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lecture 5 material Flashcards

Anxiety, Trauma & Stressor-Related, and Obsessive-Compulsive Related Disorders PT2

1
Q

What are some DSM-5 examples of Trauma/Stressor-Related Disorders

A
  • Posttraumatic Stress Disorder (PTSD)
  • Acute Stress Disorder (ASD)
  • Adjustment Disorder
  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder

in the DSM-5, these disorders are categorised together as they are the only disorders that have an identifiable event that has let to their establishment

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2
Q

How is PTSD characterised

A
  • Exposure to actual/threatened death, serious injury, or
    sexual violence
  • Intrusion symptoms: are recurrent, involuntary and intrusive –> entail a lot of sensory and physiological components
  • can include recurring dreams similarly related to the traumatic event, dissociative reactions rethinking themselves back in the situation (flashback)
  • psychological AND physiological reactions
  • Persistent avoidance symptoms including the individual actively avoids internal and/or external reminders
  • external = e.g. avoiding the location where the trauma happened, avoiding people involved during the trauma
  • internal = avoid distressing thoughts and feelings
  • Negative alterations in cognitions and moods
  • when people have the inability to remember parts of the event post trauma
  • fragmented memory
  • exaggerated beliefs about themselves or others (e.g. im not good enough, I cant trust anybody, the world is unsafe etc.)
  • Marked alterations in arousal and reactivity associated
    with the trauma
  • feeling a lot of distress when reminded of the trauma
  • blaming themselves for the trauma and thinking of the consequences of the trauma in a way that doesn’t align with the situation
  • Symptoms must have started/worsened AFTER the trauma
  • Symptoms must be present for at least 1 month
  • Symptoms must cause distress or functional impairment
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3
Q

What is the Difference between ASD and PTSD

A

ADS = Exposure to actual or threatened death,
serious injury, or sexual violence through at least one of four means
- Presence of 9 (or more) sxs from
categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after trauma
- Minimum 3 days and maximum 4 weeks of disturbance
- Clinical distress or impairment
- Not attributable to substance use or another medical condition

WHEREAS

PTSD = Exposure to actual or threatened death,
serious injury, or sexual violence through at least one of four means
- Only need 6 symptoms –> At least: 1 intrusion symptom, 1 avoidance symptom, 2 or more physiological arousal and 2 or more signs of negative alterations in cognition and mood
- require less symptoms to meet criterion because it is normal to experience symptoms post trauma, however extended/prolonged symptoms and more intense symptoms are less common
- At least one month of duration post trauma (delayed expression>6mos post trauma)
- Clinical distress or impairment
- Not attributable to substance use or another medical condition

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4
Q

Are men or women more susceptible to developing PTSD

A

women
20.4% women compared to 8.2% men developed PTSD

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5
Q

List risk factors of PTSD

A
  • Rates of PTSD are higher (up to 20%) among those in vocations with increased risk of traumatic exposure –> Vets, police, firefighters, emergency medical
    personnel
  • Highest rates of PTSD occur after rape, military
    combat and captivity, and ethnically/politically
    motivated imprisonment and genocide
    *Being in close proximity to the trauma + being subjected to more traumas
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6
Q

How is memory effected by PTSD

A

PTSD is dominated by disruptions in cognition or memory

  • Problems remembering and forgetting traumatic events
  • The memory that is encoded at the time of the trauma is
    poorly elaborated and integrated with other memories
  • poor autobiographical memory
  • memory fragments have a here-and-now quality
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7
Q

What is the immediate treatment after a trauma

A

Psychological First Aid
* Be compassionate
* Ensure immediate and ongoing safety, provide
physical and emotional support
* Calm distraught individuals
* Have survivors tell you what their immediate needs
and concerns are and offer practical assistance
and information to address these concerns
* Connect individuals to social support networks
* Be clear about the availability of all medical
providers

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8
Q

What is the treatment for PTSD

A

Trauma-focused therapy (Prolonged Exposure,
Cognitive Processing Therapy)

CBT: Psychoeducation about trauma responses,
followed by anxiety management, exposure, and cognitive restructuring

Also helpful for kids–teach kids how to regulate
emotions and behaviour first, including parents,
adapting delivery to fit the developmental stage of the kid, and placing a strong emphasis on the
therapist-client relationship

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9
Q

What is Adjustment Disorder

A

An adjustment disorder is an emotional or behavioral reaction to a stressful event or change in a person’s life. The reaction is considered an unhealthy or excessive response to the event or change within three months of it happening.

