Final Exam - Cumulative Flashcards
3 important ramifications when defining a disorder: this colors the way we may interpret behavior
- insurance (reimbursement for treatment)
- legal responsibility for treatment
- disability
3 examples of past and present diagnoses that have been controversial:
- drapetomania (propensity of slaves to run away)
- childhood masturbation
- homosexuality
why is there no single definition of psychological abnormality or normality?
most behaviors exist on a continuum (substance use, sleep, eating, etc.)
wakefield argues disorder as ____
“harmful dysfunction”
hybrid of “value judgment” (ex. harmful) and “biological disadvantage” (a failure of a mechanism to perform naturally)
harmful dysfunction
wakefield’s 5 approaches to defining abnormal behavior: “disorder as ____”
- pure value concept
- whatever professionals treat
- statistical deviance (intellectual disability)
- biological disadvantage (evolution)
- distress or suffering
judgment of desirability according to social norms and ideals
disorder defined as a pure value concept
problem with defining disorder as a pure value concept:
very subjective
2 problems with defining disorder as whatever professionals treat:
- clients come in for treatment for behaviors that are normal
- individuals do NOT come in when they are disordered
-can be statistically deviant on many traits and it is a positive attribute (ex. IQ, strength)
-even undesirable behaviors that are statistically deviant may not be a disorder (ex. being rude)
problem with defining disorder as a statistical deviance (intellectual disability)
- if behavior results in lower reproductive fitness
- if some mental mechanism is not performing the specific function it was designed to perform (ex. normal anxiety vs. pathological anxiety)
- when a mechanism fails to perform as it was designed AND it causes impairment
3 criteria for a disorder to be classified as a biological disadvantage
toward a definition of abnormal behavior:
breakdown in cognitive, emotional, or behavioral function within the individual (it comes from the inside, aka within)
psychological dysfunction
toward a definition of abnormal behavior:
difficulty performing appropriate and expected roles
-some disorders may emphasize one over the other (ex. antisocial personality disorder)
personal distress or disability (functional impairment)
toward a definition of abnormal behavior:
reaction to abnormal behavior is outside cultural norms
atypical or unexpected cultural response
widiger argues that two constructs are fundamental to the definition of mental disorder:
dyscontrol and maladaptively
“an impaired ability to direct or regulate ovolition, emotion, behavior, or cognition, or some other area, which often entails inability to resist impulses and leads to abnormal behaviors without significant provocation” (APA)
dyscontrol
“a condition in which biological traits or behavior patterns are detrimental, counterproductive, or otherwise interfere with optimal functioning in various domains, such as successful interaction with the environment and effectual coping with the challenges and stresses of daily life” (APA)
maladaptively
true or false: some argue that we will never have a perfect definition of a mental disorder
true
a widely accepted system that is used to classify psychological disorders and problems
DSM-5
DSM stands for:
diagnostic and statistical manual of mental disorders
the DSM-5 contains diagnostic criteria for behaviors that: (4)
- fit a pattern
- cause dysfunction or stress
- are present for a specified duration
- are based on prototypes
a typical or standard example of a disorder
prototype
a clinical description of abnormality begins with the ___
presenting problem (what is bringing the client/patient into treatment)
this description aims to distinguish clinically significant dysfunction from common human experience and to describe demographics, relevant symptoms, age of onset, and precipitating factors
clinical description
keep in mind three factors while using the clinical description of abnormality:
- prevalence and incidence
- course of disorders
- onset of disorders
number of people in the population with a disorder
prevalence
number of new cases during a given time
incidence
course of disorders can be ___, ___, or ___
episodic, time-limited, or chronic
onset of disorders can be ___ or ___
acute (comes on quickly) or insidious (comes on slowly)
factors that contribute to the development of psychopathology
etiology (diathesis-stress model)
combination of risk and a stressor - psychological disorders result from an interaction between inherent vulnerability and environmental stressors
diathesis-stress model
treatment development - how can we help to alleviate psychological suffering? (3 forms of treatment)
pharmacologic, psychosocial, and/or combined treatments
this form of research studies the effectiveness of clinical interventions, including the comparison of competing treatments
treatment outcome research
treatment outcome research - how do we know that we have helped?
we are limited in specifying actual causes of disorders
major psychological disorders have existed in all ____ and across all ____
cultures ; time periods
two types of antipsychotics came out in the ____ and revolutionized medicine in psychology
1950s
three dominant traditions regarding abnormal behavior include:
- supernatural
- biological
- psychological
in the past, with respect to the supernatural tradition, deviant behavior was viewed as ____ vs. ____
good vs. evil
in the past, with respect to the supernatural tradition, deviant behavior was thought to be caused by:
demonic possession, witchcraft, and sorcery
in the past, with respect to the supernatural tradition, deviant behavior was treated by means of:
exorcism, torture, beatings, and crude surgeries
some treatments that worked in the past during the supernatural tradition:
placebo, classical conditioning, and fear
other worldly causes of deviant behavior:
movement of the moon and stars (astrology)
-“lunacy” is derivative of “luna,” or “moon”
people have long looked for physical causes of psychological disorders
the past: the biological tradition
who is the father of modern medicine?
hippocrates
___ believed that psychological disorders could be treated like any other disease. he believed “disease” was not the only potential cause, but that head trauma, brain pathology, and hereditary could impact disorders
hippocrates
___ extended hippocrates’ work, creating the ___ theory of mental illness
galen ; humoral theory of mental illness
the idea that disease resulted from having too much or too little of a certain humor
humoral theory of mental illness
the humoral theory of mental illness is comprised of 4 major bodily fluids, or “humors” :
- blood (heart)
- black bile (spine)
- yellow bile (liver)
- phlegm (brain)
this tradition linked abnormality with brain chemical imbalances and foreshadowed modern views
galenic-hippocratic tradition
the biological condition comes of age:
interest in biological factors of mental illness fluctuated over the centuries until the 19th century. what happened to bolster the view that mental illness = physical illness, providing a biological basis for madness?
syphilis
a sexually transmitted disease caused by a bacterial infection
syphilis
advanced stage syphilis can result in ___ and ___
delusions and other psychotic behaviors (hallucinations)
who discovered the cause of syphilis, and what was the cause he discovered?
pasteur ; a bacterial microorganism
pasteur’s discovery that syphilis was caused by a bacterial microorganism led to ____ as a successful treatment
penicillin
the biological tradition led to ___ treatments
biological
during this time, biological treatments were standard practice (insulin shock therapy, ECT, and brain surgery)
the 1930s
during this time, medications (such as neuroleptics aka antipsychotics) were becoming increasingly available
the 1950s
this medication reduces hallucinations, delusions, agitation, and aggressiveness
neuroleptics (antipsychotics)
during this time, benzodizepines (ex. valium) were introduced, and antidepressants began being developed
1970s
the past: the psychological tradition
plato and aristotle both thought that the ____ and ____ environment and ____ experiences impacted psychopathology
social and cultural environment ; early learning experiences
normalizing treatment of the mentally ill
-reinforce and model appropriate behaviors
-emphasize importance of a nurturing environment
the rise of moral therapy
- worked best with smaller patient populations
- dorothea dix led the mental hygiene movement
- rise of mental hygiene movement - move from moral therapy to “custodial care”
- rise of biological tradition and notion that mental illness was due to brain pathology and was incurable
4 reasons for the falling out of moral therapy:
the psychological tradition reemerges in the 1900s in three different forms:
- psychoanalysis
- humanism
- behaviorism (and cognitive-behaviorism eventually)
the past: the psychoanalytic tradition was led by ___ and ___
freud and breuer
the past: the psychoanalytic tradition
breuer had patients describe psychological problems and conflicts under hypnosis, leading to two important “discoveries” :
unconscious mind and catharsis
under hypnosis, individuals revealed material that appeared to be outside of their explicit awareness
unconscious mind
individuals felt better after discussing and reliving emotionally painful events and feelings (release of emotional tension)
catharsis
unconscious needs or drives are at the heart of human motivation
-human behavior is influenced by unconscious memories, thoughts, and urges
freudian theory
structure and function of the mind (3 components)
- id
- ego
- superego
think of the ___ as the brain, the ___ as the devil on your shoulder, and the ___ as the angel
-ego as the brain
-id as the devil on your shoulder
-superego as the angel
the pleasure principle (demands immediate gratification)
id
the most primitive part of the mind (part of the mind that is “like a four year old”)
id
unique processing of information within the id
primary process
thinking that is emotional, irrational, fantastical, and primal (sex, aggression, and envy)
primary process
the id is the source of sexual and aggressive motives and “energy,” which freud called ____
libido
instinctual drive for sex, pleasure, and fulfillment
eros
the “death instinct” - drive toward aggression and death
thanatos
the reality principle; must balance the needs of the id with rules of society
ego
the thinking style associated with the ego is called
secondary process
secondary process within the ego is characterized by ___ and ___
logic and reason
ego referred to as a rider on a horse (the horse being id)
the horse is stronger, but the man can usually control it
conscience - represents the moral ideas we learn from family, friends, and society
superego
how does our superego develop?
as a result of being rewarded and punished for various behaviors (or seeing others experience this via vicarious learning)
the purpose of the superego is to:
counteract the drive toward sex and aggression offered by the id
____ must mediate between the id and superego
ego
if mediation between the id and the superego is successful…
individuals can pursue higher goals
if mediation between the id and the superego is not successful… (if either the id or superego is overpowering)
we will experience intrapsychic conflict (an over-controlling superego can cause just as many problems as an over-controlling id)
freud felt that ___ and ___ were almost entirely unconscious
id and superego
when ego cannot maintain balance between the needs of id and superego, it results in ___
anxiety
anxiety serves as a warning that ego might be overwhelmed - results in use of ____
defense mechanisms
unconscious protective processes that keep primitive emotions associated with conflict in check so that the ego can continue with its coordinating function
defense mechanisms
defense mechanisms can be ____ or ____ (some call them “coping styles”)
adaptive or maladaptive
8 defense mechanisms:
- affiliation
- humor
- sublimation
- displacement
- intellectualization
- reaction formation
- repression
- projection
deal with conflict by turning to others for help and support
affiliation
emphasize the amusing or ironic aspects of conflict or stressor
humor
deal with conflict or stressors by channeling potentially maladaptive feelings or impulses into socially acceptable behavior
sublimation
ex. of sublimation as a defense mechanism
someone with anger issues may channel their aggressive urges into sports instead of lashing out at others physically or verbally
transfer feelings about, or response to, one object onto another (usually less threatening) substitute object
displacement
ex. of displacement as a defense mechanism
a person who is angry at their boss may “take out” their anger on a family member by shouting at them
excessive use of abstract thinking or the making of generalizations to control or minimize disturbing feelings
intellectualization
ex. of intellectualization as a defense mechanism
a person might focus on funeral arrangements rather than dealing with their own grief, or spending all of their time researching an illness they have been diagnosed with, rather than talking about how they feel about the diagnosis
substitutes behavior, thoughts, or feelings that are the direct opposite of unacceptable ones
reaction formation
ex. of reaction formation as a defense mechanism
a young boy who bullies a young girl, because on a subconscious level, he is attracted to her
blocks disturbing wishes, thoughts, or experiences from conscious awareness
repression
falsely attributing own unacceptable feelings, impulses, or thoughts to another individual
projection
ex. of projection as a defense mechanism
the classroom bully who teases other children for crying but is quick to cry
stages of child development in which a child’s pleasure-seeking urges are focused on specific areas of the body called erogenous zones
psychosexual stages of development
freud posited 5 basic stages of psychosexual stages of development:
- oral stage
- anal stage
- phallic stage
- latency stage
- genital stage
inadequate or inappropriate gratification in any stage would lead to a “____,” which would be reflected in the individual’s adult behavior
“fixation”
the oral stage occurs from ___ to age ___ to ___
birth to age 1.5 to 2
the oral stage is characterized by a central focus on ____ (sucking; lips, tongue, and mouth become focus of pleasure)
food
ex. of an oral fixation
smoking or chewing on something
the anal stage occurs from age ___ to ___
2 to 3
the anal stage is characterized by a central focus on the ____ and the ____ vs. ____ of feces
anus ; expulsion vs. retention
the anal stage is resolved when:
toilet training is completed
ex. of anal fixation
anal retentive (OCD, “you’re so anal”)
anal explosive (sloppy, disorganized, “out-there”)
the phallic stage occurs from age ___ to ___ or ___
3 to 5 or 6
the phallic stage is characterized by a focus on the ___ region
genital region ; as the child becomes more interested in his genitals, and in the genitals of others
2 major conflicts during the phallic stage:
oedipus complex and electra complex
young boys have sexual fantasies tied to interactions with mother
oedipus complex
the oedipus complex leads to anger toward the father because they see father as an obstacle, but fears father - results in identification with father
castration anxiety
young girls want to replace mother and possess father
electra complex
girls desire a penis, so as to be more like father (resolved when girls develop a healthy heterosexual relationship)
penis envy
the latency stage occurs from age ___ or ___ until ___
5 or 6 until puberty
sexual interest lies ___ during the latency stage, and energy (___) is put into nonsexual interests, such as friendships, school, sports, and play
dormant ; libido
the genital stage occurs during ___
puberty
during the genital stage, the central focus returns to the ____ and interest in sexual relationships ____
genitals ; increases
freud believed that progress during the genital stage was ____ if the child remained fixated at earlier stages
impeded
the purpose of this therapy is to unearth the hidden intrapsychic conflicts through catharsis and insight (focus on childhood)
psychoanalysis
psychoanalysis is ____ (2-5 years) and high ____ (3-5 times per week)
long-term ; high frequency
-to analyze and resolve conflicts
-to restructure personality
-focus is NOT on symptom reductive
-ambitious goals - are issue focused
goals of psychotherapy
-patient lies on couch, analyst sits behind couch
-free association - no censoring!
