Exam 2: Psychopathology

5.1 Explain the factors that make people more stress sensitive and the characteristics of stressors that make them hardest to cope with.

• When challenges to our physical or emotional well-being exceed our coping abilities or resources, we experience stress. Stress can result from negative or positive situations.

• How we deal with stress is linked to our coping skills and resources. For this reason, children may be especially vulnerable. Past experiences of stress may also make us more sensitive to stress later on. In contrast, people who are optimistic, have higher self-esteem, better social support, and a greater sense of control or mastery in their own lives tend to handle life stress better overall.

• Key factors involved in making one situation more stressful than another include how severe the stressor is, how long it lasts, when it occurs, how much it impacts our lives, how expected it is, and how much control we have over the situation.

5.2 Summarize how the body responds to stress.

• Stress takes its toll on our physical and psychological well-being.

• When we are stressed, the autonomic nervous system

responds in a variety of ways. The hypothalamus stimulates the sympathetic nervous system, and hormones such as adrenaline (epinephrine) and noradrenaline (norepinephrine) are released from the adrenal medulla. These hormones circulate in the bloodstream and prepare the body for fight or flight. Heart rate increases, and the body metabolizes glucose more rapidly to provide energy.

• Stress also activates the hypothalamic-pituitary-adrenal (HPA) system. A hormone called corticotropin-releasing hormone (CRH) is released from the hypothalamus, stimulating the pituitary gland and causing it to secrete ACTH. This stimulates the adrenal cortex to produce stress hormones such as cortisol. High levels of cortisol may be beneficial in the short term but problematic over the longer term.

• Stress compromises immune functioning, slowing down wound healing. Psychoneuroimmunology is a developing field concerned with the interactions between the nervous system and the immune system.

• In the immune system, specialized white blood cells called B-cells and T-cells respond to antigens such as viruses and bacteria. They are assisted by natural killer cells, granulocytes, and macrophages.

5.3 Explain how stress causes dysregulation in the immune system.

• Activation of the immune system stimulates the production of cytokines. Cytokines are chemical messengers that allow the brain and the immune system to communicate with each other. Some cytokines respond to a challenge to the immune system by causing an inflammatory response. Other cytokines, called anti-inflammatory cytokines, dampen the response that the immune system makes when it is challenged.

• Long-term stress seems to interfere with the body's ability to turn off cytokine production, leading to inflammation.

5.4 Describe the role that emotions play in physical health and identify helpful and harmful emotions.

• Because the brain can influence the immune system, psychological factors are important to our physical well-being.

• Negative emotional states, such as depression, hostility, anger, anxiety, or feelings of loneliness, have all been linked to the development of cardiovascular disease. This may be because negative emotions function as a source of stress.

• In contrast, having a more optimistic attitude toward life, or being more forgiving, may have beneficial health consequences.

5.5 Explain the psychological interventions that can be used to reduce stress and treat stress-related disorders.

• Expressive writing, in which people write down their

innermost thoughts about their most traumatically stressful experiences, speeds up wound healing and may be a valuable approach for individuals with some stress-related illnesses. This approach may work because it allows people to vent and/or because it also permits them to think about their problems in a different way (reframing).

• Biofeedback, in which people are helped via monitoring equipment to become more aware of their heart rate, muscle tension, or blood pressure, is another approach for treating some stress-related problems such as headaches.

• Another widely used treatment is relaxation training. This can be combined with other approaches such as biofeedback.

• Meditation and other stress-reducing approaches that facilitate nonjudgmental awareness are now an active focus of research interest.

• Cognitive-behavioral therapy is also widely used. CBT can be helpful in reducing pain from headaches or stomach problems as well as providing techniques to help people cope with stress.

5.6 Identify the similarities and differences between adjustment disorder, posttraumatic stress disorder, and acute stress disorder.

• An adjustment disorder is a much less severe disorder than

PTSD or acute stress disorder. Although all of these disorders result from stress, adjustment disorder is a response to a more common stressor such as unemployment or marital problems. In the case of PTSD and acute stress disorder, the stressor is much more severe and traumatic.

