Midterm 1 Flashcards
Demons and evil spirits
In the middle ages and beyond,
psychological disorders were often thought to indicate that a person was possessed by
evil spirits
These “possessed ” individuals were then blamed for all kinds of bad things happening - and often mis treated as a result
Possession and stigma
Viewing mental illness as possession by an evil spirit was a double-edged sword…
Some believed possession was a punishment for bad behaviour
Others believed possession was
not the person’s fault
Treatment historically
Also existed on a spectrum
from well-meaning and
relatively harmless to painful
and/or traumatizing
Astrology
Theory suggesting that
psychological functioning was
impacted by the movements of the
moon and stars
This shows up in our language and
lore today
Where are we now?
The supernatural tradition remains across many cultures and religions
However, many cultures and religions integrate
alongside a scientific understanding
E.g., a Christian with depression might take anti-depressants and have a church community
praying for them
The biological tradition in ancient Greece
Greek physician, Hippocrates suggested psychological disorders
could be treated like any other disease
Hippocrates linked functioning to four bodily fluids
Too much black bile?
Depression
Too much blood?
Delirium
Too much phlegm?
Apathy/sluggishness
Too much yellow bile?
Hot temper
In the 19th century
Turns out advanced syphilis looks a lot like psychosis - except instead of staying fairly stable , they died within 5 years - unless they
contracted malaria
This was one of the firs t pieces of evidence that convinced professionals that psychological disorders might be directly treatable
Biological treatments
insulin shock therapy
electroconvulsive therapy (ECT )
tranquilizers (benzodiazepines)
Plato
Ancient Greek philosopher
Believed maladaptive
behaviour was a result of
social/cultural influences
Suggested treatment could
include educating people
towards “rational” thought
Asylums
Often housed both
people with mental
illness as well as those
in poverty
Early asylums often
functioned like prisons
rather than hospitals
Asylum reform
“Moral therapy” and the “mental hygiene movement” led to more humane conditions and
relief for individuals who were suffering
However…when conditions became better, more people presented for help -> lack of staffing and too many patients resulted in a
return to inhumane/insufficient care
Freud and Breuer
Influenced by ideas surrounding hypnosis, Breuer and Freud began looking for ways to access the “unconscious mind ”
They noticed people seemed to benefit from processing emotional trauma and understanding it’s connection to their present
Psychoanalytic model
Developed by Freud based on case observation
While not in line with current evidence - this
model remains culturally influential
Includes 3 components: the s structure of the mind, defense mechanisms, and psychosexual
development
The id
strong urges/ins tincts - animalistic,
aggressive, sexual - focused on pleasure
The ego
rational/reasonable - focused on reality - thought to mediate the id and superego
The superego
conscience - in opposition to the
id - focused on morality
If the ego is not in control what happens?
Disorders
Defense mechanisms
Thought to come out when there is too much conflict between the id and superego
Projection
attributing one’s own unacceptable
feelings or thoughts to someone else
Psychosexual development
Considers development to be a
process of resolving sexual
conflicts/seeking pleasure
Humanistic theory
Tended to be more positively-oriented
Focused on self-actualization
Carl Rogers
Through humanistic theory - originated a client-centered
approach - theorized that an
unconditionally positive relationship
would provide space for people to
handle their own challenges
Behavioural approach
Came from research with animals
The classic example is Pavlov’s dogs
Skinner took us beyond Classical
Conditioning to Operant Conditioning
He demonstrated that reinforcement and
punishment could reliably train behaviour
Where behaviourism often fails
Behaviourism often failed to
consider the human element - what effect does it have on people to “ train” them?
