PSYC1002 Flashcards
Abnormalities and perception
What is the incidence of a disorder?
number of new cases that occur during a given period
What is the prevalence of a disorder?
number of people who have a disorder during a specified period of time
What is abnormal psychology?
Scientific study (explanation) of ‘abnormal behaviour’
What is abnormal?
The 3D’s- neither on its own is necessary or sufficient
- Deviance
- Distress
- Dysfunctiona
What is deviance and what are the problems with it?
Unusual/unexpected/rare
Problems is that eccentricity or unusual lifestyles do not classify as mental disease
Classification this way can lead to an overly hostile/aggressive society towards people who are different then they
Attitude that anyone different from majority need treatment- starts social oppression
There are positively valued deviations
• Being extremely tall or being a fast runner
E.g. homosexuality- defined as a mental disorder until 1973 just because people showed a deviance from societal norms
People are seen as disturbed if they violate the unstated norms of society
• E.g. talking to yourself, intently staring at someone…
What is distress and what are the problems with it?
E.g. depression and anxiety are distressing and lead to affected to seek help
But bipolar disorder (manic phase) and narcissism, people don’t feel distress towards themselves when they have these- they feel happy and joyous
Psychopaths aren’t very distressed either
There is normal distress in everybody
• Mental disorder doesn’t mean you are distressed but being distressed doesn’t mean you have a mental disorder
Culture/society can cause natural distress towards oneself through judgement
• E.g homosexuality
What is dysfunctional and what are the problems with it?
Behaviour interferes with ability to carry out function in society
E.g. ADHD when people can’t concentrate on schoolwork interferes with school life
But pathological independent and psychopathy- they still work really well in society
Problem because it is defined by norms of surrounding society
• Function of people in society is determined by society itself and is influenced by the era
What are all the D’s affected by? In this case, are they effective means of classification
• All the d’s are affected by current social values and constructs
o Some people think behaviour is normal and some abnormal depending on their culture and context
• Henceforth, deviance, personal distress and maladaptive behaviour all determine whether behaviour is normal or abnormal
• We can attempt to define abnormal behaviour as behaviour that is personally distressing, personally dysfunctional and/or so culturally deviant that other people judge it to be inappropriate or maladaptive
Is psychological abnormality and normality on a continuum, or in well defined categories?
Continuum
What is the diagnostic and statistical manual of mental disorders?
Published by the American Psychiatric Association
Reflects biological/medical model of ‘mental illness’
Reflects the current state of knowledge about diagnostic categories and symptoms, rather than it being a reflection of reality
What are the different models of mental illness?
- Supernatural
- Biological
- Psychological
- Sociocultural
What is the supernatural model of mental illness?
o Mental disorders are caused by supernatural causes
o This is not empirically proven
o Cause: spirits, stars or moon, past lives
o Treatment- exorcism, prayer, etc.
What is the biological model of mental illness?
o Cause: internal physical problems (=biological dysfunction)
o Treatment: bleeding, diet, exercise, medication
Today, medication is commonly used
What is the psychological model of mental illness?
o Interpretations and values are such that it causes us suffering
o Eventually seek evidence to strengthen and confirm our beliefs
o Cause: beliefs, perceptions, values, motivation
o Treatment: psychotherapy
Breaks down false realities of the world
What is the sociocultural model of mental illness?
o Main causes of suffering is society’s expectations
o Causes: poverty, prejudice, cultural norms
There is the problem of culture-bound disorders, which occur only in certain locales
o Treatment: fix social ills
Are all models mutually exclusive?
No- all are as important as the others (except supernatural)
Describe a timeline of the biological/medical model
• Historically- mental illness= “madness”
o What we now classify as psychosis and dementia
o Gross distortions in perceptions of reality
o Bizarre disorganised thought, affect, behaviour
o Oldest model that is empirically verifiable
• Ancient Greece, Rome
o Hippocrates (460-377 BC), Galen (129-198)
Hippocrates suggested that mental illness was caused by physical disturbances in the body
• Middle Ages (6th-15th century)
o Europe: Catholic church took over authority
o Islamic civilisations upheld biological model
Ali al-Husayn ibn Sina (980-1037), Al-Razi (865-925)
• Europe 19th-10th century: some mental illnesses found to have physical causes (e.g. germs)
o Psychiatry became a legitimate field of medicine
o Starting point for many discoveries of bacteria and their effect on illnesses
o Biological emphasis was given impetus by the discovery that general paresis resulted from massive brain deterioration caused by syphilis
• Today: dominant model in psychiatry
o Assumes that psychological disorders can be
Diagnosed similarly to physical illness
Caused by biological disease processes
• Structural brain abnormalities (Shizophrenia)
• Neurochemical imbalance (depression)
Best treated with biological agents- medication, surgery, ECT…
What are limitations of the biological model?
