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HSCI 214 > Lecture 18 > Flashcards

Lecture 18 Flashcards

1
Q

the presence of both obsessions and compulsions is needed as part of meeting diagnostic criteria for OCD. TRUE OR FALSE

A

false

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2
Q

What is the diagnostic criteria for Obsessive-Compulsive Disorder? A and the descriptions

A

A. Presence of obsessions, compulsions, or both

Obsessions are defined by (1) and (2):
1. recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress

  1. the individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (ex. by performing a compulsion)

Compulsions are defined by (1) and (2):
1. repetitive behaviours (ex. hand washing, ordering, checking) or mental acts (ex. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

  1. the behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

Note: young children may not be able to articulate the aims of these behaviours or mental acts

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3
Q

What is the diagnostic criteria for Obsessive-Compulsive Disorder? B, C, and D, and specifications

A

B. the obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C. the obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (ex. a drug of abuse, a medication) or another medical condition

D. the disturbance is not better explained by the symptoms of another mental disorder

Specify if:
- with good or fair insight: the individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true
- with poor insight: the individual thinks obsessive-compulsive disorder beliefs are probable true
- with absent insight/delusional beliefs: the individual is completely convinced that obsessive-compulsive disorder beliefs are true

Specify if:
- tic-related: the individual has a current or past history of a tic disorder

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4
Q

What are the 2 broad frameworks that social science often makes assumptions about knowledge?

A

postivist framework and constructivist perspective

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5
Q

explain the positivist framework

A
  • sees scientific knowledge as always improving leading more perfect understanding of mental illness
  • mental health/illness as objective and concretely knowable (one reality/truth)
  • assumes that we will eventually “discover” nature of mental health/illness and best way to diagnose/treat via research and technology
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6
Q

explain the constructivist perspective

A
  • sees knowledge as fluid, contingent, contextual
  • currently unanswered questions will not be easily solved or may never be solved
    — because understanding of phenomena not based on scientific facts but instead based on consensus of “truth”/social reality (including mental health/illness)
  • regarding consensus:
    — what is agreed upon as truth is subject to change
    — reaching consensus is not based on best evidence but rather culture, research funding, personality, scientific trends, etc.
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7
Q

What are the debates about OCD symptom Dimensions

A
  • people with OCD have wide variations. in their symptoms (extensive heterogeneity in focus of both obsessions and compulsions)
  • may have one individual obsessed about contamination and compelled to clean, another plagued with intrusive thoughts about harm displaying compulsive “checking” rituals
  • this raises the question: should the disorder be further divided into “subtypes”?
  • if there are distinct subtypes this could mean that causes, level of functioning, and treatment options might be different for each
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8
Q

Should the OCD be further divided into “subtypes”?

A
  • schizophrenia was previously diagnosed using “paranoid” and “catatonic” subtypes, highlighting how overarching symptoms (delusions) are shared but behaviour may differ widely - this is now conceptualized differently in the DSm-5 as it was argued subtypes could not be reliably diagnosed
  • “checking” type of OCD may be different from subtypes focused on contamination or symmetry, and it may be that subtypes may benefit from specific treatments
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9
Q

What’s another debate about OCD symptom Dimension?

A
  • researchers disagree about how and whether OCD should be divided into subtypes
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10
Q

should classification of subtypes be categorical or dimensional?

A
  • “subtype” implied a single discrete category, but many people with OCD have symptoms which would fall into more than one subtype category
  • infrequent that individuals have only one subtype of symptoms
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11
Q

What does “symptom dimension” approach recognize?

A
  • recognizes that it is possible to have several types of symptoms (representing potential subtypes) at varying levels of severity
  • this suggests “symptom dimension” may be more accurate than symptom type or subtyep
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12
Q

What does the research on OCD symptom dimensions frequently use and rely on?

A
  • uses and relies upon the Yale-Brown Obsessive Compulsive Scale
  • deemed to be the most comprehensive symptom checklist
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13
Q

What does the Yale-Brown Obsessive Compulsive Scale include?

A
  • 7 types of obsessions
  • 6 types of compulsions
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14
Q

What are the 7 types of obsessions

A
  • aggressive
  • contamination
  • sexual
  • hoarding
  • religious
  • symmetry
  • somatic
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15
Q

What are the 6 type sof compulsions

A
  • cleaning
  • checking
  • repeating
  • counting
  • ordering
  • hoarding
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16
Q

What is the conceptual issue/concern of the Yale-Brown Obsessive Compulsive Scale?

A
  • categories (to date) are not based on empirical evidence, but rather on clinical experience/researchers’ assumptions (rationally rather than empirically derived)
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17
Q

What is one proposed framework after the debates about OCD symptom dimensions

A
  • autogenous vs. reactive symptom model (internal vs. external triggers
  • there is evidence for differences between these groups, but clinical value is unclear
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18
Q

define autogenous symptoms

A
  • self-generated triggers (sexual or aggressive thoughts)
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19
Q

define reactive symptoms

A
  • response to external stimuli (triggers regarding contamination or symmetry)
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20
Q

What is another proposed model after hte debates about OCD?