One-dimensional approach
Too little serotonin = depression
Psychopathology is neither caused nor treated by one thing
Multidimensional approach
Several factors work together to cause depression
genetics
it is estimated that about half of
individual differences in psychological
disorder are related to genetic influence
but this genetic influence is typically
polygenic
Environmental factors
genetics can also be inflenced by the environment - e.g., specific
presentations of genes can be “turned on” or “turned off” depending on different factors
some environmental factors are so
influential they can essentially overrule
genetic influence
Diathesis stress model
theory that genetic vulnerability and life stressors essentially add together to reach (or not reach) threshold for developing a psychological disorder
Gene-environment correlation
notes that some genetics seem to make people more
likely to seek out certain environments - so environment
can influence gene expression - but genetics can also
influence environment
Forebrain
mostly made up of the cerebral cortex ->
responsible for thinking, perceiving, and remembering
Emotion regulation happens kind of between the
fore and midbrain
Midbrain
responsible for coordination and movement
Hindbrain
responsible for automatic activities
Cerebral cortex
Divided into 4 lobes
Temporal lobe: sights, sounds, long-term memory
Parietal lobe: sensations of touch
Occipital lobe: integrating and making sense of
visual input
Frontal lobe: thinking and reasoning, memory
and social connection
Learned helplessness
when you have no control over your
environment -> or believe you have no control over your environment
Learned optimism
when you maintain a positive attitude
despite significant stress and challenge
Social learning theory
the idea that people can learn by
watching others also called “modelling” or “observational learning” relies on making decisions about when we are similar or different from others
Prepared learning
genetics influence what we learn
more likely to learn to fear things that have historically been dangerous - even without direct experience
Implicit cognition
unconscious processes - somewhat less
salacious then Freud thought
Stroop colour-naming paradigm ->
words that are important draw more
attention -> thus making people slower
to name the colour
emotions and psychopathology
Many disorders involve
disproportionate emotions
Either too little or too much ->
depends on context and culture
Typical first screening session
informed consent
* clinical interview
⚬ understanding current
concerns
⚬ collecting background
information
* initial plan for next steps
* possibly questionnaires
The clinical interview
we usually start with “why are
you here?” (narrow)
* then collect tons of information
and life history (broad)
* then take all of that and start
to narrow back down
Semi-Structured clinical interview
questions/prompts that
are generally followed
but can be modified
* may be more or less
scripted
* may include scoring
criteria to help with
diagnosis
Mental status exam
systematic observation tool
1. appearance/behaviour
2.thought process
3.mood/affect
4.intellectual functioning
5.sensorium (awareness of
surroundings
Cognitive assessment
diverse set of tasks looking at
thinking, reasoning, and problem-
solving, as well working memory
and processing speed
* results in an “IQ” (intelligence
quotient) score - however, we
don’t really have consensus on
what intelligence is
* evaluates cognitive abilities that
generally underlie academic skills
Academic assessment
generally looks more like school
tasks
* typically get overall measures of
reading, writing, and math
* follow-ups examine why any
areas of weakness/strength are
happening
Diagnostic interviews
can be structured or semi-
structured
* often are directly based on
DSM diagnostic criteria
* can be broad or specialized
(e.g., focusing on anxiety
disorders)
Questionaries
can assess behaviours,
emotions, social skills, etc.
* can be self-report or
other-report (e.g.,
parents, teachers)
* often most useful to have
questionnaires from
multiple sources
Projectives
originally - inkblot tests,
like the Rorschach
* intended to reveal
unconscious processes
* now - more often used to
start conversations
* rarely scored
Specialized testing
Neuropsychological testing: can
screen for brain dysfunction or
even specific brain damage
* Neuro-imaging: CAT/CT Scan,
MRI/fMRI, PET scan
* Psychophysiology: EEG,
electrodermal responding
DSM-5-TR
again, the “Bible” of diagnosis (at
least in North America)
* worldwide, the ICD-11 is more
commonly used (International
Classification of Diseases)
DSM-5-TR ICD-11
Major Depressive Disorder
at least two weeks
* at least 5 total symptoms
* at least one symptom must
be depressed mood OR
diminished/interest
pleasure in activities
* other symptoms can be
any of: insomnia, fatigue,
weight loss/weight gain,
etc.
ICD-11
Recurrent Depressive Disorder
at least two weeks
* essential features: at least
one of depressed mood OR
diminished/interest pleasure
in activities
* additional features:
insomnia, fatigue, weight
loss/weight gain, etc
Categorical classification
must meet all criteria
* often works well in medical
system
* works quite poorly in
psychology
Dimensional
Classification
thoughts, moods and
behaviours ranked on a
scale (as opposed to
present/not present)
* difficult to classify
* unclear which dimensions
and what level of severity
needed for which disorders
Prototypical Classification
Diagnosis evaluated in
relation to what we think the
average presentation of a
disorder is
* Includes essential
characteristics (must have
x/y/z) and non-essential
ones (may have a/b/c/d)
Criticisms of Psychological
Disorder Diagnosis
Comorbidity
* Reliability
* Validity
* Labelling/Stigma
Hypothesis
an educated guess
an idea that you can test
Research design
the specifics of
how you will test
your hypothesis
Internal validity
the likelihood that the independent
variable is actually what is causing
change in the dependent variable
Randomization
can help prevent
confounding variables from
distorting the data
external validity
how well your findings
describe/predict what
happens outside of the
lab or study
Statistical significance
is just the math - is
there an effect?
Clinical significance
does the effect
matter in real life?
The problem with averages
who is being tested?
who is being missed?
what happens if you
aren’t “average”?
Strengthening experimental research
use a control group - could receive no intervention, a different intervention, the
typical intervention (TAU), or a placebo randomize participants to control choose a double-blind study
Single-case experiments
repeated measurement: measure several times before manipulation
a research method that studies a single subject or case over time
Family studies
Examine a particular trait
(e.g., a disorder) in the
context of the family
Cross-Sectional Research
A type of correlational research that compares groups of people within different age brackets, helping with understanding the course/development of disorders, informing how to intervene
Longitudinal research
Follows the same group of people over time and and measures the variable of interest at multiple timepoints. Allows for measuring individual/group change.