• Both PTSD and acute stress disorder have similar symptoms. The key difference between them involves the duration of symptoms. PTSD is diagnosed when symptoms have lasted for more than 1 month. If symptoms have only recently developed and have not lasted more than a month, the diagnosis is acute stress disorder. Also, because natural recovery with time is a common pattern, not everyone diagnosed with an acute stress disorder will go on to be diagnosed with PTSD.

5.7 Describe the clinical features of and risk factors for posttraumatic stress disorder.

• Experiencing a traumatic event is thought to create a pathological memory. This memory does not abate over time. When it intrudes, the person reexperiences the traumatic event with full emotional force even when there is no longer any danger.

• (blank) can involve symptoms, including intrusive memories or recurrent and distressing dreams about the event, avoidance of stimuli associated with the trauma, negative cognitions or impaired memory about aspects of the traumatic event, and increased arousal or reactivity.

• Many factors influence a person’s response to stressful situations. The impact of stress depends not only on its severity but also on the person’s preexisting vulnerabilities. Resilience is the most common long-term trajectory.

• It's common to experience psychological symptoms after a traumatic event, these often fade with time.

• Factors that increase a person’s risk of experiencing traumatic events include certain occupations (e.g., firefighter), being male, not having a college education, conduct problems in childhood, high levels of extraversion and neuroticism, as well as a family history of psychiatric problems.

• Factors that increase the risk of developing (blank) include

being female and having low levels of social support, higher levels of neuroticism, a family history of depression, anxiety, and substance abuse, as well as preexisting problems with anxiety and depression. A tendency to have thoughts or images about traumatic events that could happen in the future has also been identified as a risk factor.

• Women with (blank) have higher baseline cortisol levels than women who do not have (blank). This is not the case for men with (blank). Under conditions of stress, people with (blank) show an exaggerated cortisol response.

• Smaller hippocampal volume is a vulnerability factor for (blank)

5.8 Explain the treatment approaches that are used to help people with PTSD.

• Medications are often used in the treatment of (blank), although they are not especially effective. Some SSRIs provide modest benefits.

• Psychological treatments include prolonged exposure

therapy, cognitive therapy, and eye movement desensitization and reprocessing therapy. A new approach is the use of virtual reality exposure therapy.

6.1 Distinguish between fear and anxiety.

• The anxiety disorders have anxiety or panic or both at their core.

• Fear is a basic emotion that involves activation of the fight-or-flight response of the autonomic nervous system; it occurs in response to imminent danger.

• Anxiety is a more diffuse blend of emotions that includes high levels of negative affect, worry about possible threat or danger, and the sense of being unable to predict threat or to control it if it occurs.

6.2 Describe the essential features of anxiety disorders.

• (blank) all are characterized by unrealistic, irrational fears or anxieties that cause significant distress and/or impairments in functioning.

• Among the (blank) recognized in DSM-5-TR are specific phobia, social anxiety disorder (social phobia), panic disorder, agoraphobia, and generalized anxiety disorder.

• People with these varied disorders differ from one

another both in terms of the amount of fear or panic versus anxiety symptoms that they experience and in the

kinds of objects or situations that most concern them.

6.3 Explain the clinical features of specific phobias.

With (blank), an individual has an intense and irrational fear of specific objects or situations that leads to a great deal of avoidance behavior; when confronted with a feared object, the person with a phobia often shows activation of the fight-or-flight response, which is also associated with panic.

6.4 Discuss the clinical features of social anxiety.

• In (blank), a person has disabling fears of one or more social situations, usually because of fears of negative evaluation by others or of acting in an embarrassing or humiliating manner; in some cases, a person with (blank) may actually experience panic attacks in social situations.

• People with (blank) also have prominent perceptions of unpredictability and uncontrollability and are preoccupied with negative self-evaluative thoughts that tend to interfere with their ability to interact in a socially skillful fashion.

6.5 Describe the clinical features of panic disorder.

• In (blank), a person experiences recurrent, unexpected panic attacks that often create a sense of stark terror and numerous other physical symptoms of the fight-or-flight response; panic attacks usually subside in a matter of minutes.

• Many people who experience panic attacks develop anxious apprehension about having another attack; this apprehension is required for a diagnosis of (blank). Many people with (blank) also develop agoraphobic avoidance of situations in which they fear that they might have an attack.