-dream analysis - content reflects primary process (id)
examine transference and counter-transference issues
psychoanalysis techniques
the key to psychoanalysis - ___ is good
transference
projecting onto the therapist the conflicts/issues one has in a stable way
transference
this occurs when the therapist projects their own unresolved conflicts onto the client
counter-transference
issue with psychoanalysis
efficacy data are limited
this theory focuses on affect and patient’s expression of emotions (may comment on; more reflection back)
psychodynamic theory
nonverbal expressions of emotion
affect
-explore patients’ avoidance of topics or decisions to engage in behaviors that hinder therapy
-identify patterns in patients’ behaviors, thoughts, and feelings (personality)
-emphasis on role of past experiences
-focus on interpersonal experiences
-emphasis on therapeutic relationship
-exploration of patients’ fantasies, dreams, and wishes
characteristics of psychodynamic theory
common factor in therapy: whether you like your therapist, can trust your therapist, etc. determines outcome of therapy (whether or not one will get better)
therapeutic alliance
notion that there was a positive, uplifting quality of humanity (humans as beings that strive for improvement and excellence)
- much more optimistic notion (gives humans the benefit of the doubt)
humanistic theory
to attain one’s highest potential is to reach ____
-only possible if overcome obstacles (ex. more basic needs, psychological problems, interpersonal problems)
self-actualization
3 major players in humanistic theory:
carl rogers, abraham maslow, and fritz perls
this person practiced client (or person)-centered therapy
carl rogers
-therapist conveys empathy, unconditional positive regard
-minimal therapist interpretation
-convey genuineness
-belief that client has the resources to solve his/her own problems if given adequate support
-belief that the client-therapist relationship was the most important aspect of the treatment
carl rogers treatment characteristics
carl rogers uses ____ the most, bouncing back what the patient says
reflection
who created maslow’s hierarchy of needs
abraham maslow
maslow’s hierarchy of needs begins at the base with ____ needs that must first be satisfied before higher-level safety needs and then psychological needs become active
physiological needs
5 components of maslow’s hierarchy of needs:
- physical
- security
- social
- ego
- self-actualizaton
this model emphasizes behavior and the ways in which it is learned
behavioral model
two components of the behavioral model:
classical conditioning and operant conditioning
a common form of learning, this type of conditioning is characterized by the pairing of neutral stimuli and unconditioned stimuli
classical conditioning
an automatic response to a stimulus
unconditioned response
something that reflects a natural automatic response
unconditioned stimulus
a stimulus that leads to an automatic response
conditioned stimuli
an automatic response from training or experience
conditioned response
if the conditioned stimulus is presented without the unconditioned stimulus for too long, ____ occurs
extinction
who is known as the father of behaviorism?
watson
another common form of learning, this type of conditioning posits that voluntary behavior is controlled by consequences (positive or negative)
operant conditioning
increases the likelihood of behavior:
reinforcement
decreases the likelihood of behavior:
punishment
skinner noted that many behaviors are ___ elicited by unconditioned stimuli
not
behavior is either strengthened (more likely to occur) or weakened (less likely to occur) depending on the consequences of that behavior
thorndike’s law of effect
3 ideas posited by skinner:
reinforcement, punishment, and shaping
positive and negative ; increases behavior
reinforcement
ex. of positive reinforcement
professor gives extra credit to students who come to class
ex. of negative reinforcement
professor allows students who come to class to leave 10 minutes early (ELIMINATES AN AVERSIVE STIMULUS)
positive and negative ; decreases behavior
punishment
ex. of positive punishment
child brings home a bad report card, gets spanked
ex. of negative punishment
child brings home a bad report card, phone gets taken away (REMOVAL OF STIMULUS)
reinforce successive approximations of desired behavior
shaping
from behaviorism to behavior therapy:
this movement was against psychoanalysis and non-scientific approaches
reactionary movement
3 early pioneers of the reactionary movement
- wolpe
- beck
- bandura
systematic desensitization was practiced by:
wolpe
cognitive therapy was practiced by:
beck
social learning/cognitive-behavior therapy was practiced by:
bandura
this type of therapy tends to be time-limited, direct, here-and-now focused (have widespread empirical support)
behavior therapy
this model explains behavior in terms of a single cause (could mean a paradigm, school, or conceptual approach)
one-dimensional models
problem with one-dimensional models:
other information is often ignored
interdisciplinary, eclectic, and integrative model (“system” of influences that cause and maintain suffering)
-uses information from several sources
-abnormal behavior as multiply determined
multidimensional models
multidimensional models of abnormal behavior include 5 factors:
- biological factors (genetics, physiology, neurobiology)
- behavioral factors
- emotional factors
- social factors
- developmental factors
according to social factors, ____ stressors are most potent
interpersonal
ex. of a social factor or interpersonal stressor
a romantic relationship ending, feeling ostracized from a social group, feeling dissociated, etc.
ex. of a developmental factor
most people with schizophrenia were behind their siblings in fundamental developmental areas at a young age
genetic contributions to psychopathology: ___ vs. ___
phenotype vs. genotype
observable characteristics
phenotype
do we know much more about phenotype than we do about genotype? or vice versa?
more about phenotype
genetic makeup
genotype
does an identical twin or a fraternal twin have a higher chance of having schizophrenia if their twin does?
identical 50% chance (both children are equally at risk of schizophrenia because it is in their genotype) ; fraternal 19% chance
development and behavior is often ____ (contribution to many genes)
polygenetic
overall genetic contribution to psychopathology is less than ___%, but schizophrenia is around ___%
50% ; 80%
in some studies, depression is ___% to ___% heritable
20% to 40%
eating disorders are ___% to ___% heritable
40% to 50%
who proposed that learning could affect genes by turning them on or activating them?
genetic structure is malleable and receptive to the environment - what is this interaction referred to as?
eric kandel ; gene-environment interactions
a genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to trigger behaviors or psychological disorders
diathesis-stress model
when a third variable affects the strength or direction of the relationship between two variables
interaction
true or false: gene-environment correlations are kind of a falsehood
true
in many cases, ____ and ___ are correlated
(robustness to psychopathology (resilience) is correlated to both
genes and environment
genes can ____ the probability that an individual will experience environmental events (which might increase the likelihood of experiencing psychological problems)
-adoption studies are interesting because genes and environment can be parsed
increase
nothing about your behavior played a role in this stressor
independent stressor
ex. of an independent stressor
getting hit by a drunk driver on the way home from class
stressors that our own characteristics contribute to
dependent stressors
ex. of dependent stressor
getting into frequent fights with your partner because of the type of partner you tend to choose
three types of gene-environment correlations
- passive
- evocative
- provocative
types of genes a child inherits may be correlated with the environment one is raised in
passive
you play no role (no bearing on what you did right or wrong, but rather the role that both genetics and environment play)
passive
ex. of passive gene-environment correlation
individuals could inherit genes for lower IQ and be raised in a non-intellectually rich environment
individual’s genes may lead to behavior that evokes a response from the environment
evocative
evocative gene-environment correlation is ____ produced only due to negative influences
NOT
ex. of evocative gene-environment correlation
antisocial child (noncompliant, aggressive) may evoke certain responses from the environment (harsh, punitive parenting)
individual’s genes make the selection of certain environments more likely
-personality tends to stabilize (become fixed) as we age because we have created niches for ourselves (ex. introversion vs. extraversion)
provocative
environment (diet, stressors, behaviors, experiences) can affect how genes are expressed (ex. turning them on or off)
epigenetics
some genes will ___ express themselves unless in a certain environment
-and, some environments may have ___ effect unless the genetic predisposition is there
never ; little
if someone has a predisposition to alcohol abuse, but lives in an environment in which alcohol is prohibited, they will likely not develop alcoholism
ex. of epigenetics
how are neurotransmitters related to psychopathology?
almost all current psychiatric drugs impact one or more neurotransmitters
functions of neurotransmitters (study by introducing three classifications):
- agonist
- antagonist
- inverse agonist
increase activity by mimicking its effects
agonist
decrease or block a neurotransmitter
antagonists
produce effects opposite to those produced by a neurotransmitter
inverse agonist
this neurotransmitter regulates behavior, mood, and cognition
serotonin
disinhibition, emotional reactivity, and impulsivity are linked to ___ levels of serotonin
low
serotonin is related to ___, ___, ___, and ___
aggression, suicide, depression, and over-eating
treated with ___
SSRIs (selective serotonin reuptake inhibitors)
ex. of SSRIs
prozac, celexa, paxil, zoloft
SSRI would be a serotonin ___
agonist
excitatory transmitter (causes action)
glutamate
this neurotransmitter reduces postsynaptic activity (inhibitory effect) and has a broad influence on mood and behavior
gamma aminobutyric acid (GABA)
this neurotransmitter affects anxiety and arousal in general (reducing anxiety, emotional reactivity, anger, aggression, and positive mood states, too)
gamma aminobutyric acid (GABA)
____ are drugs that are believed to increase GABA
benzodiazepines (ex. valium, xanax, klonopin)
this neurotransmitter increases heart rate and blood pressure (may be active in fight or flight situations)
norepinephrine (noradrenaline)
____ are used for hypertension and to reduce anxiety responses
beta-blockers
blocks beta receptors that are activated by norepinephrine
beta-blockers
this neurotransmitter works as the “switch” that impacts the effects of other neurotransmitters
dopamine
____ implicated in exploratory, reward-seeking behaviors
dopamine
high levels of dopamine are implicated in ____
schizophrenia
hallucinations and delusions will reduce if given a dopamine ___
inhibitor
learning from psychopharmacology and various scanning procedures (fMRI, PET) the function and structure of the brain and what roles they play in psychopathology
relations between the brain and abnormal behavior
____ influences can change brain function (particularly early experiences, with regard to feelings of control, safety, attachment)
psychosocial
therapy…
also changes brain function
psychosocial factors interact with brain ___ and ___
structure and function
ex. identical groups of monkeys
-group 1 has control (when to eat; what toys to play with)
-group 2 has no control (food and toys access determined by group 1)
when given a drug causing strong anxiety, “no control” group ____, and the “control” group became ____
cowered ; became aggressive
neurotransmitters interact with ____ factors to affect current behavior
psychosocial
____ conditioning found that it was not just the pairing of the uncontrolled stimulus and controlled stimulus, but that it had to be consistent
classical conditioning
seligman’s belief that one is helpless to impact life leads to depression
learned helpleessness
the opposite of learned helplessness is true, and has a huge effect on health:
learned optimism
bandura’s ____ is characterized by modeling and observational learning (vicarious learning)
-plays a role in substance abuse, aggression, interpersonal relationships
social learning
according to ____ learning, we are evolutionarily programmed to learn certain things better than others (ex. we fear snakes, heights not trees, rocks) food poisoning - rare case of one time learning
prepared learning
the nature of ___ is to elicit or evoke action (fight or flight; repair damaged relationships; promote the continuation of behavior)
the nature of emotion
short lived, temporary states
emotion
a more persistent, enduring state
mood
momentary emotional tone that accompanies behavior
affect
___/___ are to mood what weather is to climate
affect/emotion
strong link between ___ and ___ with heart disease due to a decreased pumping efficiency for the heart
anger and hostility
all of the basic emotions (fear, anger, sadness, excitement) can be linked to psychological disorders if they occur too ___, without “___,” too ___, or without ___ control
frequently ; “cause” ; strongly ; internal
chronically depressed mood
depression
overly positive, excited mood
mania
strong fear response despite a lack of threatening stimuli
panic
these factors of psychopathology contribute to the influence and expression of behavior
cultural factors
most people across different cultures experience ___ symptoms, but ___ are different
similar ; attributions
contrast european americans with schizophrenia to latinos with schizophrenia
european americans: describe life using terms related to mental illness
latinos: use “nerves” - seen as less pejorative and elicits more sympathy
___ has a strong effect on psychopathology
gender (ex. depression, eating disorders, phobias, antisocial personality disorder)
___ have higher rates of internalizing disorders across cultures (even in more matriarchal societies)
ex. anxiety, depression
women
___ have higher rates of externalizing disorders
ex. antisocial personality, substance abuse
men
social effects on health and behavior:
___ and ___ of social interaction are important
frequency and quality
relationships have a protective quality against both physical and psychological disorders for three reasons:
- give meaning to life
- help us cope with physical and psychological pain
- encourage health-promoting behaviors
___ of social support may be most vital
perceptions
this perspective addresses developmental changes
(different periods of life associated with different challenges that might influence psychological health)
life-span developmental
developmental stage will also influence how disorders are manifested and treated (ex. antisocial men at 50 may look different than at 20)
heterotypic continuity
multiple paths to a given outcome (ex. psychosis)
equifinality
same events (ex. trauma, genes) can lead to different outcomes
multifinality
this field examines the role of the nervous system in disease and behavior
the field of neuroscience
branches of the human nervous system:
central nervous system (CNS) and peripheral nervous system (PNS)
two components of the central nervous system (CNS)
the brain and spinal cord
two branches of the peripheral nervous system (PNS)
somatic and autonomic branches
the autonomic nervous system (ANS) of the peripheral nervous system (PNS) is composed of two divisions:
sympathetic division and parasympathetic division
the neuron is composed of five components:
- soma
- dendrites
- axon
- axon terminals
- synapses
the soma is the ___
cell body
branches that receive messages from other neurons (chemical messages are converted into electrical impulses)
dendrites
trunk of the neuron that sends messages to other neurons
axon
buds at the end of the axon from which chemical messages are sent
axon terminals
small gaps that separate neurons
synapses
neurons are not connected - they are separated by the ___
synaptic cleft
___ are released into the cleft and communicate with the next neuron
neurotransmitters
two main parts of the brain:
brainstem and forebrain
the most ancient part of the brain that is found in most animals and controls basic processes (ex. breathing, sleeping, physical coordination)
brainstem
largest and most recently evolved part of the brain
forebrain
three main divisions of the brain:
- hindbrain
- midbrain
- forebrain
hindbrain consists of three parts:
- medulla
- pons
- cerebellum
this part of the hindbrain regulates heart rate, blood pressure, and respiration
medulla
this part of the hindbrain regulates sleep stages
pons
this part of the hindbrain is involved in physical coordination
cerebellum
this division of the brain coordinates movement with sensory input and contains parts of the reticular activating system (RAS)
midbrain
this part of the midbrain is related to arousal and consciousness; sleep cycles
reticular activating system (RAS)
the forebrain is also referred to as the ___
cerebral cortex
most sensory, emotional, and cognitive processing occurs within this division of the brain, within two specialized hemispheres
forebrain (cerebral cortex)
four lobes of the cerebral cortex:
- frontal
- parietal
- occipital
- temporal
thinking and reasoning abilities and memory are controlled by this lobe of the cerebral cortex
frontal
touch recognition is controlled by this lobe of the cerebral cortex
parietal
this lobe of the cerebral cortex integrates visual input
occipital
this lobe of the cerebral cortex controls recognition of sights, smells, sounds, and long-term memory storage; process complex stimuli
temporal
the hippocampus, amygdala, septum, and cingulated gyrus compose which system?