o Need to avoid extreme reductionism
Certain complex psychological phenomena may be impossible to explain at the neural/molecular level
o Need to avoid over-extrapolation from animal research
Humans are more sophisticated/have more sophisticated motivations
o Need to avoid assuming causation from treatment
Avoid circular logic
o The medical model may not be applicable to conceptualising and diagnosing ‘mental illness’
Clear boundary between physical health and illness
• But continuity between mental health and disorder
What was the psychoanalytic model?
o Most dominant model of psychiatry during 1st half of the 20th century
o Don’t use classical psychoanalysis in psychology now
o Human personality is in constant conflict between three elements that develop in stages:
-Id
-Ego
-Superego
o Unresolved conflict between id, ego and superego can cause anxiety, distress, guilt and shame
o To avoid pain of unresolved conflict and to protect the consciousness, ego develops defence mechanisms
o Defence mechanisms can be more or less successful
o Defence mechanisms can create suffering and symptoms, especially when rigidly applied
Displacement depression
Projection paranoia
Reaction formation overprotection , dependence
Repression obsessiveness
o The same process explains both normal and abnormal behaviour, emotion and thought
o Revolutionised the concept of mental illness
o Popularised the concept of neurosis
o Made no clear dividing line between normal and abnormal conditions and processes
o Treatment
Insight
What is the id?
- Unconscious part of self
- Instinctual drive you are born with
- Motivation: libido-energy derived from id
- Instinct based on pleasure principle wants to feel good
- Unthinking and unreasonable motivation
What is the ego?
- Begins to develop at age 2
- Conscious self (thinking, problem solving, language)
- Second part of personality
- Reality principle
- Wants to mediate between Id and superego
What is the superego?
• Develops at about age 5-6
• Moral self, conscience
• Resolution of Oedipus conflict in male child
o Internalisation of values/expectations of society through identification with father
• In direct conflict with id
What are defence mechanisms of the ego?
Repress id impulses into unconscious
Distort id impulses into acceptable forms
• Displacement
o Displacing your hate from one thing to another
• Reaction formation
o Turning your hate into love
• Projection
o Projecting your hate on something that symbolises what you hate
• Sublimation
o Expressing the feelings in art
o According to the traditional model, only males can do this
A normal process, we all experience it
What are critiques of the psychoanalysis model?
- Limited empirical evidence
- Lack of falsifiability
What is the humanistic model?
o Psychological health:
Fully functioning, self-actualised persons
o Maladjustment results from:
Environment imposes conditions of worth
Own experience, emotions, needs are blocked
Self-actualisation thwarted
If grown in enriching environment, becomes:
• Self-actualised
• Independent, sensitive to the needs of others, loves life and loves life’s wonders
If grown in a society where there are expectations of worth
• Own emotions are blocked because trying to love life for someone else
• Unhappy
• Anxious
• Depressed
o Treatment: empathy, unconditional positive regard
o Critique: difficult to research
Not empirically verifiable
What is the behavioural model?
o Classical conditioning (Pavlov)
o Operant conditioning (Skinner)
o Maladjustment results from learning history
o Many treatment applications
Developing new learning experiences
o Critique:
Observational learning/modelling (Bandura 1974)
• Incorporated cognition to behaviourism
Ignored conditioning
Simple stimulus-reaction model
Talk about the cognitive model
o What we think influences what we feel and do
o Maladaptive behaviour results from
Latent core negative beliefs (Aaron, Beck)
• Interpretation of experiences: consistent with core negative beliefs
• Cognitive biases (overgeneralisation, selective attention, catastrophizing, personalising, magnification , mistaking feelings for facts)
• Negative automatic through
o Treatment-
Cognitive restructuring
• Cognitive-Behavioural model
o Dominant model in psychology
What is the vulnerability-stress model?
