear separation from loved ones
- Rely on others so much cannot make smallest decision for themselves
Many feel distressed, lonely, and sad
Dependent personality disorder
cluster for obsessive-compulsive PD
C
PD:
Enduring pattern of thinking, behavior characterized by perfectionism, inflexibility
Preoccupied with rules, excessively moralistic, judgmental
Unreasonably high standards (for self and others)
Obsessive-Compulsive Personality Disorder
Enduring pattern of thinking, behavior of obsessive compulsive PD is characterized by?
perfectionism and inflexibility
what gender more commonly has obsessive compulsive PD?
males
Eating disorders are on a _____
continuum
What refers to a range of unhealthy diet-related behaviors?
Eating disturbances and disordered eating
% of 10 year old girls afraid of being fat
80
Average onset of eating disorders dropped form 13-17 to what?
9-12
% of american college women engaging in disordered eating?
50%
how have eating disorders changed in males?
doubled in past decade
What has been the shift of focus in body size?
Shift in focus from body size to overall body health advocated by many healthy researchers
“healthy ideal” not “thin idea”
Main symptoms of anorexia nervosa?
Refusal to maintain 85%+ of normal body weight
Intense fear of becoming overweight
Distorted view of body weight and shape
Amenorrhea – menstruation stops
What are the two types of anorexia nervosa?
Restricting Type
Binge-eating/Purging Type
What culture is anorexia nervosa a problem in?
Euro-american
What is anorexia associated with?
Depression, low self-esteem, anxiety
Insomnia/other sleep disturbances
Substance abuse
Obsessive-compulsive patterns and Perfectionism
Medical complications of anorexia nervosa?
Caused by starvation:
Reduced bone density, dry skin, brittle nails
Low body temperature and blood pressure
Slow heart rate and poor circulation
Metabolic and electrolyte imbalance
Amenorrhea
Extreme cases: death
Bulimia Nervosa?
Not necessarily under-normal weight – not restricting intake
Regularly engage in discrete periods of overeating
Followed by compensation activities for overeating and to avoid weight gain
For someone with bulimia nervosa how often to compensatory behaviors occur?
2x per week for 3 months
Types of bulimia nervosa?
Purging type
Non purging type
what is the non purging type of bulimia nervosa?
excessive exercise
What is bulimia nervosa associated with?
Emotional distress,
Personality Disorders,
seasonal-related depression
Complications of bulimia?
Tooth decay
Gastric, rectal, and esophageal issues
Arrhythmia and cardiac arrest
percentage of cases that occur in females for bulimia?
90-96%
lifetime prevalence of bulimia nervosa?
1-2%
NOS eating disorder?
NOS = not otherwise specified
Extreme disordered behavior but do not fit the criteria for anorexia or bulimia
Examples of NOS?
AN but with some menstrual cycle or normal weight
Purging with out bingeing or lower frequency of purging
Binge Eating Disorder
percentage of people in treatment programs diagnosed with NOS?
60%
biological dimension of eating disorders?
Genetic factors
- hypothalamus development affected
Neurotransmitters
- serotonin production
Is the hypothalamus over active or under active in anorexia?
under active (opposite for bulimia)
How is neurotransmitter affected in people with anorexia?
serotonin excessively produced (opposite for bulimia)
Psychological dimension of eating disorders?
Body dissatification/distortion
perfectionism
low self esteem
lack of control
Social dimension of eating disorders
parental attitudes and behaviors
history of being teased about body
peer pressure with weight/eating
Social cultural dimension of eating disorders
social comparison
media presenting distorted images
cultural definitions of beauty
What kind of approach is necessary in treating anorexia?
team approach
What kind of treatment is preferred in anorexia?
residential treatment
Medication effective in anorexia treatment?
no, poor support
Goals for anorexia treatment?
Restore healthy weight and treat physical complications
Enhance motivation for change through psychoeducation of nutrition
Psychotherapy for emotional disturbances with food
Family therapy
Relapse prevention
what eating disorder is more likely to seek treatment?
bulimia
Treatment for bulimia?