limbic system
this system is related to emotion, motivation, and memory
limbic system
this part of the brain receives and integrates sensory information
thalamus
eating, drinking, aggression, and sexual activity are controlled by this part of the brain
hypothalamus
the 2 hemispheres of the cerebral cortex are connected by the ___
corpus callosum
this hemisphere deals with visual-spatial processing, visual imagery, and creativity
right
this hemisphere deals with language and reasoning
left
which hemisphere is usually dominant?
left
what are the two branches of the peripheral nervous system (PNS)?
somatic branch and autonomic branch
this branch of the peripheral nervous system (PNS) controls voluntary muscles and movement
somatic branch
the autonomic branch of the peripheral nervous system (PNS) is composed of two branches:
sympathetic and parasympathetic branches of the ANS
these branches regulate the cardiovascular system and body temperature, and regulate the endocrine system and aid in digestion
sympathetic and parasympathetic branches of the ANS
this system of the ANS mobilizes the body during times of stress (fight or flight; heart races, increased respiration, decreased digestion)
sympathetic system
this system of the ANS takes over when not stressed - focuses on restoring energy and equilibrium (increased digestion; slowed breathing and heart rate)
REST AND DIGEST
parasympathetic system
hormones (chemicals) are released into the bloodstream (affect response to stress, growth, metabolism, sexual characteristics)
endocrine system
systematic evaluation and measurement of psychological, biological, and social factors in a person presenting with a possible psychological disorder
clinical assessment
process of determining whether the particular problem afflicting the individual meets all criteria for psychological disorder set forth in the DSM-5
diagnosis
the purpose of clinical assessment (4 components)
- to understand the individual
- to predict behavior
- to plan treatment
- to evaluate treatment outcome
analogous to a funnel
- starts broad
- multidimensional in approach
- narrow to specific problem areas
3 fundamentals to successful assessments
- reliability
- validity
- standardization and norms
degree to which a measure is repeatable and consistent
reliability
across time (test-retest), rather (inter-rater reliability), items (internal consistency)
consistency in measurement
the degree to which a measure captures what it is designed to do (ex. does an IQ test measure intelligence?)
what does the test measure, and how well does it do so
validity
you cannot have validity if you do not have ___
reliability
reliability does not mean that you have ___
validity
reliability is a necessary but ___ sufficient aspect of validity
NOT
the degree to which the content of a test is representative of the domain it is supposed to cover
does the measure capture a full range of concepts?
content validity
___ questions could be a good component of content validity
somatic
a mathematics teacher develops an end-of-semester algebra test for her class
-the test should cover every form of algebra that was taught in the class
-if some types of algebra are left out, then the results may not be an accurate indication of students’ understanding of the subject
-similarly, if she includes questions that are not related to algebra, the results are no longer a valid measure of algebra knowledge
ex. of content validity
scores on the measure are related to other measures of the same construct
is it related to other validated measures of the same construct?
convergent validity
the scores of two tests, one measuring self-esteem and the other measuring extroversion, are likely to be correlated—individuals scoring high in self-esteem are more likely to score high in extroversion
example of convergent validity
the extent to which a measure is related to an outcome
is it related to other constructs that are thought to be related to?
criterion validity
a university professor creates a new test to measure applicants’ english writing ability
-to assess how well the test really does measure students’ writing ability, she finds an existing test that is considered a valid measurement of english writing ability, and compares the results when the same group of students take both tests. If the outcomes are very similar
example of criterion validity
scores on the measure are not related to other measures that are theoretically different
-want to show that it has specificity and is more narrowed, correlates to things it should or shouldn’t be related
discriminant validity
the scores of two tests measuring security and loneliness theoretically should not correlate
example of discriminant validity
extent to which respondents can tell what the items are measuring
does it appear to measure what it is supposed to measure?
“do you feel sad?” is more collaborative with patient, but could be potentially skewed because patient will lie for things knowing what the questions are for
face validity
you create a survey to measure the regularity of people’s dietary habits
-you review the survey items, which ask questions about every meal of the day and snacks eaten in between for every day of the week
-on its surface, the survey seems like a good representation of what you want to test
example of face validity
the success with which a test predicts the behavior it is designed to predict; it is assessed by computing the correlation between test scores and the criterion behavior
does it predict important and relevant outcomes?
predictive validity
SAT scores are considered predictive of student retention: students with higher SAT scores are more likely to return for their sophomore year
example of predictive validity
the degree to which a test measures the construct, or psychological concept or variable, at which it is aimed; context dependent
construct validity
which measure of validity is most important?
construct validity
there is no objective, observable entity called “depression” that we can measure directly, but based on existing psychological research and theory, we can measure depression based on a collection of symptoms and indicators, such as low self-confidence and low energy levels
example of construct validity
-foster consistent use of techniques
-provide population benchmarks for comparison
standardization and norms
examples of ___ and ___ include: administration procedures, scoring, and evaluation of data and IQ tests
standardization and norms
an interview method in which the researcher uses a flexible, conversational style to probe for the participant’s point of view
clinical interview
the most common clinical assessment method
clinical interview
no fixed set of questions and no systematic scoring procedure - involves asking probing questions to find out what the applicant is like
unstructured interview
this interview method is most commonly used for time and convenience (could lead to a misdiagnosis)
unstructured interview
there is a list of questions that have been worked out in advance, but interviewers are also free to ask follow up questions when they feel it is appropriate
semi-structured interview
this interview method is less spontaneous and feels less natural and takes more time (commonly used in for research purposes)
semi-structured interview
interview in which the researcher has determined what questions are important, the order in which they will be asked, and how they will be structured (no departure, and you cannot ask to clarify)
fully structured interview
college students could use this interview method since they do not have the expertise
fully structured interview
8 questions that should be asked in an interview:
- presenting problem (when it started, participating in events)
- current and past behavior relevant to the problem
- detailed history including trauma and abuse
- educational history
- work history
- romance
- substance abuse
- past psychological and physical problems; treatment used
this domain of assessment utilizes pictures of the brain
neuroimaging
two types of examinations of the brain:
structure and function
this examination of the brain assesses whether there is damage; size of various parts
structure
this examination of the brain assesses what parts are functioning during specific tasks; looks at blood flow
function
two imaging techniques used to assess brain structure:
computerized axial tomography (CAT or CT scan) and magnetic resonance imaging (MRI)
this scan utilizes x-rays of brain; pictures in slices
computerized axial tomography (CAT or CT scan)
does MRI have better resolution than CAT scan? or vice versa?
MRI has better resolution than CAT
this imaging technique operates via a strong magnetic field around the head
-more expensive, more time-consuming, and difficult for certain patients to tolerate
magnetic resonance imaging (MRI)
three imaging techniques used to assess brain function:
- positron emission tomography (PET)
- single photon emission computed tomography (SPECT)
- functional MRI (fMRI)
- provide detailed information regarding brain function
- procedures are expensive; lack adequate norms
- procedures have limited clinical utility
advantages and limitations of imaging techniques that assess brain FUNCTION
methods used to assess brain structure, function, and activity of the nervous system
psychophysiological assessment
- electroencephalogram (EEG)
- heart rate and respiration
- electrodermal response and levels
- electromyography (EMG)
- penile plethysmograph
psychophysiological assessment domains
electroencephalogram (EEG) measures
brain wave activity
heart rate and respiration measures
cardiorespiratory activity
electrodermal response and levels measure
sweat gland activity
electromyography (EMG) measures
muscle tension
penile plethysmograph measures
sexual arousal
when is a penile plethysmograph used?
in instances where someone may not be willing to report sexual arousal
clinical assessment vs. psychiatric diagnosis:
assessment is an ___ approach
idiographic approach
this approach emphasizes what is unique to this person (personality traits, family, background, culture, or other circumstances)
idiographic approach
clinical assessment vs. psychiatric diagnosis:
diagnosis is a ___ approach
nomothetic approach
this approach applies what we know about a person to what we know about people more broadly
-seeing if specific problems fit with a general class of problems
nomothetic approach
is clinical assessment or psychiatric diagnosis more important in treatment planning and intervention?
both are important
diagnostic classification:
-classification is ___ to all sciences
-develop categories based on ___ attributes
central ; shared
terminology of classification systems:
___ is classification in a scientific context
taxonomy
terminology of classification systems:
___ is taxonomy in psychological/medical contexts
nosology
terminology of classification systems:
___ is nosological labels (ex. panic disorder)
nomenclature
two widely used classification systems used to diagnose and classify psychological disorders:
international classification of diseases and health related problems (ICD-11) and diagnostic and statistical manual of mental disorders (DSM)
the international classification of diseases and health related problems (ICD-11) is published by the ___
world health organization
the diagnostic and statistical manual of mental disorders (DSM) is published by the ___
american psychiatric association
what is the most current version of the DSM?