A
  • core dimensions model
  • defines dimensions based on symptom theme
  • allows for possibility of heterogeneity of symptoms, yet still identifies core or key dimensions in classification of OCD
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21
Q

What is harm avoidance?

A
  • thoughts and actions to avoid harm
  • may lead to checking believed to ensure safety
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22
Q

WHat is fear of incompleteness

A
  • one’s actions or intentions have not been correctly achieved
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23
Q

What are the still unresolved questions about the debates about OCD?

A

improved symptom measures, larger samples of patients, and investigation of alternate models

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24
Q

PTSD extends beyond the context of war and can follow the experience of any type of stressful or traumatic event TRU OR FAULE

A

true

25
Q

What percentage of people with PTSD exhibit symptoms consistent with dissociative subtyep?

A
  • 15-30%
26
Q

What does the diagnostic criteria for PTSD include?

A
  • direct or indirect experience of a traumatic event
  • indirect examples : learning of traumatic event
27
Q

What are the 2 defining symptoms of PTSD?

A
  • hyperarousal (being highly vigilant and alert)
  • re-experiencing of events related to the truama
28
Q

Review about trauma and stressor related disorders

A
  • psychological distress following exposure to a traumatic or stressful event is quit variable
  • sometimes, symptoms can be well understood within anxiety or fear-based context
  • it is clear thought that many individuals who have been exposed to a traumatic or stressful event exhibit a phenotype in which, rather than anxiety or fear-based symptoms, the most prominent clinical characteristics are anhedonic and dysphoric symptoms, externalizing angry and aggressive symptoms, or dissociative symptoms
  • because of these, the aforementioned disorders have been grouped under a separate category: trauma- and stressor-related disorders
29
Q

What are specific examples and requirements of intrusion symptoms?

A
  • recurrent memories
  • traumatic nightmares
  • dissociative reactions (flashbakcs)
  • psychological distress at traumatic reminders
  • marked physiological reactivity to reminders
  • at least one of these 5 is required
30
Q

What are specific examples and requirements of persistent avoidance?

A
  • truama-related thoughts or feelings
  • trauma-related external reminders, such as people, places, or activities
  • at least one of two is required
31
Q

What are specific examples and requirements of alteration in arousal and reactivity

A
  • irritable and aggressive behaviour
  • self-destructive and reckless behaviour
  • hypervigilance
  • exaggerated startle
  • problems concentrating
  • sleep disturbance
  • at least two of the six are required
32
Q

What are specific examples and requirements of duration?

A
  • must experience above symptoms and meet criteria for longer than one month
  • acute stress disorder is diagnosed for symptoms occurring within one month post trauma
33
Q

What are specific examples and requirements of subtypes

A
  • dissociative subtype: used when depersonalization and derealization occur in tandem with other symptoms described above
  • delayed subtype: used to describe emergence of symptoms following a period post trauma in which symptoms were not present or were present at subthreshold level
  • at least 6 months post trauma
34
Q

What is PTSD-DS?

A
  • PTSD and its dissociative subtype
  • some people with PTSD experience dissociation
35
Q

define dissociation

A
  • psychobiological defence mechanism where normal integration of consciousness, memory, identity, perception, emotion, body representation, motor control and behaviour is disturbed
36
Q

dissociation can provide temporary what?

A
  • psychological escape in times of extreme trauma or stress
37
Q

What are the 2 defining symptoms of PTSD-DS?

A

(either one to meet diagnostic criteria)

  • depersonalization (feeling outside own body or don’t belong to your own body)
    — ex. world around the person feels like a dream or altered reality
  • derealization (feeling things around you are strange or unfamiliar)
    — feeling of being detached from events around the person
38
Q

around how many people with PTSD experience symptoms of dissociation

A
  • 15-30%
39
Q

What is PTSD-DS associated with?

A
  • with greater disease severity, increased suicidality more comorbidities, and greater illness burden
  • there is research evidence supporting this distinction, including differences in duration and severity of the illness, differences in brain activity (in imaging studies)
40
Q

What is the severity of PTSD-DS due to?

A
  • in part due to cognitive impairment associated with dissociation
41
Q

What are the difficulties associated with dissociation and cognitive impairment of PTSD-DS

A
  • lowered attention, memory, executive function
  • poorer social cognition (ex. understanding other’s emotions/intentions)
  • poorer treatment response (especially with exposure-based treatment)
42
Q

define executive function

A
  • cognitive processes related to organizing thoughts, time management, problem-solving, decision-making
43
Q

Review about PTSD-DS

A
  • Some researchers do not believe that PTSD-DS is a meaningful distinction in diagnosis (little difference stemming from subtype)- and argue including the subtype in the DSM-5 was a mistake
  • Some studies do NOT show differences in treatment outcomes when people with PTSD and PTSD-DS are compared
  • Conclusion: current literature on effects of dissociative symptoms on treatment is inconsistent- so is it worth it to view it as a separate subtype, distinct from PTSD?
44
Q