• Each of us have a degree of vulnerability (from high to low) for developing a psychological disorder, given sufficient stress
o Vulnerability can have a biological basis such as genotype or neurotransmitter issue
o Vulnerability can have a personality basis, such as low self-esteem
o Vulnerability can have an environmental basis, such as poverty or severe trauma
o Need stressor: some recent or current event that requires a person to cope
What is the International Stats Classification of Diseases and related health problems? (ICD)
o Published by World Health Organisation
o Mental disorders added for the first time in 1948
Initially collected data about physical disorders
o Currently in 10th edition ICD11 beta is just out
What were DSM-I and II
o Diagnosis strongly influenced by psychoanalytic theory
o DSM-I (1952) described depression as defence mechanism from anxiety to protect person from suffering loss that has ambivalent towards them
But what if person has not had loss or does not feel guilty? Is there depression or not
o Not very reliable way to diagnose
o Psychoanalysis has no empirical evidence
What are changes that occurred in the DSM?
• Changes in the DSM:
o Homosexuality removed from the DSM in 1973 (DSM-3)
Society’s ideas changed about homosexuality
o Generalised Anxiety Disorder (GAD) first introduced in DSM-III-R (1987)
o Binge Eating Disorder (BED) first included in DSM-5 (2013)
o Asperger’s Disorder deleted from DSM-5 (2013)
o No psychopathy in DSM anymore
Are ICD and DSM the same?
• ICD and DSM are not the same
o Problem as diagnosed differently according to where you live
English speaking countries- DSM
Europe- ICD
o Mixed Anxiety-Depression (ICD), Generalised Anxiety Disorder (DSM), Binge Eating Disorder (DSM)
How is anxiety activated?
Activated in response to perceived threat
• Realistic /objective threat to self
Physical vs social threat
• Social threat important as social rejection was dangerous in evolution
• Specific ‘prepared’ stimuli
Stimuli prepared by evolution
More likely to be uncomfortable or anxious in their presence
Insects, animals, heights, enclosed places, anger
• Novel stimuli
Something could go wrong
Elicits anxiety
o Threat appraisal
–> Expectancy of harm –> automatically elicits anxiety
What four components does anxiety have?
- A subjective-emotional component, including feelings of fear and apprehension
- A cognitive component, including worrisome thoughts and a sense of inability to cope
- Physiological responses, including increased heart rate and blood pressure, muscle tension, rapid breathing, nausea or dry mouth
- Behavioural responses- avoidance of certain situations and impaired performance on other tasks
What happens to the physical system during anxiety?
Sympathetic nervous system
Fight/flight response
Mobilises resources to deal with threat
• Wants to keep you safe
Symptoms: sweating, heart rate, trembling etc
Classic symptoms of autonomic arousal
What happens to the cognitive system during anxiety?
Perception of threat
Attentional shift to source of threat
Hypervigilance to the threat
• Difficulty concentrating on other tasks
What happens to the behavioural system during anxiety?
Escape/avoidance • Most common reaction to anxiety is avoidance • Safest is avoidance Freezing Aggression • Least safe results Do what is safest for survival
What is threat appraisal, and what is it influenced by?
-Generates expectancy of harm • Product of: Perceived probability • Overinflated probability vs probability consistent with reality • Judgement causes anxious harm if not consistent with reality Perceived cost • Often based on past Experience • Conditioning, reinforcement Observational learning Instruction
When is anxiety abnormal and what happens when it is? Why?
• Not qualitatively different from normal anxiety
Same physical, cognitive, behavioural aspects
Occurrence is excessive or inappropriate
• Anxiety occurs in absence of objective threat
• Anxiety is more intense than objective level of threat
Characterised by overestimation of threat
• Probability of negative outcome
• Cost of negative outcome
Can have genetic predisposition to anxiety, but there are a lot of psychological, environmental and social factors to it
• Heredity factors may cause over reactivity of neurotransmitter systems involved in emotional systems (such as low levels of GABA) and the over reactivity of the autonomic nervous system to perceived threats
What are the anxiety disorders in DSM-IV?