Studying behaviour across cultures
Cross-cultural research is needed, however is difficult to do. Different expectations makes direct comparison different
The replication crisis
Across fields studies are not being
replicated
Anxiety
Anxiety:
future-oriented
physical tension
feelings of worry/apprehension
Fear
happening in the present
immediate reaction to real or
perceived danger
tends to promote fight or flight
Biological aspects of anxiety
tendency towards both anxiety
and panic seem to run in
families - but have distinct
underlying systems
neurotransmitters implicated
include: GABA, dopamine,
noradrenaline, and serotonin
Behavioral inhibition system
limbic system: mediates between
brain stem and cortex - anxiety
associated with an overly responsive
limbic system
BIS is a specific circuit within the
brain that seems to promote
freezing and anxiety in the face of
this overly responsive limbic system
flight/flight system
distinct from the BIS
originates in the brain stem
but travels through much of
the midbrain
produces an immediate
alarm reaction
Psychological aspects of anxiety
Many factors and
experiences can come
together to promote
anxiety
specifically, seems to be
related to learning that
life is not in your control
- and a feeling that life is
unpredictable
parenting and anxiety
parenting that is absent,
neglectful or abusive
results in a child’s needs
not being met
lets the child know that
they cannot expect the
world to be stable, safe
and predictable
Social aspects of anxiety
stressful life events can trigger
underlying vulnerabilities
For example, big changes like
starting university, moving to a
new city, or coping with a
divorce
Ongoing stressful situations
can also add up - e.g.,
overwhelm at school
Anxiety statistics
As of 2016, Stats Canada reported 8.6% of
Canadians age 12+ had a diagnosed anxiety
disorder - similar for First Nations people
Higher rates in women compared to men
Anxiety disorders increase suicidal ideation
and suicide attempts
Nearly 30% of people with an anxiety
disorder report it causes severe
disability disorder
Anxiety and mood
Anxiety disorders frequently co-occur with mood disorders and certain physical disorders (e.g., migraines)
Specifically, roughly 50% of those with anxiety will also have another anxiety disorder and/or mood disorder
When an individual has an anxiety
disorder and a mood disorder their rates of severe disability rise from 30 to 50%
Medication
Benzodiazepines
Pros: very effective and fast-acting
Cons: extremely addictive/ easy to
become dependent
Anti-depressants (e.g., SSRIs)
Pros: reasonably effective, not typically
addictive
Cons: various side effects, typically need
to reduce slowly
CBT
Might use thought records or
evaluations
Might specifically learn about
“thinking traps” or cognitive
distortions
Might engage in behavioural
experiments or “exposures”
Tends to have a focus on
disproving anxious thoughts and
creating more balanced thoughts
Acceptance and commitment therapy
Focuses on flexible thinking
and letting anxious thoughts
pass rather than actively
fighting them
Often incorporates
mindfulness practices -
activities designed to support
non-judgmental awareness of
the present moment
Panic control treatment
A type of exposure that
involves inducing panic-
related symtoms (like
elevated heart rate) within a
session - then using cognitive
therapy to support clients in
recognizing that the
symptoms were not
catastrophic or unliveable
Group therapy
Can help normalize anxiety
symptoms
Can be especially helpful for
Social Anxiety Disorder
Meds and therapy
In many cases meds work
faster and therapy works
longer
Can be the case that using
both is the most useful,
especially in crisis or if the
person is not responding
quickly to therapy
Generalized Anxiety Disorder
worrying a lot
worrying about a lot of things
not being able to “turn worry off”
incredibly exhausting
distressing and/or impairing
Anxiety DSM criteria
A. Excessive anxiety and worry more
days than not, for at least 6 months,
about many events or activities
B. Individual finds it difficult to
control the worry
C. Anxiety and worry associated with 3 or more of the following symptoms
(with at least some present more days
than not for the past 6 months):
Restlessness/ being on edge
Being easily fatigued
Difficulty concentrating/ mind going
blank
Irritability
Muscle tension
Sleep disturbance
How might these
symptoms fit with the idea
of the “Freeze” system?
ignore
Common patterns of anxiety
intolerance of
uncertainty
belief that worry
is effective
problems = threats
-> not challenges
many worries prevents
working through worry
Social anxiety disorder
not just “being shy”
worrying a lot in or about
social situations (or
performance situations)
worrying about being
embarrassed or negatively
evaluated
Social anxiety dsm criteria
A. Marked fear or anxiety about one or more situations in which the individual is exposed to possible scrutiny by others.