DSM-5 (2013)
the nature and forms of classification systems:
3 approaches:
- classical (or pure) categorical approach
- dimensional approach
- prototypical approach
the nature and forms of classification systems:
classical (or pure) approach pertains to:
categories
- yes/no decisions
- each disorder viewed as fundamentally different from others
- clear underlying cause
- individual required to meet all requirements for classification
- viewed as inappropriate to complexity of psychological disorders
characteristics of the classical (or pure) approach
individual required to meet all requirements for classification
monothetic
is the classical (or pure) categorical approach monothetic or polythetic?
monothetic
the dimensional approach is characterized by classification along ___
dimensions
- symptoms or disorders existing on a continuum (ex. 0 to 100)
- patient might be mildly depressed (60) and moderately anxious (70)
- create a profile to represent person’s functioning
- no aggreement on number of dimensions or which dimensions required
4 characteristics of the dimensional approach
the prototypical approach is both:
classical and dimensional
- categorical (yes/no decisions) but individual does not have to for every symptom
- rather, patient must meet some minimal number of prototypical criteria (ex. 5 of 9 depression symptoms)
characteristics of the prototypical approach
is the prototypical approach monothetic or polythetic?
polythetic
(creates within-category heterogeneity and presumes homogeneity within the “yes” and “no” group)
3 purposes of the DSM system:
- aid communication
- evaluate prognosis and need for treatment
- treatment planning
evolution of the DSM:
these two versions, between these two times, relied on unproven theories and were unreliable
-very freudian - very psychoanalytically driven
-did not have the complex symptom list that they do now
DSM-I (1952) and DSM-II (1968)
evolution of the DSM:
DSM ___ through DSM ___
-atheoretical, emphasizing clinical description, not underlying etiology
-detailed criterion sets for disorders
-emphasis on reliability (inter-rater; test-retest)
-questions about validity (many decisions were not empirical - why have to have 4 panic attacks in a 4 week period; why have to be depressed for 2 weeks; why 5 of 9 depression symptoms?)
DSM-III (1980) through IV (2000)
evolution of the DSM:
this version of the DSM emphasizes the understanding that many (most) symptoms are not specific to a single disorder, but cut across many disorders (ex. anxiety, depression, suicidal ideation)
-introduction of new dimensional measures that exist across disorders
DSM-5 (2013)
-what problems cause distress or impair functioning?
-why do people behave in unusual ways?
-how can we help people behave in more adaptive ways?
questions driving a science of psychopathology
basic components of research:
research starts with a ___
hypothesis
true or false: all hypotheses are testable
false
true or false: a scientific hypothesis must be testable
true
can hypotheses be rejected or accepted?
yes
research design is a method to test ___
hypotheses
the variable that causes or influences behavior
independent variable
the behavior is influenced by the independent variable
dependent variable
ex. “exercise reduces depression”
what are the independent and dependent variables?
independent variable: exercise
dependent variable: ratings of depression
did the independent variable produce the outcomes?
-did you do the study in a competent way so you can have faith in its conclusions?
internal validity
are the findings generalizable (ex. to other settings, other locations, other types of samples, other problems)?
external validity
must have ___ validity before external validity
internal validity
how can you increase internal validity?
by minimizing confounds
factors that might make the results uninterpretable
confounds
individuals not exposed to independent variable but are like the experimental group in every other way
control group
individuals are assigned to either experimental group or control group randomly; avoid some systematic bias
random assignment procedures
study related phenomenon in controlled conditions of laboratory setting (ex. alcohol)
analog models
relation between internal and external validity
can be at odds
-want to control any confounds that could impact results
-BUT, also want results to generalize to the “real world”
researchers work hard to balance these competing needs by:
conducting multiple studies
these methods help protect against biases in evaluating data
statistical methods
are these results due to chance?
statistical significance
3 components of statistical significance:
- size of effect (correlation; difference in means)
- level of significance
- sample size
are the results clinically meaningful?
clinical significance
does statistical significance imply clinical meaningfulness?
no
extensive observation and detailed description of a client
-foundation for early developments in psychopathology
nature of the case study
- lack scientific rigor and suitable controls
- internal validity is typically weak
- often entails numerous confounds (finding unique to individual ; more inference from “researcher”)
limitations of case study
statistical relation between two or more variables
-no independent variable is manipulated
the nature of correlation
a problem of directionality (ex. breakups and depression) exists between ___ and ___
correlation and causation
true or false: correlation does not mean causation (ex. smoking and drinking)
true
nature or correlation and strength of association:
-rank from ___ to ___
___ vs. ___ correlation
rank from -1 to 1
negative vs. positive correlation
why use correlation studies?
in instances where you can’t randomly assign individual to groups and can’t manipulate the independent variable
this form of research studies incidence, prevalence, and course of disorders - looking for clues about the disorder
epidemiological research
number of new cases during a specified time
incidence
number of people with a disorder at any given time
prevalence
more or less common in certain populations
distribution
epidemiological research examines what factors are associated with ___
-ex. gender, socioeconomic status, certain behaviors
frequency
the goal of epidemiological research
to find clues as to the etiology of disorders
the nature of experimental research: 4 components
- manipulation of independent variables (ex. therapy or no)
- random assignment
- attempt to establish causal relationship
- premium on internal validity
____ are necessary to show that independent variable is responsible for observed changes
control groups
should the control group be nearly identical to the treatment groups?
yes
what does the placebo group ensure regarding treatment?
that the treatment effect is not due to an expectation that one will improve
placebo is easy to do with ___, but less so with ___ treatment
medications ; psychological treatment
within this control, both researchers and participants are unaware of their group assignment
double blind
this is often the next step after showing that treatment is better than placebo
type group design
dismantling studies (breaking study into parts and removing or focusing on certain aspects) is necessary to figure out the “___” components of the treatment
“active”
this type of treatment design compares different forms of treatment in similar persons (psychotherapy vs. medication vs. combination)
-addressed treatment outcome (did change occur)
comparative treatment designs
-systematic study of individuals under a variety of conditions
-rigorous study of single cases: manipulations of experimental conditions and time
-repeated measurement (rather than just once before and after)
-premium on internal validity
nature of single subject design
two types of single subject design:
withdrawal design and multiple baseline design
3 components of withdrawal design:
- baseline
- treatment
- withdrawal
gives psychologists a better sense if treatment causes changes
assets of the withdrawal design
involves removing a treatment that might be helpful; risking relapse; learning that it is impossible to “withdraw” most psychological treatments (once learned, can’t force a patient to unlearn them)
liabilities
this type of single subject design is characterized by not starting and stopping treatment, but rather starting intervention at different times across settings or behaviors
multiple baseline design
assets of multiple baseline design
don’t have to withdraw treatment
liabilities of multiple baseline design
still making conclusion of the basis of a small number of people
this research strategy examines the interaction among genes, experience, and behaviors
genetic research strategies
genetic research strategies examine the relationship between
phenotype (observable characteristics or behaviors) and genotype (genetic make-up)
4 strategies used in genetic research:
- family studies
- adoptee studies
- twin studies
- genetic wide association studies
this genetic research strategy examines the behavioral pattern/emotional traits in family members
family studies
problem with family studies
cannot distinguish between environmental and genetic factors
this genetic research strategy allows separation of environmental and genetic factors (are children more like adoptive parents or biological parents?)
adoptee studies
there are a number of studies looking at ___ via adoption studies
crime
does research suggest some heritable component for crime?
yes
this genetic research strategy evaluates psychopathology in fraternal vs. identical twins
twin studies
risk of developing schizophrenia (given the other twin has it) for both monozygotic and dizygotic twins:
mono: 48%
di: 17%
this genetic research strategy locates the site of related genes
genetic wide association studies
studying behavior over time may help us understand ____ factors for the manifestation of a disorder
precipitating factors
studying behavior over time is important in two forms of research:
prevention research and treatment research
study of risk factors for development of disorder (biological, psychological, environmental)
importance of studying behavior for prevention research
what helps individuals recover? (ex. psychoeducation, emotional support, medication, behavioral activation)
importance of studying behavior for treatment research
two types of time-based research strategies:
cross-sectional designs and longitudinal designs
this experimental design takes a cross selection of the population across different age groups and compares on a certain characteristic
cross-sectional design
is a cross-sectional study easier or harder than a longitudinal study? does it take more or less time?
easier ; less
cross-sectional designs are ___, meaning that all assessments are at the same time
all concurring
participants in each age group
cohorts
confounding effect of age and experience
cohort effect
what is a major limitation of cross-sectional designs?
cohort effect
2 limitations of cross-sectional designs
- tell us little about how problems develop
- can tell us that two variables are related, but not causal information
this experimental design follows one group over time and assesses changes in individuals
longitudinal design
is there a cohort effect problem within longitudinal designs?
no ; no cohort effect problem
this experimental design gets us closer to understanding causality (order of relationship, depression leads to fewer friends vs. fewer friends leads to depression)
longitudinal design
5 problems with longitudinal design:
- takes a long time to do
- expensive
- must worry about patient attrition
- study topic may no longer be relevant by the time the study is complete
- cross-generational effect
people leaving the study
attrition
may not be possible to generalize study effects to other groups whose experiences are quite different
cross-generational effect
true or false: good internal validity does not equate to good external validity
true
what is the ‘cohort effect equivalent’ of longitudinal designs?
cross-generational effect
value of cross-cultural research: (2)
- can be informative
- overcomes ethnocentric research
how is studying abnormal behavior from various cultures informative?
tells us about origins and treatment of disorders from different perspectives
- clarify how psychopathology manifests in different ethnic groups (same terminology may “look” or “feel” very different across cultures
- different thresholds for abnormal behavior
- treatment exists within cultural context
3 issues in cross cultural research
components of a research program:
true or false: no one study will definitively answer the question
true or false: studies proceed by asking slightly different questions, using slightly different procedures
true ; true
are research programs conducted in stages? do research programs involve replication?
yes ; yes
scientific knowledge typically builds incrementally or radically?
incrementally
what is vital for a research program?
replication
difference between anxiety and fear
anxiety is a future oriented mood state, while fear is a present-oriented mood state
how is anxiety characterized?
marked negative effect
anxiety is characterized by ___ symptoms of tension
somatic (ex. headache, muscle ache, gastrointestinal issues)
apprehension about future danger or misfortune
anxiety
fear is characterized by an immediate ___ or ___ response to danger or threat
fight or flight
fear is characterized by strong ___/___ tendencies
avoidance/escapist
fear abruptly activates the ___ nervous system
sympathetic
true or false: anxiety and fear are normal emotional states
true
3 characteristics of anxiety disorders:
- psychological disorders
- excessive avoidance and escapist tendencies
- causes clinically significant distress and impairment
pervasive and persistent symptoms of anxiety and fear
psychological disorders
abrupt experience of intense fear or discomfort accompanied by several physical symptoms
panic attack
2 types of panic attacks, according to the DSM-5
expected and unexpected
this panic attack happens in context of obvious cue or trigger
expected panic attack
this panic attack happens in context devoid of clear cue or trigger
unexpected panic attack
is panic disorder characterized by unexpected or expected panic attacks?
both
this type of panic attack may be seen more in phobias
expected
true or false: panic attack specifier can be used for any diagnosis in DSM-5, anxiety or other (ex. depression with panic attacks)
true
how common are panic attacks? what is the 12 month prevalence?
pretty common ; 11%
how can ‘specifier’ be remembered?
as toppings on a pizza - can be added on
biological contributions to anxiety and panic:
diathesis-stress
- inherit vulnerability for anxiety and panic, not disorders
- stress and life circumstances activate vulnerability
two biological causes and inherent vulnerabilities of anxiety and panic
- anxiety and brain circuits
- behavioral inhibition system
3 anxiety and brain circuits
GABA, noradrenergic, and serotonergic system
lower levels (GABA, serotonin) =
more anxiety
activated by signals from brain stem of unexpected events, such as major changes in bodily functioning, that might signal danger
behavioral inhibition system
what type of measures are used within the behavioral inhibition system?
self-report measures
when the ___ is activated, we tend to “freeze,” experience anxiety, and anxiously evaluate the environment for signs of danger
behavioral inhibition system (BIS)
true or false: the behavioral inhibition system is thought to be distinct from circuit involved with panic
true
when this system is aroused, it produces an immediate “alarm and escape” response
fight or flight system
how may environmental factors change the sensitivity of brain circuits?
causing one to be more or less apt to develop an anxiety disorder
this psychologist believed that anxiety is a psychological reaction to danger (but tied to early infant/childhood fears)
freud
this view characterizes anxiety and fear as a result from classical and operant conditioning and modeling (vicarious learning)
behaviorist view
early experiences with uncontrollability and/or unpredictability
-parents can, through their behavior, pass on lesson that the child had some impact on their environment, AND that the child can cope with a world that is unpredictable
psychological view
is comorbidity common across anxiety disorders?
yes
approximately ___% of patients with an anxiety disorder have another secondary diagnosis
50%
what is the most common secondary diagnosis for anxiety disorders?
major depression
excessive uncontrollable anxious apprehension and worry about a number of events of activities; worry and anxiety interfere with ability to function and/or cause distress
generalized anxiety disorders
to be diagnosed with GAD, symptoms must persist for ___ months or more
6 months
to be diagnosed with generalized anxiety disorder (GAD), an individual must have 3+ of the following symptoms: (6 total)
- restlessness
- easily fatigued
- difficulty concentrating/mind going blank
- irritability
- muscle tension
- sleep disturbance
differences between generalized anxiety disorder (GAD) and “normal worry”
more or less pervasive and distressing?