- Seperation anxiety disorder
- Specific phobias
- Social phobia
- Generalized anxiety disorder
- Obssessive compulsive disorder
- Post traumatic stress disorder
- Acute stress disorder
- Panic disorder
What is panic disorder in DSM-IV?
- With/without agoraphobia
- Unexpected/spontaneous panic attacks
- Anxiety about having another attack
- Avoidance behaviour becomes a lot more extreme and life becomes more restricted as afraid of having a panic attack and try to avoid places where they had one
- Agoraphobia- excessive fear of situations such as using public transport, being in a crowd, or being outside the home
What is acute stress disorder in DSM-IV?
Short term version of PTSD
What is posttraumatic stress disorder in DSM-IV?
- Thoughts/memories of traumatic experience
- Physical integrity has been threated (you or someone close)
- Avoid memories of traumatic event
What is OCD in DSM-IV?
• Obsessions- intrusive thoughts or impulses
o Fear of the thought
• Compulsions- Ritualised behaviours to relieve the anxiety caused by obsessions
What is generalized anxiety disorder in DSM-IV?
- Excessive and uncontrollable worry about a range of outcomes
- No focus on what the purpose feels
- Something to avoid in the future
What is social phobia in DSM-IV?
- Fear of negative social evaluation
- Don’t want to be embarrassed or criticized
- Avoid social situations
What is specific phobia in DSM-IV?
- Animal, natural environment, blood-injection-injury, situational, other
- Based on learning history
- Will avoid the specific stimulus
- Phobias- strong and irrational fears of certain objects or situations
What is seperation anxiety disorder in DSM-IV?
- Being away from primary caregiver
- Childhood anxiety disorder
- Avoidance behaviour: want to stay with primary caregiver all the time for fear that they will have an accident
What are the changes between DSM-IV and DSM-V?
From DSM-IV removed from DSM-V's anxiety category: -PTSD -Acute stress disorder -OCD Added to DSM V's anxiety category: -Selective mutism
PTSD and OCD have their own chapters in DSM-V
What is a panic attack in DSM-V?
o Abrupt and intense fear or anxiety
o Peaks within 10 minutes
o Classic symptoms of autonomic arousal
Heartbeat accelerates
Sweating
o Other associated physical symptoms
o Fear of dying, losing control, going mad
Mostly associated with unexpected panic
o Situationally bound panic
Occurs in presence or anticipation of feared stimulus
Can be associated with any anxiety or related disorder
Know when to expect it
o Unexpected panic
Associated with panic disorder
o Results of intense anxiety
What is a panic disorder in DSM-V?
o Unexpected/spontaneous panic attacks
o At least 2 panic attacks where the person cannot identify the trigger
o Anxiety/worry about having another attack
o Concerns about heart attack, going mad, epilepsy
o Significant behaviour change trying to avoid another attack
Avoid areas where they had a panic attack
• Can develop agoraphobia
o Symptoms must persist for one month or more
o Average duration is 10 years before receiving psychological treatment
Think they are physically ill instead of mentally so takes them time before they get psychological help
What is the cognitive theory of panic disorder?
Bodily sensations (shaking, breathing) misinterpretation of bodily sensations anxiety increased bodily sensations panic
• Worse in people who have body fear as they are extremely aware of body sensations
• Misinterpretation of normal bodily sensations is negative increased panic about them body sensations increase
• Interpretations are so quick most people don’t realise them
Panic attacks can be triggered by exaggerated misinterpretations of normal anxiety symptoms.
The person appraises these as signs that a heart attack is about to occur, and these catastrophic appraisals create even more anxiety until the process spirals out of control, producing a full-blown state of panic.
What is specific phobia and its causes in DSM-V?
o Extreme disabling fear or anxiety about specific targets
o Animal, natural environment, blood-injection-injury, situational, other
o Possible causes:
Classical conditioning (Bouton, Mineka and Barlow, 2001)
May not be a complete account (Menzies and Clarke, 1995)
• Conditioning event is not sufficient to cause phobia
• Conditioning event is not necessary to cause phobia
o Some people with phobias have had no encounter with their phobia
Some stimuli are more likely to become phobic than others
• Phobic fears: significant threat to survival during evolution
• Genetic preparedness (Seligman, 1971, Ohman 1975)
o Things that are man-made are less the subject of phobia
• Innate/unconditioned fears(Clarke and Jackson, 1983)
o Some people don’t unlearn the intense evolutionary fear
o May be due to overprotective environment
What is generalised anxiety disorder and its symptoms in DSM-V?
