Lecture 8- DSM disorders Flashcards
What is a phobia?
Excessive or unreasonable fears of objects, places or situations.
The phobic stimulus is avoided or endured with intense anxiety or distress
What drug can facilitate extinction in conditioned fear in animals?
D-cycloserine
Are MZ or DW twins more likely to share phobias?
MZ more likely to share animal and situational phobias
What is the DSM 5 criteria for phobias?
Marked fear or anxiety about a specific object
or situation (e.g., flying, heights, animals,
receiving an injection, seeing blood).
The phobic object or situation almost always
provokes immediate fear or anxiety.
The phobic object or situation is actively
avoided or endured with intense fear or
anxiety.
The fear or anxiety is out of proportion to the
actual danger posed by the specific object or
situation and to the sociocultural context.
Fear and anxiety is persistent
What are the types of phobias?
Animals, natural environment, blood injection injury, situational, other
What are the DSM 5 criteria for social phobias?
Marked fear or anxiety about one or more
social situations in which the individual is
exposed to possible scrutiny by others.
The individual fears that he/she will act in a
way or show anxiety symptoms that will be
negatively evaluated.
The social situations almost always provoke
fear or anxiety.
The social situations are avoided or endured
with intense fear or anxiety.
The fear or anxiety is out of proportion to the
actual threat posed by the social situation and
to the sociocultural context…
What are the types of social phobia?
Performance situations and general
How prevalent is social phobias?
60% are women
Who looked at where social phobias originate?
Ruscio et al
What did Ruscio et al find?
Social phobias originate from early-middle adolescence
How many people abuse alcohol due to social phobias?
1/3
What is the psychodynamic theory of phobias?
Phobias are from unconscious anxiety is displaced onto a neutral or symbolic object, e.g. Little Hans
What are the behavioural theory of phobias?
Phobias are from conditioned fear responses. The two process model
Who looked at behavioural theory of phobias?
Ost and Hughdahl
What did Ost and Hugdahl find?
58% of phobic clients cited traumatic experience conditioning as the source of phobia
Who made the 2 process theory of phobia acquistion and maintenance?
Mowrer
What is the 2 process model?
Classical conditioning
Operant conditioning (prevents extinction and reduces anxiety)
How are phobias evolutionary prepared?
As we are evolutionarily prepared to associate certain objects with frightening events
Prepared fears are easily acquired and resistant to extinction
Who looked at evolutionary preparedness?
Ohman et al
What did Ohman et al find?
Fear conditioned more effectively to snakes and spiders than flowers and mushrooms
Why is blood injection injury evolutionary?
As a drop in blood pressure can decrease blood loss
What are the treatments for phobias?
Exposure therapy and CBT (social phobias),
What is fear?
Activation of the fight or flight
What are the 3 components of fear?
Physiological, behavioural and cognitive
Who looked at anxiety corresponding to depression?
Brown and Barlow
What did Brown and Barlow find?
People with an anxiety disorder may experience at least one depressive episode
Who looked at neuroticism?
Klein et al
What did Klein et al find?
Neuroticism is a major factor in developing an anxiety disorder
What is OCD?
Occurrence of unwanted and intrusive obsessive thoughts. Compulsive behaviours performed to neutralise the obsessive thoughts or images or to prevent some dreaded events or situation.
What does a person with OCD feel like?
Driven to perform a compulsive ritualistic behaviour in response to an obsession.
The need to follow very rigid rules regarding how compulsive behaviour should be performed
What is OCD in the DSM 5?
Under obsessive compulsive and related disorders
What are obsessions?
Recurrent and persistent thoughts, impulses or images that are experienced as intrusive, disturbing, inappropriate
Person attempts to resist, suppress with some other thought
Person recognises they are the product of his or her mind
What are the types of obsession?
Aggressive or blasphemous impulses
Sexual thoughts and imagery
What are the types of compulsions?
Repetitive behaviours
Mental acts
What are compulsions?
Repetitive behaviours or mental acts the person feels driven to perform in response to an obsession, or according to rigid rules
Not to provide pleasure and/or gratification
Behaviours are excessive or not realistically connected to what they are intended to prevent.
What is the DSM 5 criteria for OCD?