B. The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated
C. The social situations almost always provoke
fear or anxiety.
D. The social situations are avoided or endurd with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat.
F. The fear, anxiety, or avoidance is persistent (6 months or more
G. Causes clinically significant distress or
impairment in important areas of functioning.
H. Is not attributable to a substance or
another medical condition.
I. Is not better explained by another mental
disorder.
J. If another medical condition is present, the
fear, anxiety, or avoidance is clearly unrelated
or is excessive
Social anxiety cross-culturally
Common across ethnic and cultural groups
However, presentation may look a bit different
For example, in more collectivist cultures the worry may be less about being embarassed
and more about embarassing someone else
Some evidence suggests that cultures that are more accepting towards socially withdrawn
behaviours also have more social anxiety
Underlying factors of social anxiety
Tendency towards shyness
Sensitivity to negative evaluation
Specific stressors
Traumatic social event(s)**
Perception of negative evaluation
Belief that one has poor social skills
Separation Anxiety Disorder
extreme distress about
being away from major
attachment figures
DSM criteria for separation anxiety
A. Developmentally inappropriate
and excessive fear or anxiety
concerning separation from those
to whom the individual is attached
B. Fear, anxiety, or avoidance is persistent (at
least 4 weeks in children/adolescents and
typically 6 months or more in adults)
C. Causes clinically significant distress or
impairment in important areas of functioning
D. Is not better explained by another mental
disorder.
Selective mutism
a rare childhood disorder
involving lack of speech in
one or more settings
Selective mutism DSM Criteria
A. Consistent failure to speak in specific
social situations in which there is an
expectation for speaking, despite
speaking in other situations
B. Disturbance interferes with
educational or occupational
achievement or social communication.
C. Lasts at least one month (and not
only the first month of school)
D. Failure to speak is not attributable to
lack of knowledge or comfort with the
spoken language required
E. Not better explained by a
communication disorder and does not occur only within autism,
schizophrenia, or a psychotic disorder
Panic disorder
Characterized by repeated panic
attacks and persistent worry about
having future panic attacks
Panic disorder DSM criteria
A. Recurrent unexpected panic attacks - an abrupt surge of
intense fear or discomfort that peaks within minutes and includes
four (or more) of the following symptoms:
Heart palpitations
Sweating
Trembling/shaking
Shortness of breath
Feelings of choking
ETC
B. At least one of the attacks has been followed by 1 month
(or more) of one or both of the following:
Persistent concern/ worry about additional panic attacks or
their consequences
A significant maladaptive change in behaviour related to the
attacks
C. not attributable to a substance or another medical condition
D. not better explained by another mental disorder
Women with panic disorder
women with panic disorder seem to be much more likely compared to men with panic disorder to also have agoraphobia
Men with panic disorder
men with panic disorder are not
unbothered - instead, they seem to be
more likely to turn to alcohol to cope.
Panic attacks during sleep
roughly 60% of people with panic disorder have experienced
panic attacks in their sleep - especially between 1:30-3:30am
people who experience overnight panic attacks may be
afraid to go to sleep at night
it seems that entering the deepest stage
of sleep may trigger feelings of “letting go”
which make the person anxious
Causes of panic disorder
some people are genetically more likely to have a panic
reaction when facing a stressful event
once a person has had a panic attack they may generalize
those symptoms as if they are always related to panic
then they must also believe that these physical sensations
are hinting at danger - it turns out this is often because that
has been their experience in the past
Agoraphobia DSM criteria
A. marked fear or anxiety about 2 or more of the following:
using public transportation
being in open spaces
being in enclosed spaces
standing in line or being in a crowd
being outside of the home alone
B. the individual fears or avoids these situations due to
concern that escape may be difficult or help may be
unavailable if panic symtpoms or other embarrassment
occurs
C. these situations almost always provoke fear or anxiety
D. the situations are actively avoided, require the presence
of a companion or are endured with intense fear or anxiety
E. Fear is out of proportion to any actual danger
F. typically lasting for
6 months or more
G. distress or
impairment
H. if another medical condition
- reaction is excessive
I. not better explained by
another mental disorder
Specific phobia
Characterized by strong and
persistent fear of a specific object
or situation - which causes distress
or impairment in functioning
Specific phobia DSM criteria
A. marked fear or anxiety about a
specific object or situation
B. object or situation almost always
provokes immediate fear or anxiety
C. object or situation is actively avoided
or endured with intense fear or anxiety
D. fear or anxiety is out of proportion to
any danger
Causes of specific phobia
traumatic event, vicarious experience, informational transmission
OCD
Typically involves persistent intrusive unwanted thoughts or
impulses that are ignored when possible or directly resisted via
intense focus on alternate thoughts/behaviours.