o Excessive and uncontrollable worry about a wide range of outcomes
o Physical symptoms are different from panic
Tension, irritability, restlessness, sleep problems
o Associated with
High trait anxiety
• High tendency to become anxious
• Most ambiguous information is interpreted as threatening
Reduced problem solving confidence/success
Intolerance of uncertainty
• Want to reduce uncertainty to 0
Reduced ability to tolerate distress
o Ongoing state of diffuse, or free-floating, anxiety and worry that is not attached to specific situations or objects
o Symptoms have to last for at least 6 months
What is OCD in DSM-V?
o Obsessions- Repeated, intrusive, irrational, thoughts or impulses. Causes severe anxiety
o Compulsions-Ritualised behaviours to relieve the anxiety caused by obsessions
o Can be either obessions or compulsions- doesn’t have to be both
o Associated with
Intolerance of uncertainty
• Not trusting self to have done something so need to check back
Inflated responsibility
• Think that if bad things happen it’s their fault
Thought-action fusion
• Specific to OCD thinking and actingis the same thing
Magical ideation
What is PTSD in DSM-V and the symptoms required to be diagnosed/ causes?
o Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways
Illness doesn’t count
Doesn’t count if you watch events on TV, has to happen in person
Directly experiencing the traumatic event
• Try to avoid but hard to avoid due to generalisation
Witnessing, in person, the event as it occurred to others
Learning that the traumatic event occurred to a close family member or friend
• In cases of actual or threatened death of a family member of friend, the event must have been violent or accidental
Experiencing repeated or extreme exposure to aversive details of the traumatic event (police officers repeatedly exposed to details of child abuse)
o Intrusion symptoms (1 or more needed)
Memories, dreams, flasbacks of the event
o Persistent avoidance of simuli (1 or more)
Memories or external reminders of the event
o Negative changes in cognition mood (2 or more)
Fear, negative beliefs about self, others, the world
o Changes in arousal, reactivity (2 or more)
Anger, recklessness, self-destructive acts, sleep disturbance
This is more prominent in DSM-V than DSM-IV
o Duration of symptoms is 1 month or more
o 50-60% of people experience traumatic event
o PTSD prevalence: 5-11%
Critical to identify people who need assistance to prevent post-trauma problems
o Risk factors:
Pre-trauma (coping style)
• If have avoidance coping style, more likely to develop a problem
Trauma (meaning)
• If look at the situation extremely negatively and not as a one-off incident, more likely to develop problem
Post-trauma (social support)
• If have no social support during questioning or legal processes, more likely to have problems
How are anxiety disorders treated?
Cognitive Behavioural Therapy
o Aim to reduce (biased) threat appraisal
How likely is it that the event will happen
How bad would it be if it did happen
Observe cost and probability of event
o Cognitive techniques
Given rundown of what anxiety is and how it works
Thought diaries to identify automatic thoughts
Thought challenging after thoughts are identified
• What’s the evidence against the thought/belief
• Pros and cons of having the thought/belief
Behavioural techniques
What are some behavioural techniques used to treat anxiety?
o Behavioural techniques-
Necessary to use exposure to treat anxiety as main behaviour of anxiety is avoidance
Exposure to feared stimuli
• Have to be sure they don’t have safety behaviours (such as lucky charms…) during this
• For panic disorders, expose to increased body sensations through exercise…
Exposure to feared outcomes
• In vivo vs imaginary exposure
o In vivo- in real life
• Flooding vs systematic desensitisation
o Systematic- step by step
o Flooding- worst experience in first session
Behavioural techniques also affect cognition
• Exposure to feared stimuli
o Reduces judgements of likelihood of harm
• Exposure to feared outcomes
o Reduces judgments of cost
o Exposure is essential in anxiety treatment
o Generalised Anxiety Disorder is hard to treat
Doesn’t have a clear fear focus as doesn’t have specific fear to tap into
What are DSM-IV depressive disorders?
