Midterm 2 Flashcards
Types Dissociative disorders
- dissociative amnesia
- dissociate fugue
- depersonalization/ derealization disorder
- dissociative identity disorder or multiple personality disorder
Dissociative disorders
Characterized by severe maladaptive disruptions or alterations of identity, memory, and consciousness that are experienced as being beyond ones control
Dissociation
- The lack of normal integration of thoughts, feelings, and experiences in consciousness and memory;
- Persistent maladaptive disruptions in the integration of memory, consciousness, and identity
- symptom in many mental disorders
Repressed
Referring to memories that a person cannot call into awareness, but which remain in the person’s subconscious and can be retrieved under certain conditions or with the help of psychotherapists
False memory syndrome
A proposed condition in which people are induced by therapists to remember events that never occurred
Dissociative amnesia
The inability to recall significant personal information in the absence of organic impairment
Localized amnesia
Individual can’t recall info from a specific time period
Selective amnesia
Parts of events (trauma) are remembered, others forgotten
Generalized amnesia
Individual forgets all past personal information from his or her past
Continuous amnesia
Individual forgets information from a specific date (trauma?) to present
Systematized amnesia
The person forgets certain categories of information such as people or places
Which two categories of dissociative amnesia are the most common?
-localized & selective
The five patterns of memory loss characteristic of dissociative amnesia described in DSM-5
1) localized amnesia
2) selective amnesia
3) generalized amnesia
4) continuous amnesia
5) systematized amnesia
Dissociative fugue
An extremely rare and unusual type of amnesia in which individuals not only have a loss of memory for their past and personal identity, but they also travel suddenly and unexpectedly away from home
Depersonalization/ derealization disorder
- A dissociative disorder in which the individual has persistent or recurring experiences of depersonalizations and/ or derealization
- likely related to emotional trauma
- reduced emotional reactivity to stressful or emotionally intense stimuli, & cognitive disruptions in perceptual and attentional processes
Depersonalization
A condition in which individuals have a distinct sense of unreality and detachment from their own thoughts, feelings, sensations, actions, or body (sense of unreality, detachment from self)
Derealization
Involves feelings of unreality and detachment with respect with respect to one’s surroundings rather than the self(feelings of unreality, detachment from surroundings)
Depersonalization is the _______ most commonly reported symptom
Third
Dissociative identity disorder (DID)
- (multiple personality disorder)
- diagnosed when the patient presents with two or more distinct personality states that regularly take control of the patient’s behaviour and emotions
- disruption identity & marked discontinuity in sense of self and agency
- diagnosis age 29-35
- high rate self-injury & suicide attempts
- controversial disorder
Alters
The subsequent (not host) personalities found in dissociative identity disorder (DID)
Social factors- etiology of dissociative disorders
- speculations about hat happens when parents are both loving and abusive
- Iatrogenic effects
Switching
- The process of changing from one personality to another
- often occurs in response to a stressful situation
Trauma model
According to his model, dissociative disorders are a result of severe childhood trauma, including sexual, physical, and emotional abuse, accompanied by personality traits that predispose the individual to employ dissociation as a defence mechanism or coping strategy (diathesis- stress formulation)
Abreaction
Re- experiencing of emotions that were felt at that time
Psychological factors- etiology of dissociative disorders
- trauma
- state dependent learning
- attachment theory
Treatment of dissociative disorders
- uncovering and expressing past traumas
- hypnosis (abreaction)
- DID: re-integrate all the personalities into a whole
- medication to reduce stress
Socio-cognitive model
- According to this perspective,multiple personality is a form of role playing in which individuals come to construe themselves as possessing multiple selves and then begin to act in ways consistent with their own or their therapist’s conception of the disorder
- taken by many mental health professionals who do not accept DID as a legitimate disorder
Types of somatic symptoms and related disorders
- Somatic symptom disorder with predominant pain
- illness anxiety disorder
- factitious disorder (Münchausen syndrome)
- body dysmorphic disorder
Somatic symptom disorder
- New diagnosis in DSM-5 which subsumes the former somatization disorder as well as hypochondriasis
- a disorder characterized by one or more bodily symptoms that are distressing to the individual, result in significant disruption of daily life, and are accompanied by excessive worry and preoccupation, extreme anxiety, or disproportionate time and energy
To be diagnosed with a somatic symptom disorder, a person must:
- have a history of multiple symptoms
- changing somatic complaints involving multiple organ systems
- history must have started before age 30 and include:
- pain at least 4 different sites or pain during bodily functions
- at least 2 gastrointestinal complaints
- at least one sexual or reproductive complaint
- at least one symptom other than pain suggests a neurological condition
Somatic symptom disorder with predominant pain
A subtype of somatic symptom disorder in which the presenting bodily symptom involves pain (called pain disorder in previous editions of DSM)
- pain must be sufficient to warrant professional attention and cause distress, work interruptions