Obsessions or compulsions
Obsessions or compulsions are timeconsuming (>1hr/day) or cause
clinically significant distress or
impairment in social, occupational, or
other important areas of functioning
The O-C symptoms are not attributable
to the physiological effects of a
substance or another medical condition
Disturbance is not better explained by
the symptoms of another mental
disorder
How many people believe their O-C beliefs are true?
Less than 4%
Who looked at OCD case study?
O’Dwyer & Marks
What did O’Dwyer & Marks find?
When X was 15 she had fear that harm would befall her family and friends unless she completed specific tasks
Repeated rhymes, avoided specific numbers, ritualistic hand washing
What is the OCD prevalence in the UK?
1-2% of general population
When does OCD usually begin?
Late adolescent or early adulthood
In childhood it is more common in boys than girls
What themes of OCD are more common in men?
Sexuality, exactness and symmetry
What themes of OCD are more common in women?
Contamination and cleaning
What are the psychological factors of OCD?
Unwanted cognition intrusions that have similar content to clinical obsessions. The appraisal of thought is critical to diagnosis .
Who looked at psychological factors of OCD?
Abramowitz et al
What did Abramowitz et al find?
Commonplace intrusions develop into obsessions when they are appraised as important or immoral or poses a threat
What are misapprasals caused by?
Dysfunctional beliefs
What are the dysfunctional beliefs from misappraisals about?
Inflated personal responsibility over safety
Thought action fusions (thinking about an event makes it more likely to occur and obsessional thoughts are morally equivalent to forbidden actions)
Excessive concerns about importance of controlling one’s thoughts
What can effect dysfunctional beliefs?
Culture (religion)
What does the strength of the beliefs effect?
The risk that a person will develop obsessions and compulsions
Who looked at dysfunctional beliefs?
Tolin et al
What did Tolin et al find?
Dysfunctional beliefs were associated with
OCD symptoms in both clinical and nonclinical samples.
How is distress created in OCD?
Intrusive thought and dysfunctional beliefs
What occurs when distress occurs?
Attempts to suppress the thought and attempts to prevent any harmful consequences
Who looked at the white bear effect?
Wegner et al
What did Wegner et al do?
5 minute suppression session, participants
had to ring a bell each time a white bear
came to mind.
After suppressed task subjects asked to think about the white bear for 5 minites
What were the findings from Wegner et al?
PPs signalled more than 1 white bear thought per minute
Subjects signalled more white bear thoughts than control who were asked to think about a white bear
The paradoxical rebound effect
What is the paradoxical rebound effect?
Attempts to suppress thoughts can rebound and result in an increased occurrence of the thoughts
How does the paradoxical effect relate to OCD?
Thought suppression results in more intrusions. May result in full blown suppression so the effect may be stronger for patients with OCD
What was found with the white bear effect with people with OCD?
OCD patients show faster responses to the word bear than other words
What does compulsive rituals do?
Removal of intrusion and prevent any harmful consequences
Compulsion becomes persistent and excessive because they are negatively reinforced by immediate distress reduction and by temp removal of the unwanted thought
Prevents people with PCD from learning that their appraisals are unrealistic
Can strengthen dysfunctional beliefs about responsibility
What is the cognitive behavioural model of OCD?
Intrusive thought and image
Misappraisal as important or threatening
Distress
Attempts to suppress thought and prevent consequences
Distress reduction
Maladaptive core beliefs
What is the treatment for OCD?
Exposure and response prevention
What is exposure and response prevention?
Exposing the individual to triggering stimuli (the obsession) and blocking the neutralising behaviour (the compulsion), in an anxiety hierarchy
What is exposure?
Systematic repeated confrontation with the stimuli that provoke anxiety and the urge to perform compulsive rituals
What is response prevention?
Person is refrained from performing compulsive rituals
What does the individual learn in OCD treatment?
Anxiety is temporary
The feared catastrophic consequence never
transpires
Their interpretation of the obsession weakens
Obsessional thoughts are harmless
What is the effectiveness of OCD treatments?
E/RP is more effective than other forms of psychotherapy and placebos
How many people drop out from E/RP?
25%
Who looked at treatment associations between brain activation and symptom reduction?
Norman et al
What did Norman et al find?
E/RP was more effective for relieving symptoms but individual differences in brain activation predicted effectiveness
What brain areas are associated to better responses to E/RP?
Stronger activity in the cinguloopercular and
orbitostriato-thalamic networks