• DSM-IV depressive disorders
o Unipolar- depressive mood/episodes only
Person only experiences one end of the mood spectrum
o Depressive episode: abnormally low mood
o Major Depressive Disorder, Dysthymic disorder
Major depressive disorder- episodic disorder and differs in how long and severe they are
How are DSM-IV bipolar disorders classified
o Manic episode: abnormally elevated mood Including 3 or more of: • inflated self-esteem, • grandiosity • decreased need for sleep • increased talkativeness • Distractibility • flight of ideas • increased goal-directedness • excessive pleasure seeking o Bipolar I Disorder, Bipolar II Disorder, Cyclothymic disorders Bipolar disorder/manic depression erratic changes in mood
Were bipolar and depressive disorders in the same chapter in DSM-V?
No
What is Bipolar I disorder in DSM-V?
At least one manic episode at least for 1 week
What is Bipolar II disorder in DSM-V?
One manic episode
4 days
Not quite as severe symptoms of full blown mania
Must have depressive episode
What is cyclothymic disorder in DSM-V?
Many light symptoms of both ends of the mood spectrum
Lasts for 3 years
Fluctuations in mood
What is major depressive disorder in DSM-V and what are the symptoms
o Intense state of sadness (dysphoria) and/or lack of ability to feel positive emotion (anhedonia) that leaves them unable to function effectively in their lives
o One or more major depressive episodes
o Single or recurrent depressive episode, not accounted for by other disorders
o Recurrent episodes are common
o Affective symptoms
Depressed mood most of the day, nearly every day
Markedly diminished pleasure/interest in activities
o Somatic symptoms
Significant weight loss or gain
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue/loss of energy nearly every day
o Cognitive/motivational symptoms:
Feelings of worthlessness, excessive guilt nearly every day
Diminished ability to concentrate nearly every day
Recurrent thoughts of death, suicide, suicide attempts
o 5 or more symptoms are needed, including 2 and 3 in a 2-week period
o Each episode increases likelihood of next depressive episode
What is DSM-V persistent depressive disorder and how is it classified?
o Less intense form of depression that has less dramatic effects on personal and occupational functioning, but continues for a significant amount of time largely unabated
o Depressed mood for most of the day, for more days than not, for at least 2 years
o Presence, while depressed, of two (or more) of:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
o No more than 2 months ‘normal’ mood in 2-years
o No major depressive episode during the first 2 years
o No manic features
Symptoms are milder but longer lasting than major depression
Symptoms can persist unchanged for long periods
May also develop major depression
What are recent depression trends?
- Depression is increasing and is diagnosed at an earlier age in next generation
- A lot more young women become depressed than men starting from late adolescence
_____ + ______ = depression
Cognitive vulnerability
Stress
What is the Schema theory (Beck) on depression?
o Pre-existing negative schemas
o Learned during childhood
o Activated by stress
o Result in information processing biases
Biased attention, memory, interpretations
o Negative thoughts become dominant in consciousness
Distorted view of self, world, future
o Attribute successes or other positive events to factors outside the self while attributing negative outcomes to personal factors
What is the learned helplessness theory on depression (Seligman)?
o Depression occurs when people expect bad events will occur and that there is nothing they can do to prevent them or cope with them
o Depression occurs as a result of negative attributions for failures that are personal or internal, stable, and global
What is the ruminative response style (Nolen-Hoeksema)?
o Talks about the way you think rather than content of thinking
o Ruminating on thoughts vs distracting self from thoughts
o Women more likely to have ruminating style than men
What are cognitive causes of depression?
- Cognitive vulnerability and stress
- Schema theory
- Learned helplessness theory
- Ruminative response styles
- Interpersonal factors
- Early traumatic losses or rehections create vulnerability for later depression by triggering a grieving and rage process that becomes part of the individual’s personality (Abraham, Freud
What is Lewinsohn’s behavioural perspective on depression?
o Depression is usually triggered by a loss, by some other punishing event or by a drastic decrease in the amount of positive reinforcement that the person receives from his or her environment
o As the depression begins to take hold, people stop performing behaviours that previously provided reinforcement
o Depressed people also tend to generate additional negative life events through pessimism, and make others feel depressed and anxious
o Eventually other, people begin to lose patience which drives them away and diminished social support
o This causes further depression
What are biological causes of depression?