OCD DSM criteria
A. Presence
of obsessions,
compulsions,
or both
B. Obsessions or
compulsions are
time-consuming or cause clinically
significant distress
or impairment
C. not attributable to the physiological effects of a substance
D. not better explained by another mental disorder
Obsessions
1) recurrent and persistent thoughts/
impulses/ images that are intrusive and
unwanted and cause anxiety and distress
2) individual attempts to ignore or suppress
the above or to neutralize them with
alternate thoughts/actions (compulsions)
Compulsions
1) repetitive behaviours or mental acts
that feel necessary to neutralize an
obsession or to meet rigid internal rules
2) behaviours or mental acts are intended
to prevent or reduce stress or to prevent a
dreaded situation – but they are either not
realistically connected or are clearly
excessive
Symmetry/ Exactness/ Just Right
Obsessions: making things symmetrical/aligned,
doing things over and over until they feel “just right”
Compulsions: putting things in a certain order,
repeating rituals
Forbidden Thoughts or Actions
Obsessions: fear of urges to harm self or others
in some way (often sexual or aggressive), fear
of offending God (religious)
Compulsions: checking, avoidance,
reassurance-seeking
Cleaning/Contamination
Obsessions: fear of germs/ contaminants
Compulsions: repetitive or excessive washing,
using gloves/masks when not needed
Hoarding
Obsessions: fear of throwing anything away
Compulsions: collecting and/or saving objects
with little to no actual sentimental value
Underlying factors of OCD
Thought-action fusion: belief that thoughts
and actions are the same/similar - or that
thinking something is as bad as doing it
Belief that some thoughts are
unacceptable
OCD treatment
Anti-depressants (SSRIs) seem to
work fairly well for many - but
relapse is common if they are
dicontinued
Most effective therapy
approach tends to be Exposure
and Response Prevention
In rare cases, psychosurgery
may be used - but usually
involves severe side effects
Exposure & Response Prevention for OCD
a very specialized type of Cognitive Behavioural Therapy
OCD is very sticky in both the thoughts and behaviours
categories - ERP targets both
Often looks similar to a fear hierarchy with the “fears”
being the obsessions/compulsions
For example, an early step in a cleaning type OCD might
be watching a video about germs and not washing your
hands or using sanitizer for 5 minutes
Body Dysmorphic Disorder
Involves feeling like
there is something
objectively wrong with
how you look - even
though others do not
see the same thing
BDD DSM criteria
A. Preoccupation with one or more
perceived body defects that are either not observable to others or appear slight
B. At some point the indivdual has performed
repetitive behaviours or mental acts in response to their concern
C. Clinically significant distress or impairment
D. Not better explained by concerns with weight related to an eating disorder.
BDD Causes and treatment
mostly what we know is that it
seems quite similar to OCD in
onset, course and treatment - so
it is likely the causes are similar
Plastic surgery is common - but
usually doesn’t work at all
Hoarding disorder
different from OCD (hoarding specifier) because it tends
to get worse and worse, rather than waxing and waning in
times of stress
involves a very strong emotional attachment to possessions
- rather than simply a fear of getting rid of them
Eating disorders cross-culturally
eating disorders are more of a
problem in developed countries,
where access to food is much higher
white people seem to report more
eating disorders
major risk factors: being overweight,
higher SES, Western ideals
Developmental Considerations of BD
Western body ideals currently are
muscles for men and thinness for
women
for girls adolescence usually
involves weight gain in fatty tissue
for boys usually involves
development of muscle
Bulimia Nervosa
involves regular binge-eating
episodes followed by behaviours
intended to prevent weight gain.
Bulimia Nervosa DSM criteria
A. recurrent episodes of binge-eating
B. Recurrent compensatory
behaviours in order to prevent weight gain
C. binge-eating and compensatory
behaviours occur, on average, at
least once a week for 3 months
D. self-evaluation is unduly
influence by body shape and weight
E. does not occur exclusively during
anorexia
Eating disorder stats
previously was subtyped into purging
(vomiting, laxatives) and non-purging
(exercise, fasting)
purging is not particularly effective
Frequently co-morbid with mood** and anxiety
disorders, as well as borderline personality
disorder, self-injury, and substance abuse
medical issues associated with eating disorders
Chronic bulimia, particularly with purging,
has severe medical consequences
Salivary gland enlargement
Erosion of dental enamel
Cardiac arrhythmia
Renal (kidney) failure)
Increased body fat
Anorexia Nervosa
involves restricted eating, intense
fear of weight gain, and lack of
perspective on body shape
Anorexia Nervosa DSM criteria
A. restriction of energy intake leading to a
significantly low body weight
B. intense fear of gaining weight/becoming
fat, deliberately preventing weight gain
C. disturbance in how body weight/shape is
experienced
Restricting type
during the last 3 months,
individual has not engaged in recurrent
binge-eating or purging behaviour
Binge-eating/purging type
during the
last 3 months, the individual has engaged
in recurrent binge-eating or purging
behaviour
Anorexia Nervosa stats
people with anorexia do not tend to view
themselves as ill
female athletes, models, and performers
are often at high risk
individuals typically continue to pursue
weight loss, never satisfied with their body
asssociated with mood disorders, anxiety,
substance use, OCD, and suicide
Atypical Anorexia Nervosa
anorexia has long been thought to
require a significantly low body weight
however, this excludes overweight
and obese people engaging in
extreme restrictive behaviours
these people also experience the
medical consequences.