Anti-depressants
Often have problems like depression
Work on seratonin aspect – reduce pleasure response associated with food
Therapy: CBT or E/RP (65% stop binge-purge cycle)
(Eat –> not binge–> eventually stop binge-purge behavior
What kind of approach is most effective in bulimia treatment?
combined approach of anti depressant and cognitive/behavioral therapy
Condition where someone is experiencing symptoms but is coming from a psychological condition not physiological
Somatoform disorder
What often triggers a somatoform disorder?
traumatic event
what are some somatoform disorders?
conversion disorder
hypochondriasis - (DSM-5 = anxiety disorder)
body dysmorphic disorder - (DSM-5 = OCD disorder)
pain disorder
somatization disorder
What are some somatoform-like disorders?
malingering
factitious disorder
factitious disorder by proxy
they physical symptoms of conversion disorder suggests what?
a neurological problem
what triggers conversion disorder
severe stress
common symptom of conversion disorder?
loss of limb movement
1/3 of cases of people with conversion disorder don’t seem to care that they are experiencing the symptoms associated with the disorder.
What is this called?
La belle indifference
who was conversion disorder common in
What symptoms did they experience
soldiers from World War I
loss eye sight
-had benefit of being discharged (secondary gain)
Someone who has somatoform disorder may feel pain –> they get attention, etc –> this results in what for the person?
secondary gains
What is PNES?
psychogenic non-epileptic seizures
type of conversion disorder
seizure like symptoms
What makes the seizures in PNES different from epilepsy?
No abnormal brain activity while having PNES seizure
-No misfiring of electrical signals in brain
Presence of tears during seizures
Attacks occur when others are present, but not while sleeping or alone
illness anxiety disorder (somatoform)
hypochondriasis
somatoform disorder (changed to anxiety disorder in DSM-5) where person is preoccupied that normal sensations are symptoms of a serious disease
hypochondriasis
- frequent visits to physicians
excessive concern with real or imagine defects in appearance
frequent visits to plastic surgeon
body dysmorphic disorder
What is the placement of body dysmorphic disorder (somatic) in DSM-5?
OCD
bigorexia is known as
muscle dysmorphia
physical pain caused by a psychological reaction (not physiological)
psychogenic pain
what causes an increase in pain or those with pain disorder
psychosocial facts
incredible increase in pain under stress
How might pain disorder be maintained?
by primary and secondary gains
Primary gains for pain disorder?
Developed from a primary interaction to an internal experience they don’t want to experience (trauma, depression, etc.)
Pain is a distraction from the internal experience
secondary gains for pain disorder?
Attention from environment, get out of doing things like having a responsibility due to pain
what symptom must somatization disorder include?
Must include 4 recurrent, different pains/somatic complaints before age 30
- 2 gastrointestinal (GI) symptoms
- 1 sexual symptom
- 1 pseudoneurological (PN) symptom
- Brain problem (injury or misfiring)
what do symptoms tend to be reported as with someone who has somatization disorder?
vague, unfounded or exaggerated
somatoform-like disorder where someone fakes symptoms to gain medical attention
more obsessive/anxiety like
factitious disorder
why is malingering (somatoform-like disorder) not a DSM disorder?
Behavior is motivated by external incentives only
Injury deliberately and gradually inflicted upon another
Considered a form of abuse
Person is requiring someone else to take care of them
Person in the care is being injured or caused to be sick by their care taker
Care taker wants attention/reinforcement
Factiticious disorder by proxy
who is the dependent and who is the proxy in factiticious disorder by proxy?
Care taker = proxy
Person in the care = dependant
Example of a culture-bound somatoform disorder symptoms
Dhat
Fear loss of seminal fluid during:
Nocturnal emissions
Urination
Reflects Indian belief that loss of semen is a loss of physical/mental energy
Sociocultural dimension of somatoform disorder?
cultural differences in rates and symptoms
differences in acceptance of medical vs. psych problems
-Higher incidences of somatoform in cultures that focus more on medical conditions vs psychological
Social dimension of somatoform disorder?
Parental/peer modeling
Biological dimension of somatoform disorder
Innate sensitivity to physiological reactions
History of illness or injury
Psychological dimension of somatoform disorder?
psychodynamic
cognitive-behavioral
Biological treatment for somatoform?
Medication
- Show person that pain is not physiological in nature but psychologically caused
- Or actually treat pain with medication if it helps
behavioral treatment for somatoform disorder?