more pervasive and distressing
differences between generalized anxiety disorder (GAD) and “normal worry”
lasts longer or shorter?
lasts longer
differences between generalized anxiety disorder (GAD) and “normal worry”
occurs with or without triggers
occurs without triggers
differences between generalized anxiety disorder (GAD) and “normal worry”
do worries come with or without physical symptoms?
with physical symptoms
differences between generalized anxiety disorder (GAD) and “normal worry”
associated with ___ symptoms, such as GI distress and exaggerated startle response
somatic
generalized anxiety disorder (GAD) affects ___% of the general population
3%
females outnumber males approximately ___:___ with GAD
2:1
GAD onset is often
insidious
median age of onset for GAD
30
GAD presence ___ in middle age, and ___ later in life
peaks ; declines
symptoms of GAD tend to ___ and ___ across life ; full remission is ___
wax and wane ; rare
___ onset of GAD is associated with greater comorbitity and impairment
earlier
genetic factors account for ___% of the variability of GAD
30%
temperamental factors of GAD:
___ behavioral inhibition; neuroticism
-adults who develop GAD were more emotionally-fragile children
high
are environmental factors that cause GAD clear?
no
cognitive factors of GAD
highly sensitive to threat
treatment of GAD:
are drug or psychological interventions effective?
both
2 medications used in treatment for GAD:
benzodiazepines and antidepressants
help provide immediate, short-term relief for GAD
-impairs motor and cognitive functioning, can produce dependence (psychological and physical)
-abuse potential
benzodiazepines
proving useful in treatment of GAD
-lower side effects
antidepressants
this form of treatment for GAD has better long-term benefits
-cognitive-behavioral therapy evokes and confronts anxiety provoking images and thoughts by challenging automatic, “irrational” thoughts that lead to anxiety
psychological treatment
recurrent unexpected panic attacks (discrete period of intense fear or discomfort with four or more symptoms (palpitations, sweating, trembling, sensation of shortness of breath, choking, chest pain, chills, or heat sensations, numbness/tingling, nausea, feeling dizzy, fear of dying))
panic disorder
at least one of the attacks must be followed by 1 month or more of one or both:
- persistent worry about having additional attacks or their consequences
- significant maladaptive change in behavior related to attacks
12 month prevalence of panic disorder
2-3%
___/___ with panic disorder are female
2/3
onset of panic disorder is often
acute
when does onset of panic disorder begin?
between ages 20 to 24
symptoms of panic disorder often ___ and ___ over lifespan, but tends to be ___ (if untreated)
wax and wane ; chronic
waking from sleep while experiencing panic symptoms; not usually due to dreams
nocturnal panic attacks
associated features of panic disorder:
are general physical/health concerns typical or atypical among those with panic disorder?
typical
associated features of panic disorder:
true or false: those with panic disorder tend to be sensitive to medication side effects
true
associated features of panic disorder:
do people with panic disorders have concerns about ability to function due to panic?
yes
associated features of panic disorder:
is there any link between substance use and controlling panic?
may see excessive substance use to control panic
associated features of panic disorder:
true or false: those with panic disorder avoid panic cues (ex. exercise)
true
true or false: individuals with panic disorder have a biological predisposition to be “over-reactive” to life’s events. some will have an “emergency alarm reaction” (ex. heart racing, sweating, breathing heavily) as a response to a stressor
true
medication treatment of panic disorder targets 3 systems:
serotonergic, noradrenic, and benzodiazepine GABA
what are the preferred drugs used in the treatment of panic disorders?
SSRIs
are relapse rates high or low for individuals with panic disorder after medication discontinuation?
high
what type of psychological treatment is highly effective for panic disorder?
cognitive-behavioral therapy
not going out in crowded places
agoraphobia
true or false: it is helpful to create panic (mini-panic attacks) in cognitive-behavioral therapy sessions as exposure for those with panic disorder
true
this therapy alone creates the best long-term outcome for those with panic disorder
cognitive-behavior therapy
characterized by an extreme and irrational fear of a specific object or situation
-this object/situation almost always provokes intense fear and anxiety
-fear is out of proportion with actual danger
-causes significant distress/impairment
-still go to great lengths to avoid phobic objects or endures with great distress
specific phobia
12 month prevalence of phobia
7-9% (one of the most prevalent)
this phobia has an entirely different physiological response (drop in blood pressure and heart rate)
-may have strongest heritability
-unique susceptibility to fainting
blood-injury-injection phobia
phobia of public transportation or enclosed placees (ex. planes)
situational phobia
phobia of events occurring in nature (ex. heights, storms)
natural environment phobia
phobia of animals and insects
animal phobia
these phobias do not fit into the other categories (ex. fear of choking, vomiting, clowns, etc.)
other phobias
is direct conditioning a cause of phobia?
yes
is experiencing a panic attack in a specific situation a cause of phobia?
yes
true or false: observing (vicarious learning) someone else’s fear is a cause of phobia
true
is information transmission (being told about danger) a cause of phobia?
yes
more likely to develop fear for certain objects - an inherited tendency to fear things that have always been dangerous to humans (ex. snakes, storms, heights)
biological and evolutionary vulnerability
___ are highly effective in treating phobias
cognitive-behavioral therapies
this type of therapy builds an anxiety hierarchy, and can use counter-conditioning and modeling
-uses SUDS
exposure therapy
subjective units of distress
SUDS
marked fear/anxiety about one or more social situations in which individual is exposed to scrutiny/judgment of others
social anxiety
social anxiety is most common in ___/___ situations (ex. speaking, eating, using restroom, writing, typing)
social/performance
true or false: social situations must almost always provoke fear or anxiety for one to be diagnosed with social anxiety
true
out of proportion fear from social anxiety causes distress and impairment ; must last for ___ months or more
6 months
12 month prevalence of social anxiety
7%
are females or males slightly more represented than males? the ratio is close to ___:___
females ; 2:1
when does onset for social anxiety usually occur? majority have it onset between ___ and ___ years
adolescence ; 8 to 15 years
evolutionary vulnerability to social anxiety
evolved to fear disapproving faces
some individuals born with a shy, inhibited temperament. introverted individuals are chronically more aroused and thus need less stimulation. social/performance experiences may cause over-arousal
biological vulnerability to social anxiety
taught that social evaluation is important and/or dangerous via direct conditioning, observational learning, or information transmission
psychological factors that can cause social anxiety
4 medication treatments of social anxiety
- beta blockers
- tricyclic antidepressants
- monoamine oxidase inhibitors
- SSRI paxil
this blood-pressure medication dampens the fight or flight response, but is somewhat ineffective
-can be taken before giving a big talk
beta blockers
this medication reduces social anxiety (have to be on it for several weeks for it to be effective)
tricyclic antidepressants
this medication reduces anxiety
monoamine oxidase inhibitors
this medication is FDA approved for social anxiety disorder
SSRI Paxil
are relapse rates for social anxiety high or low following medication discontinuation?
high
are cognitive-behavioral therapies effective for social anxiety?
highly effective
what appears to be the most important component within cognitive-behavioral therapy for social anxiety disorder?
exposure portion
persistent, recurrent, and intrusive thoughts, images, or urges that one tries to resist or eliminate
-ex. “did i turn my stove off, did i turn my stove off…”
obsessions
feels intrusive and out of one’s own control. not consistent with “regular” thought content
ego-dystonic
repetitive thoughts or actions that a person feels driven to perform or according to rigid rules
compulsions
goal of compulsions
to prevent or reduce distress associated with the obsession
3 specifiers for OCD:
- good to fair insight
- poor insight
- absent insight/delusional
recognizes OCD beliefs may not be true
good to fair insight
OCD beliefs probably true
poor insight
convinced OCD beliefs are true
absent insight/delusional
12 month prevalence of OCD:
1.2%
most people with OCD are ___ (although more ___ have the disorder in childhood)
female ; males
OCD tends to be ___, especially if untreated
chronic
onset is typically in early ___ or ___ (mean age = 20)
-high comorbidity with ___ disorders
adolescence or adulthood ; tic disorders
are genetic factors a probable cause of OCD?
yes
is lower or greater neuroticism a cause of OCD?
greater neuroticism
having the thought becomes equated with the action
-ex. i thought about hitting that woman with my car - “i hit that woman with my car”
thought action fusion
medication treatment of OCD:
clomipramine and other SSRIs benefit about ___%
60%
___ is used as a medication treatment for OCD in extreme cases
psychosurgery (lesion the brain only used in extreme cases)
is relapse common or uncommon with medication discontinuation for OCD?
common
this psychological treatment for OCD is most effective
cognitive-behavioral therapy
CBT for OCD involves ___ and ___ prevention
exposure and response prevention
requires exposure to actual or threatened death, serious injury, or sexual violence: directly experiencing events; witnessing, in person events; learning of events that occurred to close family member/friend; experiencing repeated or extreme exposure to aversive details of traumatic events
post traumatic stress disorder (PTSD)
recurrent, intrusive, involuntary memories; distressing dreams; dissociative reactions (flashbacks), intense distress at cues of events (internal or external) physiological reactions to cues
intrusive symptoms of PTSD
is the avoidance of stimuli associated with events common for those with PTSD? (memories, thoughts, feelings associated with events ; reminders of events)?
yes
inability to remember important details; exaggerated negative beliefs about oneself, others; world; distorted cognitions about cause (ex. blame), negative emotional states, diminished interest or participation in significant activities, detachment, or estrangement from others; anhedonia
negative alterations in thoughts or mood associated with PTSD
loss of ability to feel pleasure
anhedonia
irritability/anger; recklessness/self-destructive behavior; hypervigilance; exaggerated startle; sleep and concentration problems
alterations in arousal/reactivity associated with traumatic events
to be diagnosed with PTSD, disturbance must last ___ month or more
1 month
PTSD specifier:
with dissociative symptoms
2 dissociative symptoms
depersonalization and derealization
feel detached from oneself and one’s thoughts/feelings; behaviors
depersonalization
lifetime prevalence vs. 12 month prevalence of PTSD
lifetime = 8.7%
12 month = 2.5%
higher rates of PTSD among
veterans, certain vocations (police, EMT), survivors of rape, combat, captivity, etc.
when do symptoms of PTSD usually begin?
within 3 months trauma, although delayed expression is not uncommon
childhood emotional problems, other mental disorders; lower education, lower socioeconomic status, prior trauma, lower intelligence, female gender and younger age at time of trauma
risk factors of PTSD prior to trauma
severity of trauma, perceived life threat, personal injury, dissociation. for veterans, killing the enemy, witnessing atrocities
-peri trauma factors
risk factors for PTSD during trauma
cognitive-behavioral treatment involving graduated or massed imaginal exposure (re-experience event in safe, controlled environment)
psychological treatment of PTSD
___ may be effective in reducing the anxiety and panic associated with PTSD
SSRIs
4 types of depressive disorders
- major depressive disorder
- persistent depressive disorder (dysthymia)
- premenstrual depressive disorder
- disruptive mood dysregulation disorder
this depressive disorder has a longer duration, but less severe symptoms
persistent depressive disorder (dysthymia)
this depressive disorder refers to children who have a lot of temper tantrums
disruptive mood dysregulation disorder
3 bipolar and related disorders
- bipolar I disorder
- bipolar II disorder
- cyclothymic disorder
5 or more symptoms present during the same 2-week period and represent a change from previous functioning. At least one must be depressed mood or loss of interest/pleasure
-depressed mood most of day, nearly every day
-marked diminished interest or pleasure in all, or most activities
-significant weight loss when not dieting or gain or decrease/increase in appetite
-insomnia or hypersomnia nearly every day
-psychomotor agitation or retardation (observable to others)
-fatigue or loss of energy
-feelings of worthlessness or excessive/inappropriate guilt
-diminished ability to think clearly or concentrate; indecisive
recurrent thoughts of death, suicidal ideation, or attempt
-single episode - relatively unusual
-recurrent episodes (must be separated by two months during which criteria not met) - more common
major depressive disorder
recurrence of major depressive disorder is higher in ___ individuals, people whose last episode was ___, and people who have already had ___ episodes
younger ; severe ; multiple
depressed mood most of the day, more days than not, for at least 2 years (1 for children/adolescents)
-milder or fewer symptoms
2 of the following: poor appetite or overeating; insomnia or hypersomnia; low energy/fatigue; low self-esteem; poor concentration; difficulty making decisions; feelings of hopelessness
-can persist unchanged over long periods - greater than or equal to 20 years
dysthymia (persistent depressive disorder)
onset for dysthymia
early onset - before age 21
true or false: there is greater chonicity, poorer prognosis, and more comorbid diagnoses (ex. personality disorders, substance use) for dysthymia
true
in majority of cycles, 5 symptoms in final week before onset of menses; start to improve after onset of menses, minimal or absent in week postmenses
-affective lability (mood swings)
-irritability; anger; interpersonal conflict
-depressed mood; hopelessness
-anxiety; tension
-decreased interest in activities
-poorer concentration
-lethargy; lack of energy
-change in appetite and sleep
-feel overwhelmed or out of control
-physical symptoms (bloating; tenderness)
premenstrual dysphoric disorder
prevalence of premenstrual dysphoric disorder over 12 months
2.6%
treatment for premenstrual disorder (3)
SSRIs, cognitive-behavioral therapy, birth control pill
essential feature of bipolar I disorder
occurrence of one or more manic episodes or mixed episodes (depression and mania)
-individuals typically have or will experience a major depressive episode
distinct period of elevated, expansive, or irritable mood and abnormally increased goal directed activity or energy: (1 week)
mania
to be diagnosed with bipolar I disorder, individuals must portray ___ of the following symptoms:
-inflated self-esteem or grandiosity
-decreased need for sleep
-more talkative; pressured speech
-flight of ideas; racing thoughts
-distractibility
-increase in goal-directed behavior
-excessive involvement in pleasurable activities
3 or more
average age of onset for bipolar I disorder
18 years
___% or more of individuals with one manic episode have recurrent mood episodes
90%
true or false: bipolar I disorder tends NOT to be chronic
false
suicide rate for people with bipolar I disorder verses the general population
15x higher for those with bipolar I
key difference between bipolar I and bipolar II
mania - bipolar I
hypomania - bipolar II
in order to be diagnosed with bipolar II disorder, individuals must
meet criteria for current or past hypomanic episode and current or past depressive episode
main difference from mania is that the symptoms aren’t severe enough to cause serious impairment or hospitalization
hypomania
true or false: individuals with BP-II usually come to treatment because of depression
-learn of hypomania later on (often from informants)
-many don’t receive BP-II diagnosis until after experiencing multiple depressive episodes
true
average age of onset for BP-II
mid 20s, but can begin in childhood
true or false: most people with BP-II progress to full BP-I
false
___% to ___% of BP-II cases progress to BP-I
5% to 15%
does BP-II tend to be chronic and impairing?
