Psychopathology #3 (CHPT SUMMARY)

What are the somatic symptom and related disorders, and what do they have in common? What causes these conditions and how are they treated?

-Somatic symptom and related disorders involve prominent somatic complaints that cause significant distress or impairment in the life of the individual and include somatic symptom, illness anxiety, conversion, and factitious disorders.

-Somatic symptom disorder (SSD) is characterized by at least one physical complaint accompanied by excessive anxiety, thoughts, or behaviors associated with health concerns.

-Illness anxiety disorder is characterized by a belief that one has a serious and undetected illness or physical problem. In contrast to somatic symptom disorder, somatic symptoms are not a major feature of this disorder.

-Conversion disorder (functional neurological symptom disorder) involves neurological-like symptoms that are incompatible with a medical condition.

-Factitious disorders involve self-induced or feigned physical complaints, or symptoms induced in others.

-Biological explanations have suggested that there is increased vulnerability to somatic symptom disorders when individuals have high sensitivity to bodily sensations, a lower pain threshold, or a history of illness or injury.

-Psychological factors include high anxiety or stress, and catastrophic thoughts regarding bodily sensations.

-Social explanations suggest that the role of “being sick” is reinforcing. External stressors such as sexual abuse, bullying, or role models who attend to illness can also be influential.

-From a sociocultural perspective, somatic symptom disorders result from societal restrictions placed on women, who are affected by these disorders to a much greater degree than are men. Additionally, marginalization, social class, limited knowledge about medical concepts, and cultural acceptance of physical symptoms can play a role.

-Treatment involves psychoeducation about physical complaints, altering distorted cognitions, and strategies for tolerating changes in bodily sensations.

What are dissociations? Why do they occur, and how are they treated?

-Dissociation involves a disruption in consciousness, memory, identity, or perception, and may be transient or chronic.

-Dissociative amnesia, including localized amnesia and dissociative fugue, involves a selective form of forgetting in which the person cannot remember information that is of personal significance. Depersonalization/derealization disorder is characterized by feelings of unreality—distorted perceptions of oneself and one’s environment. Dissociative identity disorder (DID) involves the presence of two or more personality states in one individual, or an experience of possession.

-Biological explanations for DID have included atypical neurological connectivity, disruptions in encoding memories, and atypical neural activity that may indicate an inhibition of brain areas associated with memory. Some researchers believe that childhood trauma and chronic stress can result in permanent structural changes within the brain.

-Psychoanalytic perspectives attribute these disorders to the use of repression to block unpleasant or traumatic events from consciousness.

-Social explanations include childhood abuse, subtle reinforcement, mislabeling of dissociative experiences, and responding to the expectations of a therapist.

-Sociocultural explanations for dissociation include exposure to media portrayals of dissociation and role enactment by vulnerable individuals.

-Dissociative amnesia, dissociative fugue, and depersonalization/derealization disorder tend to remit spontaneously; cognitive-behavioral therapy and stress management techniques can be beneficial in preventing symptom recurrence. DID is often treated with trauma-focused cognitive therapy that addresses safety concerns and the integration of the personality states, and incorporates strategies for eliminating cognitive distortions and dealing with current stressors. Newer approaches reframe the perception of alter personalities as modifiable methods of coping with stress or trauma.

What are the symptoms of depression, hypomania, and mania?

-Depression involves feelings of sadness or emptiness, social withdrawal, loss of interest in activities, pessimism, low energy, and sleep and appetite disturbances.

-Mania produces significant impairment and involves high levels of arousal, elevated or irritable mood, increased activity, poor judgment, grandiosity, and decreased need for sleep. Hypomania refers to milder manic symptoms, which may be accompanied by productive, goal-directed behaviors.

What are depressive disorders, what causes them, and how are they treated?

-Depressive disorders are diagnosed only when depressive symptoms occur without a history of hypomania/mania. Depressive disorders include major depressive disorder, persistent depressive disorder (dysthymia), and premenstrual dysphoric disorder.