Anorexia medical issues
amenorrhea (loss of menstrual
period)
dry skin
brittle hair and nails
sensitivity to cold
lanugo (hair on limbs and cheeks)
low blood pressure/low heart rate
Binge eating disorder
Involves binge eating with
lots of distress - but no
compensatory behaviours
Binge eating disorder DSM-5 Criteria
A. recurrent episodes of binge-eating
B. binge-eating episodes associated
with 3 or more of the following:
eating much more rapidly
eating until uncomfortably full
eating lots when not hungry
eating alone due to embarassment
feeling disgusted/guilty afterwards
C. Marked distress regarding binge-eating
D. binge-eating occurs, on average, at
least once a week for 3 months
E. binge eating not associated with
recurrent compensatory behaviour and
does not occur exclusively during bulimia
or anorexia
BED Stats
BED is quite common in obese individuals,
but happens at all weights - people who
binge-eat are more likely to become obese
common for BED to turn into bulimia
half try binging first and half try dieting first
about 33% of those with BED use food to
regulate mood
BED Biological causes
seems to run in families - but
unclear genetic vs. environmental
some underlying traits may be
emotional instability, perfectionism,
and poor impulse control
also seems to be some relationship
with hormonal cycle
BED Psychological causes
Psychological Causes
difficulty tolerating negative emotions
distortions in body image (including
instability)
intense emotions triggered by food cues
overly reactive to food cues
BED Social causes
thinness is valued and
overrepresented (particularly
for women in the media)
dieting is typically ineffective
however, dieting is also
culturally encouraged and can
be a part of female bonding
BED Drug treatment
medication generally does not seem to be
effective for anorexia
however, anti-depressants (SSRIs) may be
helpful in reducing both binging and
purging in bulimia
when medication is helpful, it is generally
best used alongside therapy
BED Therapy treatment
family-based therapies, which
involve parents in support
individual interpersonal therapy
focused on improving relationship
with self and others
CBT targeting eating behaviours
and attitudes about bodies
What is
trauma?
A deeply distressing or
disturbing experience
emotional shock
following a stressful
event or physical injury
single event trauma
an incident of violence
a sexual assault
a car crash
death of a loved one***
living through a war or
natural disaster
witnessing violence
repeated trauma
ongoing childhood neglect
or abuse
relationship with an
abusive partner
ongoing bullying
long term exposure to a
cult or high-control religion
Trauma risk factors
highly related to direct
exposure to danger and to
the intensity of exposure
family history of anxiety
family instability
lack of social support
limited education (predicts
exposure to trauma)
PTSD
generally refers to
re-experiencing (or going
to great lengths to avoid
re-experiencing) aspects
of trauma even after the
incident is resolved.
PTSD DSM criteria
A. Exposure to actual or threatened death,
serious injury, or sexual violence
B. Presence of one (or more) intrusion symptoms:
recurrent, involuntary, and intrusive distressing
memories of the event(s)
1.
Recurrent distressing dreams in which the
content/affect are related to the event(s)
2.
Dissociative reactions (e.g., flashbacks) which
feel like the event is recurring
3.
Intense or prolonged psychological distress
related to internal or external cues that
resemble the trauma event
4.
Physiological reactions to internal or external
cues that resemble the trauma event
C. Persistent avoidance of stimuli
associated with the traumatic
events
D. Negative alterations in cognitions and mood associated
with the traumatic events,
E. Marked alterations in arousal and reactivity
associated with the traumatic event,
F. duration of the distrubance
(B, C, D, E) is more than one month
G. clinically significant
distress or impairment
H. disturbance is not attributable
to the physiological effects of a
substance or another medical
condition
Specify whether PTSD is
with dissociative symptoms
Depersonalization: feeling detached
from/ outside one’s body
Derealization: recurrent experiences of
world feeling dreamlike or unreal
Specify if:
with delayed expression
if full diagnostic criteria are not met
until at least 6 months after the event
Acute stress disorder
Similar symptoms to
PTSD, but occurring
within the month
following the event(s).