**While adults can experience adjustment disorders, it is predominantly diagnosed in children and adolescents

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10
Q

How is Adjustment Disorder categorised

A
  • Development of emotional or behavioural symptoms in response to an identifiable stressor(s) within 3months of the onset of the stressor
  • Symptoms are clinically significant
  • The stress-related disturbance does not meet criteria for another mental disorder and is not merely the exacerbation of another disorder
  • Symptoms do not represent normal bereavement
  • Once the stressor and its consequences have
    terminated, the symptoms do not persist for more than 6 months
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11
Q

What is Reactive Attachment Disorder

A

Reactive attachment disorder (RAD) = condition where a child doesn’t form healthy emotional bonds with their caretakers (parental figures), often because of emotional neglect or abuse at an early age. Children with RAD have trouble managing their emotions.

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12
Q

How is Reactive Attachment Disorder categorised

A

A consistent pattern of inhibited, emotionally withdrawn behaviour toward adult caregivers, manifested by both:
1) Child rarely seeks comfort when distressed
2) Child rarely responds to comfort when distressed

Characteristics
* A persistent social and emotion disturbance
* Child has experienced extreme insufficient care and this insufficient care is thought to be responsible for the child’s symptoms
* Cannot meet criteria for Autism
* Must be at least 9mos old, needs to occur before the age of 5

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13
Q

What is Disinhibited Social Engagement Disorder

A

A pattern of behaviour in which a child actively
approaches and interacts with unfamiliar adults in
uncharacteristic ways

Involves socially aberrant behaviours such as wandering away from a care-giver, willingness to depart with a stranger, and engagement in overly familiar physical behaviours (e.g., seeking physical contact such as a hug) with unfamiliar adults

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14
Q

How is Disinhibited Social Engagement Disorder categorised

A

*Not limited to acts of impulsivity (e.g., ADHD)
*Child must be at least 9mos old
*Child has likely experienced extreme insufficient care and this
is thought to be responsible for the child’s symptoms

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15
Q

What are some DSM-5 examples of Obsessive-Compulsive Disorders

A
  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania
  • Excoriation (skin picking) disorder
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16
Q

What is Obsessive-Compulsive Disorder (OCD)

A

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviours, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person’s daily activities and social interactions.

17
Q

How is Obsessive-compulsive disorder (OCD) categorised

A
  • Presence of obsessions, compulsions, or both
  • Obsessions/compulsions are time-consuming
    *Symptoms are chronic but can wax and wane
  • Disturbance is not due to substance abuse
  • Disturbance not better explained by another mental health disorder
  • Insight (good/fair; poor; absent/delusional)
  • Specify if tic-related
18
Q

Compared to OCD, what is Tourettic OCD (Tic-related specifier)

A
  • Tics are sudden, repetitive, stereotyped motor movements
    or phonic productions that are often perceived as involuntary but may include premonitory sensory urges
  • In Tourettic OCD, compulsions are not associated with anxiety, but with sensory phenomena (such as localized
    physical tension, generalized somatic discomfort) and/or diffuse psychological distress (such as “feelings” of
    incompleteness)
  • The performance of compulsions tends to serve the purpose of reducing the focal, localized, or general
    discomfort as opposed to playing a more central role in the
    modulation of anxiety and/or prevention of catastrophic
    consequences
19
Q

What are some common obsessions

A

Obsessions
1) Contamination - i.e. fear of germs such as from saliva or genitals (e.g. what if the public toilet i used had AIDS virus on it?)

2) Responsibility for harm - e.g. If I don’t warn people that I might have dropped my medication, a child will eat it and die, and it will be my fault

3) Sex and Mortality - unwanted thoughts of incestuous relationships, unwanted impulses to grab women’s buttocks

4) Violence - Thoughts of hurting others and loved ones (e.g. thoughts of stabbing someone with the knife one is using to eat, thoughts of loved ones losing their lives in terrible accidents)

5) Symmetry and order - characterized by the need for things to be perfect, exact or “just right,” symmetrical, or correctly aligned (e.g. sense that odd numbers are “bad”, feeling that books have to be arranged “just right” on the shelf)

20
Q

What are some common compulsive rituals

A

1) Decontamination - i.e. overly cleaning objects or self (e.g. washing hands for 30 minutes at a time after touching someone else’s shoe

2) Checking - Directing one’s attention to a physical object in an attempt to be reassured (e.g. checking locks, appliances, electrical outlets and windows overly to ensure they are turned off even if already switched them off)

3) Repeating Routine Activities - performing repetitive and ritualistic actions that are excessive, time-consuming and distressing (e.g. getting up and down out of a chair until the obsessional thought has been dismissed)

4) Ordering/arranging - repetitive arranging, organizing, or lining up of objects until end result feels ““right” (e.g. fixing the pictures on the wall until they are hung “just right”)

5) Mental Rituals - Replacing a “bad” thought by thinking “good” thoughts, repeating a prayer until it is said “just right”

21
Q

How would you categorise the obsessions and compulsions examples together

A
  • Incompleteness –> i.e. ordering, arranging and counting
  • Harm –> i.e. checking, reassurance seeking
  • Contamination –> i.e. washing, cleaning
  • Religion, sex, violence –> mental rituals, checking, reassurance seeking
22
Q