• Biological theories of (blank) emphasize that the disorder may result from biochemical abnormalities in the brain as well as abnormal activity of the neurotransmitters norepinephrine and serotonin. Panic attacks may arise primarily from the brain area called the amygdala, although many other areas are also involved in panic disorder.

• The cognitive theory of (blank) holds that this condition may develop in people who are prone to making catastrophic misinterpretations of their bodily sensations, a tendency that may be related to preexisting high levels of anxiety sensitivity.

• The learning theory of (blank) proposes that initial panic attacks can become associated with both internal cues (interoceptive, such as dizziness or rapid heartbeat) and external cues (exteroceptive, such as crowds). Because of this pairing, those internal and external cues can later trigger the onset of panic attacks.

6.6 Explain the clinical aspects of generalized anxiety disorder.

• A person has chronic and excessively high levels of worry about a number of events or activities and responds to stress with high levels of psychic and muscle tension.

• (blank) may occur in people who have had extensive experience with unpredictable or uncontrollable life events. People with (blank) seem to have danger schemas about their inability to cope with strange and dangerous situations that promote worries focused on possible future threats.

• The neurobiological factor most implicated in (blank) is a functional deficiency in the neurotransmitter GABA, which is involved in inhibiting anxiety in stressful situations; the limbic system is the brain area most involved.

• Once a person has an anxiety disorder, mood-congruent

information processing, such as attentional and interpretive biases, seems to help maintain it. Without treatment, anxiety disorders are often chronic conditions.

• Many people with anxiety disorders are treated by physicians with medications designed to allay anxiety or with antidepressant medications that also have antianxiety effects when taken for at least 3-4 weeks. Such treatment focuses on suppressing the symptoms, and some anxiolytic medications have the potential to cause physiological dependence. Once the medications are discontinued, relapse rates are high.

• Behavioral and cognitive therapies have a good track record with regard to treatment of the anxiety disorders. Prolonged exposure to fear is effective in treatment.

• Cognitive therapies focus on helping clients understand their underlying automatic thoughts, which often involve cognitive distortions such as unrealistic predictions of catastrophes that in reality are very unlikely to occur. Clients then learn to change these inner thoughts and beliefs through a process of logical reanalysis known as cognitive restructuring.

6.7 Describe the clinical features of obsessive-compulsive disorder and how it is treated.

• In (blank), a person experiences unwanted and intrusive distressing thoughts or images that are usually accompanied by compulsive behaviors performed to neutralize those thoughts or images. Checking and cleaning rituals are most common.

• Biological causal factors are also involved in

(blank), with evidence coming from genetic studies, studies of abnormalities of brain functioning, and psychopharmacological studies.

• Once this disorder begins, the anxiety-reducing qualities

of the (blank) may help to maintain the disorder.

• Behavior therapies that involve exposure are effective in the treatment of (blank). Rituals must also be prevented following exposure to the feared situations.

6.8 Summarize some examples of cultural differences in sources of worry.

• In Nigeria, sources of worry center on creating and maintaining a large family, being bewitched in one's dreams,

and having problems with one's brain (such as experiencing insects or worms crawling in the brain).

• In China and other Southeast Asian countries that have cultural concerns about male sexual potency, a common source of worry is the penis retracting into the body.

7.1 Describe the types of mood disorders, their primary symptoms, and their prevalence.

• Mood disorders are those in which extreme variations in mood—either low or high—are the predominant feature.

• Unipolar depressive disorders are those in which a person experiences only depressive episodes; bipolar and related disorders are those in which a person experiences both depressive and manic episodes.

• Major mood disorders occur at almost the same rate as all the anxiety disorders taken together; rates for unipolar major depression are always much higher for women than for men, as well as individuals in lower socioeconomic groups and those who have high levels of accomplishments in the arts. Rates occur less frequently among Black people than among European White American people and Hispanic individuals.

7.2 Distinguish between the different types of depressive disorders.

• Major depressive disorder (MDD; also known as major

depression) requires that a person must be in a major depressive episode and never have had a manic, hypomanic, or

mixed episode.

• Persistent depressive disorder (formerly called dysthymic

disorder or dysthymia) is a disorder characterized by persistently depressed mood most of the day, for more days than not, for at least 2 years (1 year for children and adolescents).