~50% will go on to
develop PTSD
Acute stress disorder DSM criteria
A. same as PTSD (trauma exposure)
B. 9 or more symptoms across 5
categories: intrusion, negative mood, dissociation, avoidance, and arousal
C. duration of symptoms is 3 days-1
month after trauma exposure
D. clinically significant distress or
impairment
C-PTSD
Typically results from
repeated/ ongoing
exposure to trauma
Not in the DSM, but in
the ICD and widely used
C-PTSD ICD-11 Criteria
exposure to an event or series of events (threatening or horrific) from which escape is difficult
re-experiencing traumatic event
deliberate avoidance of reminders likely to promote re-experiencing
persistent perceptions of heightened current threat
severe and pervasive problems in affect regulation
persistent beliefs about oneself as defeated, with shame/ guilt related to stressor persistent difficulties in sustaining relationships and in feeling close to others results in significant impairment
C-PTSD Developmental info
In children: may look like regression,
reckless behaviour, aggression towards
self and others, and difficulty with peers
In adolescence: may look like substance
use, risk-taking behaviours, and
aggressive behaviours
In kids and teens: attention issues
In older adults: may be more anxiety,
regret, and avoidance focused
Treating trauma
Cognitive-Behavioural Therapy (CBT)
particularly related to confronting
beliefs involving blame or guilt
Medication (SSRIs)
can be helpful in relieving the anxiety
and panic associated with PTSD
Exposure Therapy
as a general rule, when avoidance
and anxiety are present, treatment
tends to involve exposure
obviously, in PTSD, we don’t want
to recreate the actual trauma
instead, imaginal exposure is often
the tool of choice
Narrative Therapy
goes beyond just reviewing the
trauma as it happened
therapist supports client in taking
ownership of their story and
incorporating new meaning
helps promote identity as trauma
survivor
Eye-Movement Desensitization and Reprocessing
somewhat newer treatment, but
around since the late 90s
involves moving the eyes in
specific ways thought to help the
brain re-process trauma events
still unclear why exactly it works -
but it does seem to be effective
Dissociation
Involves feeling detached from your own body,
your surroundings, or reality in general.
Dissociative experiences are common - what
follows is discussion of dissociative disorders.
Depersonalization-derealization disorder
Repeated experiences of feeling
detached from thoughts or body -
although aware that this is not the case.
Depersonalization-derealization disorder DSM
A. Presence of persistent or recurrent experiences
of depersonalization, derealization, or both:
Depersonalization: experiences of unreality,
detachment, or being an outside observer of
your thoughts, feelings, body, or actions
Derealization: experiences of unreality or
detachment with surroundings (e.g., feeling like
in a dream or things are foggy)
B. During depersonalization/derealization the
person is still aware of what is and is not real.
C. Clinically significant distress or impairment
D. Not result of substance or medical condition
E. Not better explained by another mental disorderD
Dissociative amnesia
Involves missing personal memories, usually related to trauma/stress.
Dissociative amnesia DSM
A. An inability to recall important autiobiographical
information, usually of a traumatic or stressful
nature - inconsistent with ordinary forgetting.
B. Clinically significant distress or impairment
C. Not result of substance, neuorological, or medical
condition
D. Not better explained by DID, PTSD, acute stress
disorder, or a neurocognitive disorder
DID
Formerly known as Multiple Personality
Disorder - typically involves adopting multiple co-existing identities which may be entirely or
only somewhat distinct from each other.
DID DSM
A. Disruption of identity characterized by two or
more distinct personality states - involves changes
in affect, behaviour, memory, cognition, etc.
B. Recurrent gaps in recall of everyday events,
personal information and/or traumatic events that
go beyond ordinary forgetting.
C. Clinically significant distress or impairment.
D. Not a normal part of a broadly accepted cultural
or religious practice (and, in children, not simply
imaginary playmates/fantasy play).
E. Not the effect of a substance or another medical
condition.