yes
is suicide risk for BP-II lower or higher than that for BP-I?
equally high
more chronic version of bipolar disorder (2 years or more; 1 if child/adolescent)
-numerous periods of hypomanic symptoms (that don’t meet full criteria for hypomania) and depressive symptoms (that don’t meet the criteria for major depression)
-manic or depressive mood states are present for at least half of the time (without remitting for greater than 2 months)
cyclothymic disorder
additional defining criteria for mood disorders: symptom specifiers
tense; restless; worry; catastrophic thoughts; concerns for one that will lose control
anxious distress
additional defining criteria for mood disorders: symptom specifiers
symptoms of mania or hypomania during depressive episodes (ex. grandiosity; more talkative; increased energy)
mixed features
additional defining criteria for mood disorders: symptom specifiers
mood reactivity, weight gain/appetite increase, hypersomnia, sensitivity to rejection
atypical
additional defining criteria for mood disorders: symptom specifiers
near absence of pleasure; not reactive to pleasurable stimuli; profound despair, symptoms worse in the morning; EMAs (early morning awakenings); anorexia or weight loss; guilt
melancholic
additional defining criteria for mood disorders: symptom specifiers
absence of movement - very serious
catatonic
additional defining criteria for mood disorders: symptom specifiers
mood congruent or incongruent hallucinations/delusions
psychotic
additional defining criteria for mood disorders: symptom specifiers
depressive episodes during pregnancy or within 4 weeks of childbirth
peripartum
additional defining criteria for mood disorders: symptom specifiers
pattern of relationships between onset of depressive episodes and seasons
seasonal pattern
worldwide lifetime prevalence for major depression
16.1%
worldwide lifetime prevalence for dysthymia
3.6%
worldwide lifetime prevalence for bipolar
1.3%
worldwide lifetime prevalence for cyclothymia
<1%
___ are more likely to suffer from major depression (rate changes after puberty)
females
___ disorders equally effect males and females
bipolar disorders
does the prevalence of depression vary across subcultures?
no
relation between anxiety and depression
most depressed people are anxious, but not all anxious people are depressed
according to family studies, the rate of mood disorders is ___ in relatives of probands
high
the person with the disorder
proband
rate of mood disorders is ___ to ___ times higher in family members of a mood disordered individual
2 to 3
according to twin studies, concordance rates are ___ in identical twins
high
according to twin studies, ___ cases have a stronger genetic contribution
severe
according to twin studies, heritability rates are approximately ___ for men and women
equal
___ regulates other neurotransmitters - most targeted by antidepressants
serotonin
-low serotonin allows other neurotransmitter to vary more substantially and thus become dysregulated (too much or too little), which can lead to mood dysregulation
-balance between neurotransmitters probably more important than absolute levels
the “permissive” hypothesis
endocrine system:
elevated ___ (“stress hormone” ; increases energy, attention ; lowered pain sensitivity)
-may impact depression by reducing the ability to develop new neurons (particularly in the hippocampus)
cortisol
hallmark of most mood disorders
sleep disturbance
enter REM sleep more quickly, experience less slow wave, “deep” sleep
relation between depression and sleep
___ is strongly related to mood disorders
-poorer response to treatment
-longer time before remission
-better predictor of initial episodes than later recurrences
stress
this theory of depression is related to a lack of perceived control over life events
the learned helplessness theory of depression
3 depressive attributional styles:
- internal attributions
- stable attributions
- global attributions
negative outcomes are one’s own fault
internal attribution
believing there is little room for change
stable attributions
believing negative events will have wide-ranging effects
global attributions
all three attributions contribute to a sense of hopelessness but it is the hopelessness that leads to ___
depression
depressed persons engage in cognitive errors
-a tendency to interpret life events negatively
aaron t. beck’s cognitive theory of depression
4 types of cognitive errors:
- arbitrary inference
- overgeneralization
- dichotomous thinking
- personalization
this cognitive error is characterized by overemphasizing the negative
arbitrary inference
this cognitive error is characterized by applying negatives to all situations
overgeneralization
cognitive error characterized by thinking in black or white
dichotomous thinking
cognitive error characterized by believing that others’ behavior is directed at you
personalization
3 components of the depressive cognitive triad (thinking negatively about…)
- think negatively about oneself
- think negatively about the world
- think negatively about the future
females over males for mood disorders ratio of ___:___
2:1
widely used medication - examples include tofranil, elavil
tricyclic medication
this medication blocks trip take (norepinephrine and other neurotransmitters)
tricyclic medications
how long does it take for the effects of tricyclic medications to be known
2 to 8 weeks
are negative side effects common or not common for tricyclic medications? (ex. blurred vision, dry mouth, constipation, weight gain, sexual dysfunction)
common
true or false: tricyclic medications may be lethal in excess doses
true
enzyme that breaks down serotonin/norepinephrine
monoamine oxidase (MAO)
MAO inhibitors ___ monoamine oxidase
block
are MAO inhibitors more or less effective than tricyclics?
slightly more
must avoid foods containing ___ while taking MAO
tyramine
are MAOs frequently or rarely used?
can they interact safely or dangerously with other medications?
rarely ; dangerously
this medication specifically blocks reuptake of serotonin (ex. celexa, lexapro, luvox, paxil, zoloft)
selective serotonergic reuptake inhibitors (SSRIs)
true or false: SSRIs pose no unique risk of suicide or violence
true
are side effects common for SSRIs? (upset stomach, insomnia, physical agitation, sexual dysfunction, or lower sexual desire)
common
are side effects of SSRIs generally more or less tolerable than other antidepressants?
more
a type of mood stabilizer made of common salt found in the natural environment
lithium
primary drug of choice for bipolar disorders
lithium
is lithium best suited in lowering suicide risk?
yes
true or false: antidepressants are often problematic for BP disorders if not paired with a mood stabilizer
true
___ are also commonly used for BP disorders (tegretol and/or depakote)
___ effective at reducing suicide
anticonvulsants ; less
dosage of lithium carefully monitored using ___ tests
side effects may be ___
blood tests ; severe
this psychological treatment of mood disorders addresses cognitive errors in thinking, with the hope of substituting more realistic thoughts
-also includes behavioral components (ex. exercise, increased social activities)
-collaborative, empirical approach
-structured, time-limited; use of homework (thought records)
cognitive therapy (CBT)
this psychological treatment of mood disorders involves increased contact with reinforcing events
behavioral activation
two components of behavioral activation
exercise and increased social contact
this psychological treatment of mood disorders focuses on problematic interpersonal relationships
interpersonal psychotherapy (IPT)
are psychological treatments (CBT and IPT) comparable to medications?
yes
true or false: combined treatment (psychotherapy and medication) may be more useful for chronic depression
true
is maintenance treatment important for the prevention of relapse?
yes
these studies emphasize the role of family tension in relapses
-didactics about illness
-work on family communication
milkowitz studies
what is the 10th leading cause of death in the US (2010)?
suicide
suicide is overwhelmingly a phenomenon among which racial populations?
white and native american
two protective factors for suicide:
- religion (african americans tend to be more religious)
- familial support (more prevalent in african american cultures)
states with the highest rates of suicide:
white, rural, conservative places
-high gun ownership
-mental health more stigmatized
-high white population
-lots of alcohol consumption
are suicide rates very high or low in elderly populations?
very high
are suicide rates higher or lower in those divorced, separated, widowed?
higher ; lowest in those married
most common method of suicide
firearm (50% completed)
gender differences of suicide:
___ are more likely to commit suicide (4-5x) higher
___ are more likely to attempt suicide (3x higher)
males (commit) ; females (attempt)
___ choose more lethal methods (gun, jumping, etc.), while ___ tend more to use pills (more latitude for surviving)
men ; women
suicidal attempts (___:___)
-ratio of attempts to completions
25:1
mental illness is prevalent in ___% of completed suicides
90%
true or false: suicide risk may be 6x higher if family member committed suicide
true ; probably a biological connection
risk factors for suicide:
___ dysregulation (related to depression, impulsivity, and aggression)
serotonin dysregulation
is evidence of a pre existing psychological disorder a risk factor for suicide?
-depression is linked to suicide but redundant - ___ is key
yes ; hopelessness is key
alcohol use and abuse is implicated in ___-___% of suicides
25-50%
is past suicidal behavior a risk factor for suicide?
yes
interpersonal-psychological theory of suicide (joiner)
3 key factors:
- sense of thwarted belongingness
- perception of self as a burden
- acquired capability for suicide
feeling socially isolated and alone is characteristic of
a sense of thwarted belongingness
the belief that others would be better off if individual was not alive is characteristic of
the perception of self as a burden
person must desensitize the thought of death and physical pain
-repeated attempts (the norm) and non-suicidal self-injury may help with both aspects
acquired capability for suicide
professions with high rates of suicide
doctors, vets, first responders, police officers, emts, pilots, army vets, military personnel
treatment intervention for suicide:
(5 characteristics)
- never be afraid to ask about suicide
- well-developed plan?
- means?
- no suicide contract - specific treatment plan
- hospitalization (last resort)
three major types of DSM-5 eating disorders
anorexia nervosa, bulimia nervosa, binge eating disorder
characterized by severe disruptions in eating behavior, and extreme fear and apprehension about gaining weight
eating disorders
do eating disorders have strong sociocultural origins?
yes ; westernized views
what percentage of eating disorders are young females from wealthy families?