Review about conceptual issues

A
  • Typically, the experience of a particular mental illness (and specific symptoms) predates the creation of a diagnostic category- later society tries to make meaning of the experience (primarily through medicine) and it is named
  • Important question: have the symptoms and components of mental disorders always existed among humans?
  • Some researchers say yes, and that it is only recently it has been named/classified as OCD (for example), perhaps it was a form of “madness” before, or not seen as an illness at all
  • Alternative view: mental disorder (e.g., OCD and PTSD) are newly emerged conditions resulting from need to cope with highly complex and rapidly changing society: unique social environment leads to truly new conditions and disorders
  • We can look at this debate through the social trajectory of PTSD: what are we seeing that are common or unique experiences of war and trauma over time?
  • Likely a combination of “timeless” symptoms and new phenomena resulting from changing social/political context
45
Q

How is “social trajectory” of a disorder?

A
  • how it “emerges” or comes to attention in society
  • how it comes to be officially recognized (ex. in the DSM)
  • is it considered “treatable”?
46
Q

Explain the emergence of disorder

A
  • often a contentious or disputed process
  • differing views and perspectives form those living with the condition and those in positions of authority (government, clinicians)
  • the way “combat-induced trauma” has evolved to be viewed differently now than it was in the second world war provide and illustration of these processes
  • as a condition is legitimized or delegitimize as a diagnostic category, consider the role of various actors (patients, physicians, government, militaries_
47
Q

explain the emergence of PTSD and WW1

A
  • understood as “shell shock”
  • very broad range of symptoms with both biological and psychological explanations
  • questioned whether they were truly sick or wounded (deserving of compensation and treatment, or not)
48
Q

explain the emergence of PTSD and post-WW1

A
  • shell shock diagnosis declined, and was banned
  • militaries argued non-medical conditions were cause (cowardice, poor morale), enacting screening to reduce problems stemming from psychological weakness, setting up barriers to claiming compensation
  • Military response: attempts to root out recruits and soldiers “predisposed” to shell shock
49
Q

explain the emergence of PTSD and WWiI

A
  • “combat neurosis” and “battle exhaustion” diagnoses
  • even healthy individuals could break down under stress of war (everyone has a breaking point was the argument made)
  • Military response: quick attention to problems, rest, and return to duty
50
Q

What were the symptoms of combat neurosis and battle exhaustion?

A
  • restlessness, irritability, aggression, fatigue, sleep difficulties, anxiety rather than the tremors, blindness, and paralysis of shell shock
51
Q

explain the emergence of PTSD and post-WW2

A
  • some former soldiers received compensation for psychiatric injury, but American psychiatry relied on psychoanalysis which located problems in ex-soldiers childhood experiences instead of combat related stress/truama
  • subsequently combat neurosis diagnoses declined
52
Q

explain the emergence of PTSD and the 1960s

A
  • vietnam war
  • emerging understanding of the effects of trauma - but the lack of a diagnostic category made accessing treatment difficult
  • as the way grew more unpopular, veterans and sympathetic medical figures argued that conditions int he war were producing mental health problems
  • DSM-II did not have a diagnosis related to combat trauma (previously existing “gross stress reaction” from DSM-I had been eliminated in second version -> lack of access to mental healthcare for ex-soldiers
53
Q

review more about the emergence of PTSD in 1980

A
  • Advocacy led to the inclusion of PTSD in DSM-III in 1980, partially due to demands that the APA recognize suffering and illness related to combat
  • Addition of PTSD to DSM-III in 1980
  • Cause was attributed to the experience of war, (being inherently insanity provoking) as opposed to the characteristics of the individual
  • Flashbacks as dissociative episodes (reliving traumatic episode) recognized as new and key symptom
  • Soon, a range of traumatic events other than war were understood to be causes of PTSD
54
Q

All people experiencing PTSD today would meet diagnostic criteria for shell shock TRUE OR FALSE

A
  • false
55
Q

How did the emergence of PTSD change?

A
  • initially understood in relation to “extreme stressors such as combat, rape, severe assault, and natural or manmade disasters”
  • has evolved to include “hearing hate speech, learning of relative’s death, or watching a catastrophe unfold on TV”
56
Q

What are the similarities and differences of shell shock, combat neurosis and PTSD

A
  • describe significant distress and impairment stemming from trauma

-flashbacks were not recognized until PTSD

57
Q

What are the 2 views of PTSd

A
  • constructivist view and positivist view
58
Q

explain the constructivist view of PTSD

A
  • each disorder (cause/symptoms) is understood in relation to social factors

— military goal to return soldiers to duty
— protests advocating for recognition of war horrors and combat trauma

59
Q

explain the positivist view of PTSD

A
  • perhaps PTSD always has existed, but it took a few tries and modifications through the DSM-3 to accurately describe and diagnose it

— challenge to this view is all the social factors that lead to emergence of PTSD diagnosis (listed as “constructivist view”)

HSCI 214 (25 decks)

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