DID Stats
Research on DID is largely based on case studies
so statistics are somewhat unreliable
It is common for individuals to have many alters
(~15) and DID seems to be much more common in
women compared to men
Onset is typically in childhood and it usually takes
several years to identify the disorder
Without treatment, will typically be lifelong
DID causes
Typically co-occurs with other significant disorders
(e.g., substance abuse, depression, borderline
personality disorder)
Some believe DID is actually better accounted for by
severe Borderline Personality Disorder or severe PTSD
Often misdiagnosed as psychosis
Seems to regularly reflect severe history of child abuse
- often sexual or physical in nature
DID Treatment
The goal of DID is re-integration - understanding that alters are all reflections of parts of the self
Largely involves working through trauma, as in PTSD - but can involve strategies like hypnosis since
some alters are not aware of the traumas
The risk is that pushing trauma too much or too fast
can result in further disintegration
Depression
depression looks more like
drastically reduced arousal
Most people experience depression
- but most people do not experience
a depressive disorder
Mainia
Depression -> significantly reduced
arousal
Mania -> significantly increased arousal
Depression stats
Average onset of Major Depressive
Disorder (MDD): 25-29
seems to be decreasing
A first depressive episode typically
lasts between 2-9 months without
treatment
Children with depressive symptoms
often go on to develop MDD
Depression across the lifespan
Children: much less common and
may look more like irritability
Adolescence: dramatic rise, may be
higher than in adults
Older adults: can be easier to miss
due to things like dementia - but
similar rates to other adults
Bipolar stats
Average onset of Bipolar 1 is 15-18
and Bipolar 2 is 19-22
notably, this is younger than
MDD and also tends to be more
suddden
It remains unclear if Bipolar is
distinct from MDD or just a more
extreme version
course of bipolar
~25 percent of those diagnosed with
MDD eventually have a full manic
episode
Bipolar rarely begins after age 40
Bipolar tends to be chronic
Bipolar, like MDD, is highly
associated with risk of suicide
Bipolar prevalence
Worldwide, roughly 2.4%
experience Bipolar disorder
Compared to MDD tends to
be much more chronic
Gender ratio is more even
for Bipolar Disorder
Children: may look more like irritability
(but also Bipolar is rare in children)
Adolescence: can look like irritability or
more classic mania
Causes of mood disorers
family and genes, stressful life events
psych factors of mood disorders
Learned Helplessness: perception that
actions have no effect on outcome
When this results in hopelessness -
depression can be the natural result
Cognitive Triad: Beck noted specific
cognitive “errors” that involved thinking
negatively about oneself, the immediate
world, and one’s future
psych factors mood disorders
Learned Helplessness: perception that
actions have no effect on outcome
When this results in hopelessness -
depression can be the natural result
Cognitive Triad: Beck noted specific
cognitive “errors” that involved thinking
negatively about oneself, the immediate
world, and one’s future
social factors mood disorders
Marital dissatisfaction/ marital split (especially for men)
Gender: Depression is higher in women
women are taught to be more passive
women are more prone to rumination
women are more likely to live in poverty
women are more likely to have a history of abuse
Racial discrimination
Lack of social support - including living alone
mood disorder medication
Tri-cyclic antidepressants: effect more than one neurotransmitter system via
preventing reuptake
MAO inhibitors: effect more than one
neurotransmitter system via preventing
breakdown of neurotransmitters
SSRIs: specifically prevents serotonin
reuptake
SSRIs are typically first choice for depression - with tricyclics
prescribed if not effective and then MAO inhibitors
SSRIs tend to have less bothersome side effects, although
sexual dysfunction is a frequent concern
Lithium Carbonate is a salt which at medicinal dosages seems
to be able to stabilize moods - making it the strongest choice
for treatment of Bipolar Disorder
major depressive episode
a. 5 (or more symptoms),
present at least 2 weeks,
change in functioning
b. distress/impairment
c. not substance/medical
major depressive episode symptoms
- depressed mood most of the day nearly every
day - indicated by subjective report or
observation by others - in children, can be
irritable mood - markedly diminished interest or pleasure in
all or almost all activities most of the day,
nearly every day - self or other-report - weight loss/weight gain or decreased/increased appetite
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive or
inappropriate guilt - diminished ability to think/concentrate
or indecisiveness - recurrent thoughts of death/suicidal
ideation/suicide plan/ suicide attempt
major depressive disorder
a-c. Major Depressive Episode
d. at least one MDE not better explained by
another disorder (schizophrenia, psychosis, etc)
e. there has never been a manic or hypomanic
episode (other than substance-induced)
manic episode
a. abnormally and persistently elevated, expansive,
or irritable mood and increased activity or energy for
at least one week, most of the day, nearly every day
(any duration, if hospitalization occurs)
b. 3 or more symptoms during mood disturbance
c. impairment, hospitalization, risk of harm to self or
others, or psychotic features
d. not due to substance/medical condition
hypomanic episode
a. abnormally and persistently elevated, expansive,
or irritable mood and increased activity or energy for
at least four days, most of the day, nearly every day
(any duration, if hospitalization occurs)
b. 3 or more symptoms during mood disturbance
c. not severe enough to cause marked impairment,
or necessitate hospitalization
d. not due to substance
bipolar I disorder
criteria have been met for at least 1 manic episode
at least one manic episode is not better explained
by a different disorder (e.g., psychosis)
can also include hypomanic and/or major
depressive episodes
bipolar II disorder
criteria have been met for at least one hypomanic
episode and at least one major depressive episode
there has never been a manic episode
at least one hypomanic and one depressive
episode not explained by another disorder
clinically significant distress/impairment overall