• Depressions are nearly always precipitated by stressful life events. Some of the most stressful events possible are those involving the loss of life, as well as the creation of new life. Psychologists have struggled with how to appropriately diagnose (or not) a person's response to them.

7.3 Describe the factors believed to cause unipolar mood disorders.

• Among biological causal factors for depressive disorder, there is evidence of a moderate genetic contribution to the vulnerability for major depression and probably dysthymia as well. Moreover, major depressions are clearly associated with multiple interacting disturbances in neurochemical, neuroendocrine, and neurophysiological systems. Disruptions in circadian and seasonal rhythms are also prominent features of depression.

• Among psychosocial theories of the causes of depressive disorder are Beck's cognitive theory and the reformulated helplessness and hopelessness theories, which are formulated as diathesis-stress models; a tendency to ruminate about one's mood or problems exacerbates their effects. The diathesis is cognitive in nature (e.g., dysfunctional beliefs and pessimistic attributional style, respectively), and stressful life events are often important in determining when those diatheses actually lead to depression.

• Personality variables such as neuroticism may also serve as diatheses for depression.

• Psychodynamic and interpersonal theories of unipolar depression emphasize the importance of early experiences (especially early losses and the quality of the parent-child relationship) as setting up a predisposition for depression.

7.4 List and distinguish among different types of bipolar disorders.

• In the (blank) (cyclothymia and (blank) I and II

disorders), the person experiences episodes of both depression and hypomania or mania. During manic or hypo-manic episodes, the symptoms are essentially the opposite of those experienced during a depressive episode.

• Cyclothymic disorder refers to the repeated experience of hypomanic symptoms for a period of at least 2 years.

• (blank) I disorder is distinguished from MDD by the presence of mania. A mixed episode is characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, either intermixed or alternating rapidly every few days.

• (blank) II disorder is when the person does not experience full-blown manic (or mixed) episodes but has experienced clear-cut hypomanic episodes as well as major depressive episodes.

7.5 Describe the causal factors influencing the development and maintenance of bipolar disorders.

• Biological causal factors probably play an even more prominent role for (blank) disorders than for unipolar disorders. The genetic contribution to (blank) disorder is among the strongest of such contributions to the major psychiatric disorders. Neurochemical imbalances, abnormalities of the HPA axis, and disturbances in biological rhythms all play important roles in (blank) disorders.

• Stressful life events may be involved in precipitating manic or depressive episodes, but it is unlikely that they cause the disorder.

7.6 Explain how cultural factors can influence the expression of mood disorders.

• Factors such as differing rates of stigma, stressors, risk factors for mood disorders, and a different manifestation of symptoms across cultures all have been suggested as possible explanations for the different rate and expression of mood disorders across cultures.

7.7 Describe and distinguish between different treatments for mood disorders.

• Biologically based treatments such as medications or

electroconvulsive therapies are often used in the treatment of the more severe major disorders. Increasingly, however, specific psychosocial treatments such as cognitive therapy, behavioral activation treatment, and interpersonal therapy are also being used to good effect in many cases of these more severe disorders as well as in the milder forms of mood disorder.

• Considerable evidence suggests that recurrent depression is best treated by specialized forms of psychotherapy or by maintenance on medications for prolonged periods.

7.8 Describe the prevalence and clinical picture of suicidal behaviors.

• (blank) is one of the leading causes of death worldwide. Nearly 10 percent of adults report that they have seriously considered (blank) at some point in their life, and nearly 3 percent report having made a (blank) attempt at some time.

• The rate of (blank) thoughts and behavior increases drastically during the adolescent and young adult years, and psychological disorders such as mood and bipolar disorders are especially strong risk factors for these outcomes.

7.9 Explain the efforts currently used to prevent and treat suicidal behaviors.

• (blank) prevention (or intervention) programs generally

consist of crisis intervention in the form of hotlines. Although these programs undoubtedly avert fatal (blank) attempts in some cases, the long-term efficacy of treatment aimed at preventing suicide in those at high risk is much less clear at the present time.

9.1 Identify the clinical aspects of eating disorders.

• Included in DSM-5-TR are three different eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder.