What increases vulnerability to OCD

A
  • Biological vulnerability: genes contribute about 50%
  • Psychological vulnerability: early life experiences/learning –> If child had poor childhood experience, or suffered trauma, abuse, discrimination or bullying, they might learn to use obsessions and compulsions to cope with anxiety
  • Maladaptive beliefs: (e.g. not feeling good enough, “if im not perfect no one will love me etc.) can strengthen the disorder and the need for perfection
  • Avoidance: is considered a compulsion –> continued avoidance strengthens obsessions and worsens the disorder
23
Q

What are treatments for OCD

A

1) Selective serotonin reuptake inhibitors (SSRIs) (the most commonly prescribed antidepressants (e.g. clomipramine)
- For Selective SSRIs: effect size is large, but relapse starts soon after meds are discontinued (24-89% relapse)

2) CBT is the only empirically supported psychological treatment
* Emphasising exposure therapy( Exposure and Response Prevention (ERP)) to violate peoples expectancies –> i.e. patients must continue with exposure therapy until their expectancies of harm have been violated such as sharing a sandwich with others until they learn that sharing food will not contaminate and kill them
* ERP can be delivered differently, which can change outcomes to
* Large effect size, about double that of meds
- Maybe 25% of people drop-out—but not higher than other treatments
- 12% will relapse

GOOD TO REMEMBER
- Adding meds to CBT does NOT improve outcomes
- Adding CBT to meds DOES improve outcomes

24
Q

What is Body Dysmorphic Disorder (BDD)

A

Preoccupation with one or more perceived defects or
flaws in physical appearance that are not observable or appear slight to others

25
Q

How is Body Dysmorphic Disorder (BDD) characterised

A
  • Repetitive behaviours or mental acts are performed in response to appearance concerns
  • The preoccupation causes clinically significant distress
    or impairment
  • Appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnosis criteria for an eating disorder
  • Specify with muscle dysmorphia if appropriate
  • Symptoms are chronic
  • Usually starts in teens
26
Q

What are treatment methods for Body Dysmorphic Disorder

A
  • CBT: help individuals in identifying their unhelpful appearance-related thoughts and developing more flexible beliefs
  • SSRIs: help control negative thoughts and repetitive behaviours
27
Q

What is Hoarding Disorder

A

Persistent difficulty discarding or parting with
possessions, regardless of actual value

28
Q

How is Hoarding Disorder Characterised

A
  • Difficulty is due a perceived need to save the items and to distress associated with discarding them
  • The difficulty discarding possessions results in accumulation of possessions that congest and clutter active living areas and substantially compromises their
    intended use
  • Causes clinically significant distress or impairment
  • Not attributable to another medical condition or mental disorder
29
Q

What are some attributes associated with Hoarding Disorder

A
  • Inattention
  • Memory Deficits
  • Indecision
  • Categorisation Deficits
  • Perfectionism
  • Emotional Attachment to Items
  • Mood
  • Emotional sensitivity/reactivity
30
Q

What is the treatment for Hoarding Disorder

A

CBT
- Builds motivation for change
- Skills training including: Ignoring unhelpful thoughts, reduce inquiring, increase practical preparation and provide sort and discard session (i.e. exposure therapy) to show that disposing of items wont cause detrimental effects

31
Q

What is Trichotillomania

A

Recurrent hair pulling, resulting in hair loss

32
Q

How is Trichotillomania Characterised

A
  • Repeated attempts to stop
  • Hair pulling causes clinically significant distress or impairment
  • Hair pulling/hair loss not attributed to another medical
    condition
  • Not better explained by another mental disorder
  • Chronic, but waxes and wanes
  • Sites of hair pulling may vary over time
33
Q

What is the treatment for Trichotillomania

A

Habit Reversal Training
* Awareness training is used to bring greater attention to the behavior
* Mimics the behavior
* Develops a competing response
* Practices carrying out the behavior and stopping the
behavior using the competing response

34
Q

What is Excoriation (Skin Picking) Disorder

A

Recurrent skin picking resulting in lesions

35
Q

How is Excoriation (Skin Picking) Disorder

A
  • Repeated attempts to decrease or stop skin picking
  • Causes clinically significant distress or impairment
  • Not attributable to the effects of a substance or medical condition
  • Not better accounted for by another disorder
  • Chronic, but waxes and wanes
  • Sites of picking may vary over time
36
Q

What is the Treatment for Excoriation (Skin Picking) Disorder

A

Habit Reversal Training
* Awareness training is used to bring greater attention to the behavior
* Mimics the behavior
* Develops a competing response
* Practices carrying out the behavior and stopping the
behavior using the competing response

psychopathology (11 decks)

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