-Biological factors, including heredity, increased vulnerability to depression. Biochemical irregularities involving neurotransmitters, stress reactivity, and cortisol levels are associated with depression.

-Behavioral explanations for depression focus on reduced reinforcement following losses. Cognitive explanations focus on negative attributions and thinking patterns, irrational beliefs, and rumination.

-Social explanations focus on relationships and interpersonal stressors that increase vulnerability to depression. Early childhood stressors are particularly important.

-Sociocultural explanations have focused on cultural factors, including gender, ethnicity, and sexual orientation.

-Behavioral activation therapy, cognitive-behavioral therapy, and interpersonal psychotherapy have received extensive research support as treatments for depression; mindfulness-based cognitive therapy has also shown promising results. Biomedical treatments include light therapy and electrical stimulation of the brain. Antidepressant medications are frequently used to treat depression; they are most effective with severe depression, but often produce only temporary effects. Psychotherapy is more likely to prevent the return of depressive symptoms.

What are bipolar disorders, what causes them, and how are they treated?

-Bipolar disorders involve symptoms of mania or hypomania. Depressive episodes are also common in bipolar disorder.

-Bipolar I involves at least one weeklong manic episode and impaired functioning. Psychotic symptoms are sometimes present. Bipolar II is diagnosed when there is a history of hypomania and at least one major depressive episode. Cyclothymic disorder is a chronic disorder involving milder hypomanic episodes that alternate with depressed mood for at least 2 years.

-Bipolar disorders have a strong genetic basis involving multiple, interacting genes. Biological factors, including neurochemical and neuroanatomical abnormalities and circadian rhythm disturbances, contribute to bipolar disorder. There are many overlaps between bipolar I disorder and schizophrenia.

-The most effective treatment for bipolar disorder is ongoing use of mood-stabilizing medication combined with psychotherapy, psychoeducation, and psychosocial interventions.

What do we know about suicide

-Suicide is the intentional, direct, and conscious taking of one’s own life. The topic is often avoided, even among those directly affected by a suicide.

-A variety of demographic and specific risk factors are associated with suicide.

-Although women make more suicide attempts, men are more likely to kill themselves.

How does suicide affect friends and family?`

suicide can affect surviving friends and family for years- feelings of guilt and responsibility are common

How is suicide unique in different age groups?

-In recent years, childhood and adolescent suicides have increased at an alarming rate.

-Suicide among college students is also a serious concern.

-Suicide rates are high among the baby boomer generation and other older adults

What mights cause someone to commit suicide?

-Genetic risk and biochemical abnormalities involving serotonin and neuropeptides are associated with suicide; alcohol use also exerts biological effects that increase suicide risk.

-Psychological factors include mental disturbance, depression, hopelessness, psychache, and suicide myopia resulting from excessive alcohol consumption.

-Lack of positive social relationships, feelings of loneliness and disconnection, interpersonal conflicts, and loss of a significant other can increase the chances of suicide.

-Ethnicity, economic downturns, male gender, and other demographic variables are all associated with increased risk of suicide.

How can we prevent suicide?

-The best way to prevent suicide is to recognize risk factors and intervene before suicide occurs.

-Crisis intervention strategies can help individuals who are contemplating suicide become more hopeful and consider other options. Intensive short-term therapy is used to stabilize the immediate crisis.

-Suicide prevention centers operate 24 hours a day to provide intervention services to people contemplating suicide.

-After a suicidal crisis has been resolved, ongoing therapy can help teach coping skills and treat underlying mental disorders. Cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) can help reduce suicidal ideation and suicide attempts.

-Suicide survivors benefit from a focus on activities that increase optimism and social connection.

Are there situations in which suicide should be an option?

A few states allow physician-assisted suicide for carefully screened people who are terminally ill and wish to end their suffering

What are future directions in the field of suicidology?

-Researchers worldwide are attempting to stem the tide of suicide by focusing on risk factors associated with suicide and effective methods of intervention.

-There is hope that the use of technology and innovative programs that analyze medical records and social media posting will eventually succeed in reducing the number of suicides.