• Anorexia nervosa is a relentless pursuit of thinness as well as behaviors designed to accomplish this goal (e.g., restricted eating). Patients with anorexia nervosa are severely underweight. Individuals who meet the diagnostic criteria for anorexia nervosa (including significant weight loss) but who still have a weight that is at or above what is considered normal can be given a diagnosis of atypical anorexia nervosa.

• Bulimia nervosa is recurrent episodes of binge eating combined with efforts to minimize the weight gain that might come from this (by purging, using laxatives, or excessive exercise). People with bulimia nervosa are usually of normal weight or overweight.

• Binges are also a key clinical feature of binge-eating disorder. However, no effort is made to compensate for the effects of consuming so much food. As a result, people with binge-eating disorder are commonly overweight or obese.

• More common in females than in males (3:1). They can develop at any age but typically emerge in adolescence or early adulthood. Anorexia nervosa usually begins at an earlier age (16–20) than bulimia nervosa (21–24) or binge-eating disorder (30–50).

• Anorexia nervosa has a lifetime prevalence of under 1%. Bulimia nervosa is more common but still has a lifetime prevalence of under 1%. Binge-eating disorder has an overall prevalence of just over 2%. All have higher prevalence in females than males. Many more people experience less severe forms of disturbed eating patterns.

• Eating disorders are more common in transgender individuals. People identifying as a sexual minority also report higher rates of eating disorders compared to those who are heterosexual.

9.2 Explain the risk and causal factors in eating disorders.

• Genetic factors play an important role in eating disorders although we still know little about the specific genes that are involved. Genes may make some people more susceptible to binge eating or to sociocultural influences, or may underlie personality styles (e.g., perfectionism) that increase risk for eating disorders.

• The neurotransmitter serotonin has been implicated in eating disorders. This neurotransmitter is also involved in mood disorders, which are highly comorbid with eating disorders.

• Sociocultural influences are integral in the development of eating disorders. Our society places great value on being thin. The more people are exposed to media content that emphasizes being thin, the more dissatisfied they are with their bodies. Widespread exposure to Western values concerning thinness may help explain why eating disorders are now found throughout the world.

• Individual risk factors such as internalizing the thin ideal, body dissatisfaction, dieting, negative affect, and perfectionism have been implicated in the development of eating disorders.

9.3 Discuss how eating disorders are treated.

• Anorexia nervosa is very difficult to treat. Treatment is long term, and many patients resist getting well. For younger patients, family therapy appears to be very beneficial. Olanzapine is also helpful.

• The treatment of choice for bulimia nervosa is cognitive- behavior therapy. CBT is also helpful for binge-eating disorder. Interpersonal therapy seems to be helpful for binge-eating disorder and may be especially acceptable to people who identify with a racial or ethnic minority group. Developing culturally relevant approaches to treatment is a high priority.

• A new development in the treatment of eating disorders is to use a transdiagnostic approach. Enhanced cognitive behavior therapy is an example of this. The treatment targets eating issues as well as concerns about shape and weight, extreme dieting, purging, and binge eating.

9.4 Define obesity and explain why it is a worldwide problem.

• (blank) is defined as having a body mass index of 30 or above.

• (blank) is associated with many medical problems and increased mortality. (blank) is not currently viewed as an eating disorder or as a psychiatric condition in the DSM.

9.5 Describe who is most at risk for obesity.

• A tendency toward being thin or heavy may be inherited. Although some cases of obesity involve single genes, most commonly many genes are thought to be involved. Our genetic makeup may make us more or less likely to gain weight in a cultural environment that promotes overconsumption of food and a sedentary lifestyle.

• Black people, Indigenous people, and people of color (with the exception of Asians) are at especially high risk for obesity. Obesity rates are highest in Black women. Overall, however, men are slightly more likely to be obese than women are.

9.6 Explain current treatments for obesity.

• (Blank) is a chronic problem. Lifestyle modifications and

medications such as Orlistat can help patients lose small

amounts of weight. Drastic weight loss, however, usually requires bariatric surgery.

• A new treatment option for people with (Blank) makes

use of diabetes medications. These can lead to substantial weight loss, although weight gain is common if people stop taking the medications.

• Because (Blank) tends to be a lifelong problem and because

treating (Blank) is so difficult, there is now a focus on trying to prevent people from becoming obese in the first place. Implementing many of the approaches that have been recommended will require changes in social policy.