Address “sick role”/avoidance reinforcers
Issues with trauma –> trauma manifestation –> treat trauma
cognitive treatment for somatoform disorder
Correct “cognitive distortion” or magnification of physical symptoms
Have to work with beliefs and motivation to change
DSM symptoms for autism?
Impaired Social Interactions
E.g. poor nonverbal activity
Impaired Communication
-Delay in spoken language development
Restricted, Repetitive, & Stereotyped Behavior Patterns
-Stereotyped movements:
Repetitive, destructive behaviors (e.g. hand flapping)
Shows some signs “in early childhood” (before age 3)
Symptoms limit and impair daily functioning
what is asperger’s
form of autism, but doesn’t display all the symptoms
trouble with social interactions
don’t have delay in language, deviance in behavior, or repetitiveness
percentage of people with autism who remain severely disabled as adults and unable to lead independent lives
90%
percentage of people with autism who has severe IDD
70%
what is the IQ like for people with aspergers?
average or above
how much more prevalent is autism in boys than girls?
4X
why is autism more common in boys
genetic condition on Y chromosome
racial, ethnic, social differences in people with autism?
no differences
prevalence of people within autism spectrum?
1 in 68
rate has tripled in last 10 years
Biological etiology of autism?
genetic factor
brain structure deficits
- hippocampus under developed (memory center)
- issues with cerebellum (balance)
- amygdala over firing (emotional expression)
IDD also affect (intellectual developmental disability)
Treatment for autism?
Early intervention
- test genetic factors
- social interaction test
- behavior treatment
Types of treatment for autism?
Behavioral therapy, communication training, stress management, parent training
- Disorder prevents them to learn these things naturally
- Comprehensive and intensive training
DSM criteria for AD/HD
6 symptoms of :
- Inattention AND/OR
- Hyperactivity & Impulsivity
- In order to be diagnosed need to have 6 symptoms
- If have both symptoms (6 of each) = mixed type
AND
-Onset before age 12
-Impairment in at least 2 settings
-Impairment in social, academic or occupational function
-No other pervasive disorder
(AD/HD can look like anxiety; if someone has anxiety and displaying AD/HD symptoms, they do not have AD/HD)
how does the prevalence of ADHD differ from younger people to older people
A lot less people age 40 (1:2000) have ADHD compared to school age children (1:25)
pitfalls to the diagnosis of ADHD
DSM criteria also describes normal kids
no physical or lab markers
significant overlap with other disorders (anxiety)
Public awareness and misinformation (parents and confirmation bias)
Keys to accurate diagnosis of ADHD
get a lot of history
standardized checklists/questionnaires
computer based testing
behaviorally observe interactions with others
look for slower developmental milestones (not all cases)
what is the social aspect of ADHD
parenting skills/environment is never the cause but it can influence it
genetic aspect of ADHD?
Overly active CNS
Agitated
Attention and memory centers under active
Medication used for ADHD
stimulants
what do stimulants do for ADHD
target CNS and activate it
- do so body sees as abnormal and responds by cutting production of processes activating CNS
activate attention and memory parts of brain
- originally under active
therapy for ADHD?
behavior modification
need structured schedule and environments
short term adverse effects of stimulants?
sleep disturbance
appetite suppression
tic
problems of stimulants
misinformation
controlled substance
adverse effects
overprescribed
what was the long term effect of stimulants on rats?
consequence in nuclear accumbent (translates motivation into action)
rats lacked drive as adults
growth/maturation affected
parts of brain dealing with attention, memory, energy, focus damaged
diagnosis for conduct disorder
violation of age appropriate basic rights/societal norms, with presence of at least 3 of the following:
- aggression towards people/animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
percentage of kids who grow out of conduct disorder
70%
excessive and inappropriate anxiety around separation from caregiver
separation anxiety disorder
% of kids whose symptoms go away at adolescence for separation anxiety disorder
80-90%
intellectual developmental disorder? (IDD)
deficits in intellectual functions, adaptive functioning, and onset during developmental period (not indicative of autism or other pervasive disorder)
IQ of mild IDD
50-70
2 SD away
IQ of moderate IDD
35-50
3 SD away
IQ of severe IDD
20-35
4 or more SD away
what areas of brain are affected for IDD
verbal and spatial