- Both genetic and neurochemical factors have been linked to depression (twin studies).
- Behavioural inhibition system and the behavioural activation system are involved in the development of mood disorders
- Mania high BAS low BIS
- Depression High BIS low BAS
How are depressive disorders treated?
o Addresses cognitive errors in thinking
Aims to develop more realistic view of life (thought diaries and help person adjust thoughts in a way more consistent with reality), not positive thinking
o Includes behavioural components
Behavioural activation- increase reinforcing events
• Reintroduce things they enjoy
• If they hated it, look at cognitive aspect of why they enjoyed it before and now hate it
Behavioural experiments- test beliefs
• Empirically test beliefs
• Outcomes comparable to drug therapy
o Lower relapse rates than biological treatments
Meta-analysis: 29% vs 60%
o Following CBT treatment, has learned to see world in more realistic way
What eating disorders have been added to DSM-V that weren’t in DSM-IV?
- Pica
- Rumination disorder
- Avoidant/restrictive food intake disorder
- Binge-eating disorder
What eating disorders are in DSM-V?
o Pica
o Rumination Disorder
o Avoidant/restrictive food intake disorder
o Anorexia Nervosa
o Bulimia Nervosa
o Binge-eating disorder
Added officially as an eating disorder in DSM-V
Binge but don’t purge
o Other Specified feeding or eating disorder
o Unspecified feeding or eating disorder
What is anorexia nervosia?
• Restriction of energy intake, leading to a significantly low body weight for age, sex, developmental stage and physical health
o BMI <18.5
BMI- weight standardised against height
o Need to be severely underweight to be anorexic
• Intense fear of gaining weight or becoming fat even though underweight
• Body image disturbance
o Persistent lack of recognition of seriousness of low body weight
o Undue influence of body weight/shape of self-evaluation
What is restricting anorexia nervosia?
Restrict food intake or excessive exercise
What is binging/purging nervosia?
Overeating followed by purging
Overeating can be subjective or objective amounts of food
Purging normally achieved through self-vomiting or a lot of laxatives
What are psychological symptoms of anorexia nervosa?
o Psychological problems
Depressed mood, irritability, anger, social withdrawal, preoccupation with food, poor concentration
• Often associated with starvation syndrome
• Social withdrawal- can’t eat with everyone else due to different eating patterns and long list of forbidden foods
What are physical problems of anorexia nervosia?
Low body temperature, brittle hair/nails, increased body hair growth
Low aestrogen Osteoporosis (brittle bones)
• Stop having periods
Malnutrition, anaemia, immune system suppression
What are some comorbid disorders associated with anorexia?
• Depressive disorder
• Anxiety disorders (social phobia)
• Substance use disorders
• Personality disorders (Obsessive Compulsive Personality Disorder)
o Anorexics have rigid perfectionist behaviours and attitudes
What is the prevalence and course of anorexia?
o Affects 0.5-1% of females in western societies
o 90% of individuals with anorexia nervosa are female
-Mostly teens
• Course-
o Slow recovery (takes up to 10 years)
o 20% remain chronically ill
o About 50% develop bulimia
What is bulimia nervosa?
• Binge eating + compensatory behaviours
• Recurrent episodes of binge eating
o Eating in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
o A sense of lack of control over eating during the episode
• Recurrent inappropriate compensatory behaviour in order to prevent weight gain
o Purging: self-induced vomiting, laxative abuse
o Non-purging: fasting, excessive exercise
• Body image disturbance
o Undue influence of body weight/shape on self-evaluation
• Can have normal or overweight body weight
o Unsuccessful anorexia
• Can be fast eaters that eat in secret spontaneously, or planned
• Feelings of shame and guilt after binge
What are psychological problems in people with bulimia?
o Comorbid mood disorders
o Anxiety disorders
o Substance abuse
o Personality disorders (Borderline personality disorder)
Emotional and impulsive- probably why can’t reach their goal of thinness
What are physical problems of bulimia?
o Associated with binges Stomach rupture o Associated with compensatory behaviours Scarring of oesophagus Electrolyte disturbances irregular heartbeat and heart failure Dehydration Salivary gland enlargement Loss of dental enamel
What is the prevalence, onset and course of bulimia?