- people must have excessive, unrealistic thoughts, feelings, or behaviour related to the symptom, exaggerated concerns about its seriousness, high levels anxiety, and/ or devote excessive time to dealing with it
- ‘doctor shopping’
Hysteria
An outdated psychiatric term once used to describe a a symptom pattern characterized by emotional excitability and physical symptoms (e.g. Convulsions, paralyses,numbness, loss of vision) without any organic cause
Conversion disorder (functional neurological symptom disorder)
Individuals with this disorder have a loss of functioning in apart of their body that appears to be due to neurological or other medical cause, but without any underlying medical abnormality to explain it
Somatic symptom and related disorders
A group of disorders in which individuals present with physical symptoms suggestive of medical illnesses, along with significant psychological distress and functional impairment at cannot be explained by organic impairment
Symptoms: impairment somatic system, multiple symptoms, preoccupation about the body, fear of physical illness
Glove anaesthesia
Involves a loss of all sensation throughout the hand, with the loss sharply demarcated at the wrist, rather than following a pattern consistent with the sensory innervation of the hand and forearm
La belle indifference
A nonchalant lack of concern about the nature and implications of ones symptoms
Illness anxiety disorder
A disorder characterized by preoccupation with having or acquaint a serious illness, even though the individual does not have any serious bodily symptoms. Individuals with this disorder are very preoccupied and anxious about their health, become easily alarmed by even mild symptoms,and perform excessive health-related behaviours such as repeatedly checking their body for signs of disease (hypochondriasis)
- fear life threatening condition
- Doctor shopping
Difference between panic disorder and illness anxiety disorder
- people with illness anxiety disorder do not have the symptoms of a panic attack
Difference between somatic symptom disorder and illness anxiety disorder
People with somatic symptom disorder do have symptoms, which are unexplained by standard medical science
Factitious disorder (Munchausen syndrome)
Individuals deliberately fake or generate the symptoms of illness or injury to gain medical attention
- can be physical or psychiatric
- there must not be any evidence of external rewards. Must be “sick role”
Factitious disordered imposed on another (Münchausen by proxy)
An individual falsifies illness in another person, most commonly one’s own child
Body dysmorphic disorder (BDD)
- Excessive preoccupation with an imagined or exaggerated body disfigurement, sometimes to the point of delusion
- distressing & difficult to control & interfering with social relations
- classified as an anxiety disorder under OCD
Are somatoform disorders more common in men or women
Except for,illness anxiety disorder, much more common in women in North America & Europe
More common in men in Puerto Rico and Greece
Somatoform disorders are more common in:
- low SES groups
- people less than high school education
- some cultures
- people lost a spouse
- Comorbidity with mood and anxiety disorders
Two-factor psychobiological theory: somatoform disorders
- Increased bodily signals due to biological factors related to prolonged distress, lack of physical condition, chronologically stimulated HPA axis
- A deficient ‘filter system’ that amplified body signals rather than inhibitiong them or effectively selecting them
Psychological factors: somatoform disorders
- unconscious expression of conflict, negative affect
- secondary gain
- positive and negative reinforcement
- learned sick role
- Tendency to pay excessive attention & amplify somatic symptoms
- misattribution of normal somatic symptoms
- alexithymia: deficit in the capacity to recognize and verbalized emotions
Alexithymia
Deficit in the capacity to recognize and verbalized emotions
Illness
Defined by symptoms, which are subjective reports of internal states
Disease
Defined by signs, which are objective indications of disease process observable directly or by the use of tests
Stress
An event that creates physiological and/or psychological strain, thus creating a need for adaptation by the individual; influences all physical disorders
Coping
The thoughts and behaviours a person uses to regulate distress (emotion-focused coping), manage the problem causing distress (problem-focused coping), and manta ion positive well-being (meaning-based coping)
Dualistic
A view of mind and body as separate entities, subject to different laws. Nowadays avoided in DSM terminology, hence the substitution of the term psychophysiological for psychosomatic
4 ways in which psychological or behavioural factors can affect a medical condition:
- The factors affect the course of the medical condition
- Psychological factors interfere with the treatment of the condition
- Psychological factors present an abnormal risk to the health of the individual
- Psychological factors influence the pathophysiology of the disorder
Behavioural medicine
Application of the methods of behaviour modification to the treatment or prevention of disease- for example, the use of psychological techniques to control pain in patients undergoing medical procedures, or interventions to improve the diabetics’ ability to control blood glucose
Health psychology
Any application of psychological methods and theories to understand the origins of disease, individual response to disease, and the determinants of good health
Mechanism
An activity of a living system that mediates the influence the influence of an antecedent factor on disease
Lesions
Disruptions of bodily tissue or of the normal function of a bodily system
Nonspecific immune responses