90%
a collection of signs and symptoms which is restricted to a limited number of cultures primarily be reason of certain of their psychosocial features
culturally bound syndrome
is anorexia culturally bound?
no ; descriptions of similar syndrome described in other cultures, a long time ago
-AN has been seen in every non-western culture
is bulimia culturally bound?
yes ; exists in non-western cultures, but not in the absence of western influence
what is the hallmark of bulimia?
binge eating
eating excessive amounts of food ; eating is perceived as uncontrollable
binge
compensatory behaviors related to bulimia nervosa:
purging and excessive exercise or fasting
self-induced vomiting, diuretics, laxatives
purging
binge eating and compensatory behaviors occur at least __ a week for ___ months
1 a week for 3 months
most are 10% within normal weight
-purging can result in severe medical problems
-erosion of dental enamel
-electrolyte imbalance of sodium and potassium
-kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
associated medical features of bulimia nervosa
most are overly concerned with body shape
-fear of gaining weight
-between binges, individuals will typically restrict calories and avoid high fat foods and “trigger foods”
-high comorbidity - anxiety, mood, and substance abuse
associated psychological features of bulimia nervosa
what is the hallmark of anorexia nervosa?
successful weight loss
restriction of energy intake relative to requirements that lead significantly low body weight in context of age, sex, developmental trajectory, and health
-defined as 15% below expected weight (DSM-IV)
anorexia nervosa
how does anorexia often begin?
with dieting ; intense fear of obesity
two DSM-5 subtypes of anorexia:
restricting subtype and binge-eating/purging subtype
this subtype of anorexia is characterized by limiting caloric intake via diet, fasting, and excessive exercise
restricting subtype
this subtype of anorexia is like bulimia, but with significant weight loss
binge-eating/purging subtype
marked disturbance in body image
-high comorbidity with other psychological disorders
-weight loss methods have life threatening consequences
-never satisfied with weight - need continuous loss to feel comfortable
associated features of anorexia nervosa
amenorrhea (loss of period)
-dry skin
-brittle nails and hair
-sensitivity to cold temperatures
-lanugo (downy hair on limbs and cheeks)
-cardiovascular problems
medical consequences of anorexia
depression, withdrawal, anxiety, irritability, reduced sex drive (may be secondary to starvation)
psychological consequences of anorexia
this disorder is characterized by engaging in food binges without compensatory behaviors
-perceived loss of control during binges
-binging associated with eating more rapidly, until uncomfortably full, when not hungry, feeling embarrassed about intake, feeling disgusted/guilty after
-distressed about binge eating
binge eating disorder
how often must binge eating occur to be considered binge eating disorder?
once a week for three months
many are normal weight or overweight or obese
-often older than bulimics or anorexics
-more psychopathology vs. non-binging obese people
-concerned about shape and weight
-binging used as a coping mechanism
-no major differences across gender or cultural/racial groups
associated features of binge eating disorder
true or false: majority of those with bulimia are female
true (90%)
onset for bulimia
16-19 years of age
___-___% of college women suffer from bulimia
6-8%
does bulimia tend to be chronic if left untreated?
yes
risk factors for bulimia (2)
childhood obesity and early pubertal onseet
majority of those who have anorexia are:
females from middle-to-upper middle class families
when does anorexia usually develop?
around age 13 or early adolescence
is anorexia more or less chronic and resistant to treatment than bulimia?
more
anorexia is found in ___ cultures
westernized
medical treatment of bulimia nervosa:
___ help reduce binging and purging, but are not efficacious in the long term
antidepressants
psychological treatment of choice for bulimia nervosa
CBT or interpersonal psychotherapy (does not work as fast as CBT)
medical treatment for binge eating disorder
sibutramine (meridian) - used to control hunger
psychological treatment for binge eating disorder
CBT, interpersonal therapy
medical tretament of anorexia nervosa
none exists with demonstrated efficacy
psychological treatment of anorexia nervosa: primary goal
weight restoration
is the longterm prognosis for anorexia better or poorer than bulimia?
poorer
schizophrenia vs. psychosis
psychosis: broad term (ex. hallucinations, delusions)
schizophrenia: a type of psychosis
nature of schizophrenia and psychosis:
this person used the term dementia praecox (premature dementia)
-focused on subtypes of schizophrenia (paranoid, catatonic)
-recognized it as a “disease of the brain”
-recognized that several distinct symptoms appeared to be part of a broader syndrome
-differentiated “dementia praecox” from manic-depressive illness
emil kraepelin
nature of schizophrenia and psychosis:
this person introduced the term “schizophrenia”
-“splitting of the mind” ; inability to keep a consistent train of thought
-described “positive” and “negative” symptoms
eugen bleuler
characteristic symptoms: two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
-delusions
-hallucinations
-disorganized speech (frequent derailment or incoherence)
-grossly disorganized or catatonic behavior
-social/occupational dysfunction
-continuous signs of disturbance for at least 6 months
-not schizoaffective or mood disorder
-not due to substance abuse
DSM-IV diagnostic criteria for schizophrenia
active and obvious manifestations of abnormal behavior, excess or distortion of normal behavior
the positive symptoms of schizophrenia
two positive symptoms of schizophrenia
delusions and hallucinations
distortion in thought content
-erroneous beliefs that usually involve a misinterpretation of perception or experiences. beliefs are typically held very strongly
delusions
the most common delusion
-“the FBI is after me”
persecutory delusion
___ delusion: “when madonna waved to the audience, she was really signaling to me”
referential delusion
___ delusion: “madonna is in love with me”
erotomanic delusion
___ delusion: “my liver is dead and rotting inside me”
somatic delusion
___ delusion: “the world is ending”
nihilistic delusion
___ delusion: “I am the president of the entire world”
grandiose delusion
___ delusions: thought insertion, thought withdrawal, outside forces are controlling one’s body or actions
“bizarre” delusions
experience of sensory events without environmental input
-can experience any sensory mode (auditory, visual, olfactory, gustatory, tactile)
hallucinations
___ are the most common hallucinations; usually in the form of “voices,” familiar or not, that are heard as being distinct from own thoughts
auditory hallucinations
scary form = “___” hallucinations
command hallucinations
___ or more voices conversing or ___ voice keeping a running commentary are considered highly characteristic of schizophrenia
two ; one
absence or insufficiency of normal behavior
the negative symptoms of schizophrenia
spectrum of negative symptoms: (5 A’s)
- avolition (or apathy)
- alogia
- anhedonia
- asociality
- affective flattening
lack of initiation and persistence (ex. lack of hygiene)
avolition (or apathy)
relative absence of speech - may be due to a decrease in thought production
alogia
lack of pleasure, or indifference
anhedonia
limited interest in social interactions
asociality
little expressed emotion
affective flattening
the disorganized symptoms of schizophrenia include severe and excess disruptions in: (3 components)
- speech
- behavior
- emotion
the nature of disorganized speech (3 components)
- tangentiality (going off on a tangent)
- loose associations (conversation in unrelated directions)
- word salad; neologisms (make up new words)
nature of disorganized affect
inappropriate emotional behavior - behavior not consistent with context
ex. of disorganized affect
smiling when talking about death
includes a variety of unusual behaviors (disheveled; odd appearance; inappropriate or unpredictable behavior)
-catatonia (wild agitation, waxy flexibility, immobility)
the nature of disorganized behavior
schizophrenic symptoms for a few months (less than 6; more than 1)
-impaired functioning not required
-some never progress on to schizophrenia, but more do (or schizoaffective disorder)
schizophreniform disorder
symptoms of schizophrenia and a mood disorder (unlike a mood disorder with psychotic features)
-both disorders are independent of one another (at times, you are psychotic when you are not in a mood state)
-prognosis is similar for people with schizophrenia
-such persons do not tend to get better on their own
-need to have delusions and/or hallucinations that are present for at least two weeks in the absence of the mood disorder
schizoaffective disorder
two types of schizoaffective disorder:
bipolar type and depressive type
if mania is part of the presentation
bipolar type
if only major depressive episodes are part of the presentation
depressive type
may reflect a less severe form of schizophrenia
-immense idiosyncrasies
-lies on the schizophrenia spectrum
schizotypal personality disorder
defunct subtypes of schizophrenia: (5 types)
- paranoid type
- disorganized type (hebephrenic)
- catatonic type
- undifferentiated type
- residual type
presence of prominent hallucinations and delusions (usually persecutory or grandeur) but have relatively intact cognitive skills and affect; organized around coherent theme
-do not show disorganized behavior (speech, thought, or affect)
-later onset
-the best prognosis of all types of schizophrenia
paranoid type
classification systems and their relation to schizophrenia:
process vs. reactive distinction
process: insidious onset, biologically based, negative symptoms, poor prognosis
reactive acute onset (extreme stress), notable behavioral activity, best prognosis
past diagnosis of schizophrenia
-absence of prominent delusions, hallucinations, disorganized speech and behavior (positive symptoms have faded, negative symptoms remain)
-continue to display less extreme residual symptoms
residual type
marked disruptions in speech and behavior
-flat or inappropriate affect
-hallucinations and delusions, if present, tend to be fragmented (unlike paranoid type)
-develops early, tends to be chronic, associated with a continuous course without remissions
disorganized type (hebephrenic)
onset of first psychotic episode for men vs. women
men - early to mid 20s
women - late 20s
bimodal distribution for women (second onset in 40s)
when does schizophrenia usually develop?
early adulthood
are positive or negative symptoms more treatable?
positive
schizophrenia affects males and females about equally, but there is a slightly higher prevalence in ___
men
____ tend to have a better long-term prognosis for schizophrenia
females
classification systems and their relation to schizophrenia:
type I vs. type II distinction
type I: positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment
type II: negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments
wastebasket category (if a patient did not fit in another subtype, they would be classified in this way)
-major symptoms of schizophrenia
-fail to meet criteria for another type
undifferentiated type
high comorbidity of schizophrenia with ___ use disorder and ___ disorders
tobacco use disorders and anxiety disorders
what percentage of those with schizophrenia die via suicide? what percentage of those attempt suicide?
5-6% die via suicide ; 20% attempt suicide
____ deficits (ex. working memory) are common and partially explain significant functional impairment
cognitive deficits
true or false: schizophrenia has a weak genetic component
false ; strong genetic component
family studies: inherit a ___ for schizophrenia ; do not inherit specific forms of schizophrenia
tendency
monozygotic twins vs. fraternal (dizygotic) twins risk for schizophrenia:
monozygotic: 48%
fraternal: 17%
according to adoption studies, risk for schizophrenia remains ___ in cases where a biological parent has schizophrenia
high
twin studies: both parents schizophrenic - ___%
one schizophrenic parent - ___%
46% ; 16%
among the most prominent theories of schizophrenia
-drugs that increase dopamine (agonists, amphetamines, L-Dopa) result in schizophrenic like behavior
-drugs that decrease dopamine (antagonists) reduce schizophrenic-like behavior and produce side effects that look like parkinson’s disease, which is known to be related to too little dopamine
the dopamine hypothesis
is the dopamine hypothesis problematic?
yes
current theories emphasize many ____
-higher density of dopamine receptors
-may make and release more dopamine
-excessive stimulation of dopamine D2 receptors in the striatum
-deficient stimulation of prefrontal dopamine D1 receptors
neurotransmitters
enlarged lateral ventricles (50 studies) ; real problem is that the areas next to the ventricles may never have developed fully or atrophied ; not found in all schizophrenics ; found in “healthy” siblings of schizophrenic patients
-less active frontal and temporal lobes
-less frontal, temporal, and whole-brain volume (smaller hippocampus - most reliable difference)
-BRAIN DYSFUNCTION APPEARS BEFORE ONSET OF SCHIZOPHRENIA
structural and functional abnormalities in the brain
classification systems and their relation to schizophrenia:
good vs. poor premorbid functioning in schizophrenia
focus on functioning prior to developing schizophrenia (no longer widely used)
show unusual motor responses and odd mannerisms (immobility, excessive motor activity, motor negativism - resistance to instructions or attempts to be moved, waxy flexibility)
-tends to be severe and quite rare
catatonic type
those with schizophrenia exhibit higher or lower intelligence and achievement scores than healthy siblings as children
lower
presence of one or more delusions that persist for one month or more
-lack other positive and negative symptoms
-rare (0.2%)
-better prognosis than schizophrenia
delusional disorder
normalities or abnormalities in social behavior? more or less socially responsive, more or less positive emotion, better or poorer social adjustment?
abnormalities ; less ; less ; poorer
one or more positive symptoms of schizophrenia (delusions, hallucinations, disorganized behavior/speech)
-lasts at least 1 day but not longer than 1 month
-not due to substance use
-usually precipitated by extreme stress or trauma
-tends to remit on its own
brief psychotic disorder
true or false: delays and abnormalities in motor development (ex. walking)
true
subclinical signs of psychosis (unusual ideas and sensory experiences; eccentric behavior - signs of schizotypal personality disorder) show during ___
adolescence
mothers exposed to influenza in second trimester may have children more predisposed
viral infections during early prenatal development
cognitive dysfunctions are substantial and are linked with functional impairment (2)
episodic memory and executive functioning
medical treatment of schizophrenia:
historical precursors (5)
- wrap in wet sheets
- electric shock
- insulin comas
- frontal lobotomies
- institutionalized
what is often a problem with medications for schizophrenic patients?