• Prevalence-
o Affects 1-3% of females in western societies
o 90% of individuals with bulimia are female
• Age of onset-
o Late adolescence to early adulthood
• Course
o Long term outcome is better than for AN
10% still affected after 10 years
What is muscle dysmorphia?
• In men eating disorders are becoming recognised
o Muscle Dysmorphia
Keeps wanting to be more ripped
Change behaviour in way similar to eating disorders
Self-esteem strongly based on appearance
Less common than eating disorders in women
What are proposed biological causes of people with eating disorders?
• Genetic factors
o Genetic factors more general for neurotic disorders- not one specific gene for each disorder
o Family and twin studies suggest moderate heritability component for anorexia and bulimia
Also higher depression, personality disorders and substance use in families of people with eating disorders
o No adoption studies have been conducted
Hence, difficult to separate the effects of genetics and the effects of the environment
• Neurotransmitter disturbances
o Serotonin involved in appetite regulation
Mixed findings regarding direction of causation
What are proposed psychological causes of people with eating disorders?
• AN and BN have many features in common:
o Tendency to base self-worth on weight/shape
o Desire to attain unrealistic levels of thinness
o Intense fear of gaining weight
• High degree of overlap in proposed causes
o Cognitive behavioural theory- Transdiagnostic model (Fairburn)
Core low self esteem
Perfectionism
Distress intolerance
Interpersonal difficulties (fairburn)
What are psycho-social causes of eating disorders?
• Family factors
o Higher parental criticism, control and conflict
o Lower parental empathy and support
o Comments regarding child’s eating/body
o Parental modelling of eating/body concerns
• Peer factors
o Social approval
o Usually have some level of social anxiety
o Increase behaviour after positive feedback from peers
• Sociocultural values
o Emphasis on thinness as a key basis of attractiveness (especially for females)
o Values in society support eating disorders
What is the treatment for eating disorders?
- Hardest part is convincing the person that they need help
- Build their self-esteem on a wider range of factors than just weight
- More difficult to treat people with ED cause they don’t seek health or don’t recognise that there is a problem
What is sensation?
Refers to how your senses transform physical properties of the environment and body into electrical signals related to the brain
Based on the existence of different types of energy- see because energy interacts with objects in a specific way
Sensors take EM energy and transform it into electrical impulses in your brain that have a specific pattern
Senses defined based on kind of energy that makes them fire –> specific to stimulus
What is perception?
The process of actively organizing, selecting and interpreting these signals into meaningful representations of the world and interpolates what is missing when it perceives an object to be missing
Hemholtz- Unconscious inference
Need to interpret sensations for them to have meaning
Report things we need to know in an evolutionary point of view
We perceive what is important for our survival
Perception is the apprehension of the world by means of our senses – finds the relationships towards what we sense
Rely mainly on proximal stimuli to perceive the world
What are the six senses and what does each do?
• Vision- receptors in eyes respond to light
o Only 3 photoreceptors in eye
o Photoreceptors are at the back of the eye, behind a layer of blood vessels that cast shadows on the photoreceptors, which is ignored as not considered to be part of the world
o Brain can confuse eye movement with movement of the world
o Troxler fading-
Colors start to fade and appear to move- these movements are caused by micro-saccades
• Hearing- receptors in ears respond to sound vibrations
• Somatosensation- the awareness of the body
• Taste- receptors on tongue respond to chemicals
• Smell (olfaction)- receptors in the nose respond to chemicals
• Vestibular- inner ear senses gravity and movement
o Fluids at side of the head
What are issues with our knowledge of perception?
- The problem of qualia
- The fallibility of the senses
Describe the problem of qualia
o All of our different senses transform their physical input into electrical impulses in the brain
o Why do we experience on set of electrical impulses as sight, and others as sounds, flavors…
o How does the brain know what is causing the stimulation it receives?
o What can happen if it gets this wrong or mixed up?
Synesthesia
Describe the fallability of the senses (errors and illusions)
o Our knowledge of the world and ourselves is mediated by our senses. If our senses can make errors, then how do we know what’s real?
o The thatcher illusion
o Illusions indicate we don’t know exactly how things are structured in the world around us
o They provide insight into how perceptual systems break down
o Reveal the kinds of assumptions or general rules we are using to make inferences about the physical world