One of the three general categories of immune response, in which circulating white cells called granulocytes and monocytes identify invading agents and destroy them by phagocytosis engulfing and digesting them
Cellular immunity
One of the three general categories of immune response, based on the action of a class of blood cells called T-lymphocytes. The “T” designation refers to the locus of their production, the thymus gland. Cellular immunity results from a cascade of actions of various types of T-lymphocytes
Humoral immunity
One of the three general categories of immune response, in which invading agents are presented by macrophages to B-lymphocytes…
Psychoneuroimmunology
The study of mind-brain-immune system interaction
Three pathways through which psychosocial variables can influence immune activity:
1) by the direct action of CNS on organs and structures of the immune system
2) as a secondary consequence of the hormonal changes
3) by changes in behaviour (ie poor diet) that reflect personal characteristics of adaptations to changing life conditions
General adaptation syndrome (GAS)
A stereotyped pattern of bodily changes that occurs in response to diverse challengers to the organism, first described by Hans Selye. The syndrome comprises three stages: alarm, resistance, and exhaustion. The GAS was the first formal description and definition of stress
Alarm
The first phase of the general adaptation syndrome (GAS), a concept that was the first formal description and definition of stress as a consequence of adaptation to demands on the body. In the alarm phase, the body, faced with an adaptive challenge, mobilizes its defences
Resistance
The second phase of the general adaptation syndrome (GAS. In the resistance phase, if the challenge of the alarm phase persists, the body actively fights or copes with the challenge through immune and neuroendocrine changes. These adaptive responses enhance the body’s ability to ward off threats in short term
Transactional model
A model of stress that conceives of stress as a property neither of stimulus nor of response, but rather as an ongoing series of transactions between an individual and his or her environment. Central to this formulation is the idea that people constantly evaluate what is happening to them and its implications for themselves (appraisals)
People that can appraise an event as a ….
Challenge rather than a harm or threat cope with stress better
Appraisal
In the transactional model of stress, evaluations that people constantly make about what is happening to them and its implications for themselves
Primary appraisals
In the transactional model, Cognitive evaluation of the challenge, threat, or harm presented by an event
Secondary appraisals
In the transactional model of stress, a set of appraisals that occur after a primary appraisal if the individual concludes there is an element of threat, equivalent to the question: “is there anything I can do about this?”; the assessment of ones abilities and resources for coping with a difficult event
Internal locus of control
See themselves as the masters of their own destiny
Physiological responses to stress
- endocrine system (HPA axis)
- autonomic nervous system & sympathetic-Arsenal medullary system (SAM)
- immune system (paychneuroimmunogy)
External locus of control
See themselves as being buffeted by the random events of the world
Who is less likely to develop stress related illness?
- those who can recognize and express emotion within reasonable ranges, and those who are prepared to discuss emotional and traumatic experiences
Longitudinal study
A large group of people are evaluated for psychological or behavioural features and then are followed up, years or decades later, to determine whether they have developed the disease
Ischemic heart disease
Blood supply to the heart becomes compromised
Myocardial infarction
Heart attack
Stroke
Blood supply to the brain is interrupted, leading to death of neural tissue
Potential years of life lost (PYLL)
A measure calculated by subtracting age of death from an individual’s life expectancy
Vasculature
The system of arteries, arterioles, capillaries, venues, and veins responsible for circulation of the blood to all parts of the body and its return to the heart
Systolic blood pressure/ diastolic blood pressure
A measure of the pressure of the blood flowing through the Vasculature. It is obtained by finding the number of millimetres of mercury displaced by a sphygmomanometer (blood pressure cuff)
Cardiac output
The amount of blood pumped by the heart
Total peripheral resistance
The diameter of the blood vessels
Arrhythmias
Disturbances in the normal pumping rhythm of the heart
Atherosclerosis (Atherogenesis)
A buildup of deposits, known as plaques, on the walls of the blood vessels
Controllable risk factors
Factors increasing the likelihood of a disease, such as poor diet or smoking, that are under the control on the individual
Protective factors
Events or circumstances that help to offset, or buffer, risk factors, anything that lessens the likelihood of disease. For example, exercise is thought to be a protective factor for cardiovascular disease
Hypertension
A characteristically high level of resting blood pressure (more than 140/80)
Stress reactivity paradigm
A viewpoint that sees the reaction to stress as important to an understanding of cardiovascular disease
Cardiovascular reactivity
How much an individual’s cardiovascular function changes in response to a psychologically significant stimulus
Type A
A syndrome of behaviours that includes hyper alertness and arousabilty, a chronic sense of time-urgency, competitiveness, hostility, and job-involvement
Psychophysiological reactivity model’s theory of how hostility lead to health risk?
- hostile people are at higher risk because they experience exaggerated autonomic and neuroendocrine responses during stress