compliance with medications (3/4 patients stop taking medication for at least 1 week in a two year period)
usually the first line treatment for schizophrenia
antipsychotics (neuroleptics)
most antipsychotics reduce or eliminate ___ symptoms
positive
true or false: acute and permanent side effects are common
true
extrapyramidal side effects
movement probleems
expressionless face, slow motor activity, shuffling gait
parkinsonian symptoms
feeling restless and a need to move
akathisia
abnormal muscle tone - muscle spasms
dystonia
involuntary movements of the tongue, face, mouth, and jaw (ex. tongue sticking out, chewing motions)
tardive dyskinesia
according to this psychologist, personality is an individual’s characteristic patterns of thought, emotion, and behavior together with the psychological motivation behind those patterns
finder
according to this psychologist, a personality trait is a long-standing pattern of behavior expressed across time and in many different situations
millon
five factor model: OCEAN
Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
personality disorders are composed of personality traits that are: (3)
- inflexible
- maladaptive
- cause signification, functional impairment, or subjective distress
various ___ disorders are associated with:
-decreased social functions
-decreased occupation functions
-increased risk of substance abuse
-increased risk of depression/anxiety
-increased risk of schizophrenia
-increased risk of suicide
-increased risk of imprisonment
-increased risk of hospitalization
personality disorders
an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual’s culture. this pattern is manifested in two (or more) of the following areas:
-cognition
-affectivity
-interpersonal functions
-impulse control
DSM-IV/5 criteria for personality disorders
the ways of perceiving and interpreting self, other people, and events
cognition
range, intensity, lability, and appropriateness of emotional response
affectivity
theoretical issues with personality disorders: comorbidity
if diagnosed with a personality disorder, likely to have more than one
certain personality disorders are believed to be more common in men vs. women
___: paranoid, schizoid, schizotypal (cluster A); antisocial, narcissistic, OCPD
___: histrionic, borderline, dependent
men ; women
coverage: most common personality disorder diagnosis in clinical practice
PD NOS
PD NOS
personality disorder not otherwise specified (have a PD not recognized by the DSM or have features of more than one PD but don’t meet criteria for any specific PD but features cause distress/impairment)
DSM-5 personality disorders: cluster A is referred to as
“the weird”
three cluster A (“the weird”) personality disorders
paranoid PD, schizoid PD, and schizotypal PD
a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent
paranoid PD
a pattern of detachment from social relationships and a restricted range of emotional expression
schizoid PD
a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior
schizotypal PD
which two cluster A personality disorders were almost removed as a diagnosable disorder from DSM-5
paranoid PD and schizoid PD ; only schizotypal to remain
DSM-5 cluster B personality disorders are referred to as
“the wild” (dramatic/erratic)
4 cluster B (“the wild”) personality disorders:
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
a pattern of disregard for, and violation of, the rights of others
-chronic criminality - chronic violation of rules, laws, norms
antisocial PD
a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity
-tremendous emotional instability
-variability in how you view yourself - no core sense of identity
borderline PD
a pattern of excessive emotionality and attention seeking
-emotions change in a manipulative/attention-seeking way
histrionic PD
a pattern of grandiosity, need for admiration, and lack of empathy
narcissistic PD
DSM-5 cluster C personality disorders are referred to as
“the worried”
three cluster C (“the worried”) personality disorders:
- avoidant PD
- dependent PD
- OCPD
a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
avoidant PD
a pattern of submissive and clinging behavior related to the excessive need to be taken care of
-“you need someone to captain your ship”)
dependent PD
a patten of preoccupation with orderliness, perfectionism, and control
OCPD (obsessive-compulsive personality disorder)
a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- has a grandiose sense of self-importance
- is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- believes that he or she is “special” and unique and can only be understood by, or should associate with other special or high-status people (or institutions)
- requires excessive admiration
- has a sense of entitlement
- is interpersonally exploitative
- lacks empathy
- is often envious of others or believes that others are envious of him or her
- shows arrogant, haughty behaviors or attitudes
DSM-5 criteria for narcissistic personality disorder (NPD)
assessment issues: self-report vs. other report
problems with both
gold standard assessment:
semi-structured interviews
psychopathy described by the five factor model: (11 characteristics)
- glib and superficial charm
- grandiose sense of self-worth
- pathological lying
- conning/manipulative
- lack of remorse or guilt
- callous lack of empathy
- impulsivity
- irresponsibility
- early behavior problems
- parasitic lifestyle
- failure to accept responsibility for own actions
theoretical implications:
using a general model of personality is very clearly a dimensional approach - no attempt to delineate normal from “disordered”
dimensional vs. categorical
theoretical implications:
the number of PD diagnoses patients typically receive varies: 2.4 and 4.6
-comorbidity expected to the extent that the same broad domains and/or specific traits underlie the various PDs
comorbidity
theoretical implications:
gender differences in prevalence rates of PDs should be consistent with gender differences in general personality functioning
gender differences
men lower in aggreableness
antisocial ; narcissistic
women higher in neuroticism
borderline ; dependent
coverage: most common PD diagnosis in clinical practice
PD NOS (personality disorder not otherwise specified)
DSM-5 was set to use a radical new approach, derived largely from the type of FFM-like work
-viewed as too untested at the last moment, and was put in section ___ for further study
section III
this DSM-5 section approach is:
-moderate or greater impairment in personality (self/interpersonal) functioning
-one or more pathological traits
-inflexible/pervasive
-longstanding
section III approach
two forms of impairment
self and interpersonal
two components of self impairment
identity and self-direction
experience oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; capacity/ability to regulate emotional experience
-impairment potentially evidence of a personality disorder
identity
pursuit of coherent and meaningful short and long-term goals; use of constructive and prosocial internal standards of behavior; ability to self-reflect
self-direction
two components of interpersonal impairment
empathy and intimacy
comprehension and appreciation of others’ experiences and motivations; tolerance of differing perspectives; understanding the effects of one’s own behavior on others
empathy
depth and duration of connection with others; desire and capacity for closeness; mutuality of regard reflected in interpersonal behavior
intimacy
DSM-5 trait model:
5 domains (25 specific traits)
- negative affectivity
- detachment
- antagonism
- disinhibition
- psychoticism
according to the DSM-5 trait model, only six disorders would remain:
- schizotypal (cluster A)
- antisocial (cluster B)
- borderline (cluster B)
- narcissistic (cluster B)
- avoidant (cluster C)
- OCPD (cluster C)
prevalence of personality disorders in the general population
about 0.5% to 2.5% of the general population
personality disorders are thought to begin in ___
-predicted by sexual, physical, emotional abuse, neglect
childhood
___-___% prevalence of personality disorders in inpatient settings
10-30%
personality disorders run a ___ course
chronic
comorbidity rates are ___ both within and across different psychopathology (other personality disorders and other disorders)
high
men are more likely to have cluster ___ PDs, APD, NPD, OCPD
A
women are more likely to have
borderline, histrionic, dependent
pervasive and unjustified mistrust and suspicion
causes:
-biological and psychological contributions are unclear
-early learning that the world is a dangerous place
-evidence unclear whether it is a variant of a psychotic disorder; research suggests “no” or “maybe”
treatment:
-few seek professional help on their own
-treatment focuses on development of trust
-cognitive therapy to counter negativistic thinking
-lack of good outcome studies
paranoid PD
pervasive pattern of detachment from social relationships
-not interested in close relationships
-little interest in sexual experiences
-no close friends
-indifferent to praise or criticism
-very limited range of emotions in interpersonal situations (takes pleasure in few things; flattened affectivity - appear cold, detached)
causes:
-etiology unclear
-preference for social isolation resembles autism; extreme variant of shyness/introversion
treatment options:
-few seek professional help on their own
-focus on the value of interpersonal relationships
-building empathy and social skills
-lack good outcome studies
schizoid PD
which cluster A PDs were almost removed from the DSM-5? (2)
paranoid and schizoid were going to be removed - only schizotypal to remain
odd and unusual behavior, appearance, and cognition
-most are socially isolated, highly suspicious (paranoid)
-magical thinking, ideas of reference, and illusions
-unusual perceptual experiences
-many meet criteria for major depression
causes:
-phenotype of a schizophrenia genotype?
-diagnosis came about as a result of research on family members of schizophrenics; higher rates of schizotypal PD in family members of schizophrenic
-generalized cognitive deficits
treatment options:
-main focus on developing social skills
-treatment also addresses comorbid depression
-medical treatment similar to schizophrenia - use of antipsychotics
-treatment prognosis is generally poor
schizotypal PD
noncompliance with social norms
-violate rights of others
-irresponsible, impulsive, and deceitful
-lack empathy and remorse
-lack concern for safety of self or others
-must be evidence of conduct disorder before age 15
antisocial PD
early histories of behavioral problems (ex. conduct disorder)
-families with inconsistent parental discipline and support
-families have histories of criminal and violent behavior
relation with conduct disorder and early behavioral problems
neurobiological contributions and treatment of antisocial personality
brain damage - little or large support for this view?
little support
neurobiological contributions and treatment of antisocial personality
underarousal hypothesis: ___
-future criminals have lower skin conductance activity, lower resting heart rate, and more slow frequency brain activity
cortical arousal is too low
neurobiological contributions and treatment of antisocial personality
cortical immaturity hypothesis - ___
-based on evidence that theta waves are correlated with psychopathy. theta waves uncommon in adults; could be due to lack of anxiety
cortex is not fully developed
neurobiological contributions and treatment of antisocial personality
fearlessness hypothesis - ___
fail to respond to danger cues
this model proposes an underactive “behavioral inhibition system” paired with overactive “behavioral activation system”
gray’s model of behavioral inhibition and activation
cognitive problem: once psychopathic people have a routine set, they do not take in new information to change course very easily
response modulation difficulties
There is a pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:
-Frantic efforts to avoid real or imagined abandonment
-A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
-Identity disturbance: marked and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging
-Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
-Affective instability due to marked reactivity of mood
-Chronic feelings of emptiness
-Inappropriate, intense anger or difficulty controlling anger
-Transient stress-related paranoid ideation or severe dissociative symptoms
borderline PD
most common of ten DSM-IV personality disorders in psychiatric settings
borderline PD
the causes: runs in families (see higher rates in families with mood disorders)
-early trauma and abuse seem to play some role
causes of borderline PD
major theory: biosocial theory (linehan) - two components
emotionally vulnerable individual and invalidating environment
excessive reaction to stress; long recovery rate following stressor
emotionally vulnerable individual
broadly conceived, being told feelings are not okay or reasonable, being told perceptions are wrong; physical or sexual abuse - invalidates one’s autonomy, sense of boundaries, privacy
invalidating environment
antidepressant medications - short-term relief
antipsychotic - reduces aggression
-dealectical behavior therapy (DBT) - most promising treatment
treatment options for borderline PD
overly dramatic, sensational, and sexually provocative
-impulsive and need to be the center of attention
-thinking and emotions are perceived as shallow
-common diagnosis in females
histrionic PD
etiology largely unknown
-sex-typed variant of antisocial personality? variant of NPD?
the causes of histrionic PD
focus attention seeking long-term consequences
-address problematic interpersonal behaviors
-little evidence that treatment is effective
treatment options for histrionic PD
exaggerated/unreasonable sense of self-importance
-preoccupation with receiving attention
-lack sensitivity and compassion for other people
-sensitive to criticism, envious, and arrogant
-mainly causes social impairment. mildly distressing over time, but secondary to impairment it causes
narcissistic PD
link with early failure to learn empathy as a child because of parents’ failure to effectively “mirror” child (Kohut)
-parents are spiteful and cold but find 1 talent or quality in the child to reward (ex. Athlete, student, genius). Grandiosity conceals concerns about defectiveness (Kernberg)
-child over-valued - parents provide non-contingent praise, attention, and tribute to the child (Millon)
Appears that over OR under valuation can cause it. Too much or too little attention; pampering or neglecting; excessive praise or no praise
causes of NPD
-extreme sensitivity to the opinions of others
-highly avoidant of most interpersonal relationships
-interpersonally anxious and fearful of rejection
-“look like” schizoid individuals - different motivations for similar outward behavior
avoidant PD
numerous factors have been proposed
-difficult temperament and early rejection
-recall feeling isolated and rejected in childhood
-extreme variant of introversion?
causes of avoidant PD
several well-controlled treatment outcome studies exist
-treatment is similar to that used for social phobia
-treatment targets include social skills and anxiety-reduction
treatment options for avoidant PD
which cluster C personality disorder was proposed to be removed from DSM-5?
dependent PD
reliance on others to make major and minor life decisions
-unreasonable fear of abandonment
-clingy and submissive in interpersonal relationships
-focused on maintenance of supportive/nurturing relationships
-correlates strongly with borderline PD
dependent PD
still largely unclear
-may be due to feelings of incompetence and low self-efficacy
-linked to early disruptions in learning independence
-early disruption of important attachment relationships
-temperamental differences in negative emotionality
causes of dependent PD
research on treatment efficacy is lacking
-therapy typically progresses gradually
-treatment targets include skills that foster independence
-on surface, seem to be perfect patient population; must confront patients’ dependence on therapy and therapist
treatment options for dependent PD
excessive and rigid fixation on doing things the right way (ex. “my way or the highway”)
-frugal
-highly perfectionistic, orderly, and emotionally shallow
-true obsessions and compulsions are rare
-“can’t see the forest for the trees”
-looking at the specifics, missing the full picture
obsessive-compulsive PD
largely unknown
-impairment may be more limited than other PDs
causes of OCPD
data supporting treatment are limited
-addresses fears related to the need for orderliness
-address rumination, procrastination
treatment options for OCPD
