pp exam 2

anxiety vs fear

Anxiety- vague threat, uncertainty

Fear - immediate response to something in front of you

effects of extreme anxiety levels

• Extreme low levels of anxiety can lead to boredom or apathy and low performance due to lack of care

• High levels can be debilitating

according to the DSM-5, what are the most common mental disorders in the U.S.?

anxiety disorders

Generalized Anxiety Disorder (GAD)

1. For 6 months or more, a person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters.

2. The symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems.

3. Significant distress or impairment.

GAD is 2x more common among ____

women

sociocultural factors of GAD

low income, violent or stressful upbringing

anxiety is also more common among:

LGBTQ+ individuals, people facing dangerous ongoing social conditions, or other high stress including poverty, exposure to COVID 19, etc.

cognitive-behavioral factors of GAD

thinking styles/habits, intolerance to uncertainty

GAD treatment

SSRIs alone or in combination with therapy

CBT for GAD

cognitive restructuring of excessive worry thought to be maintained through unhelpful thinking patterns

phobia vs fear

Phobia is long-lasting and intense, specific fear that leads to avoidance of situations consistently

categories of phobias

specific, agoraphobia

specific phobia

1. Marked, persistent, and disproportionate fear of a particular object or situation; usually lasting at least 6 months

2. Exposure to the object produces immediate fear

3. Avoidance of the feared situation

4. Significant distress or impairment

Agoraphobia

1. Pronounced, disproportionate, or repeated fear about being in at least two of the following situations:

• Public transportation (e.g., auto or plane travel)

• Parking lots, bridges, or other open spaces

• Shops, theaters, or other confined places

• Lines or crowds

• Away from home unaccompanied

2. Fear of such agoraphobic situations derives from a concern that it would be hard to escape or get help if panic, embarrassment, or disabling symptoms were to occur.

3. Avoidance of agoraphobic situations.

4. Symptoms usually continue for at least 6 months.

5. Significant distress or impairment.

how are phobias treated

exposure therapy with or without medication such as SSRIs

Social Anxiety Disorder (SAD)

1. Pronounced, disproportionate, and repeated anxiety about social situation(s) in which the individual could be exposed to possible scrutiny by others; typically lasting 6 months or more.

2. Fear of being negatively evaluated by or offensive to others

3. Exposure to the social situation almost always produces anxiety

4. Avoidance of feared situations

5. Significant distress or impairment

SAD prevalence

12% of people experience it throughout lifetime

SAD often begins in ___

late childhood or adolescence

___ are about 1.5x more likely to be diagnosed with SAD

women

SAD treatment

CBT, exposure therapy, medication

Panic Disorder

1. Unforeseen panic attacks occur repeatedly

2. One or more of the attacks precedes either of the following symptoms:

• At least a month of continual concern about having additional attacks

• At least a month of dysfunctional behavior changes associated with attacks (for example, avoiding new experiences)

__ are twice as likely to be diagnosed with panic disorder

women

lifetime prevalence of panic disorder

5%

panic disorder may co-occur with ___

agoraphobia

perspectives of panic disorder

biological (family history), cognitive-behavioral

treatments of panic disorder

CBT w/ exposure, sometimes medication

Obsessive Compulsive Disorder (OCD)

1. Occurrence of repeated obsessions, compulsions, or both

2. The obsessions or compulsions take up considerable time

3. Significant distress or impairment

obsession

Unwanted, intrusive, and persistent thoughts, urges, images, or doubts that pop into your mind and cause significant distress or anxiety.

compulsion

Repetitive physical behaviors or mental acts that you feel driven to perform.

OCD in the DSM-5

Used to be in anxiety section of DSM, now has its own distinct section

repeated handwashing is a/an:

compulsion

persistent thoughts of being contaminated is a/an:

obsession

urges to stab someone is a/an:

obsession

Counting to a certain number over and over (i.e., mental act) is a/an:

compulsion

Checking pockets repeatedly is a/an:

compulsion

OCD often begins in ___

childhood or young adulthood

for kids with OCD, rule this out first

not due to drugs or general medical condition (e.g., PANDAS/pediatric autoimmune neuropsychiatric disorders associated with strep infections) and OCPD

cognitive behavioral OCD treatment perspective

Exposure & response prevention (ERP) treatment

biological OCD treatment perspective

SSRIs

for treatment of OCD, most people benefit from

ERP with or without antidepressant

other disorders under OCD umbrella

Hoarding disorder, Trichotillomania, Excoriation disorder, Body dysmorphic disorder

PTSD (Post Traumatic Stress Disorder)

1. A person is exposed to a traumatic event - death or threatened death, severe injury, or sexual violation

2. A person experiences at least one intrusive symptom

3. The person completely avoids trauma-linked stimuli

4. The person experiences negative changes in trauma-linked cognitions and moods, such as being unable to remember key features of the fervent(s) or experiencing repeated negative emotions

5. The person displays changes in arousal or reactivity, such as excessive alertness, extreme startle responses, or sleep disturbance

6. The person exp significant distress or impairment, with symptoms lasting more than a month.

Acute stress disorder

• Fear and related symptoms begin with four weeks of events and last for less than one month.

• 50% of these cases develop into PTSD

Post traumatic stress disorder (PTSD) relating to acute stress

• Fear and related symptoms may begin either shortly after event, or month or years afterward

  • 25% of people with PTSD do not develop a full clinical syndrome until 6 months or more after their trauma

a trauma disorder can occur at

any age

lifetime prevalence of trauma related disorders

7-12%

___ are twice as likely to be diagnosed with a trauma related disorder

women

___ are at a higher risk for trauma related disorders

marginalized communities

Why/how do people develop PTSD?

• Low tolerance to uncertainty and lack of a social support system

• Genetics

• Socioeconomic status, abuse, neglect, family issues

• Stress sensitivity

about ___ of all PSTD cases improve within ___

1/3, 12 months

goals of treating trauma

• End lingering stress reactions

• Gain perspective on painful experiences

• Return to constructive living

PTSD treatment

• SSRIs/antidepressants

• CBT, e.g.,

  • Cognitive processing therapy (CPT)

  • Prolonged exposure (PE)/CBT

  • Trauma Focused CBT (TFCBT) (~ages 3-18*)

• EMDR - Eye movement, involves exposure

• Couple, family, group therapy

racial trauma

psychological injury caused by hate or fear of a person due to their race, ethnicity, or skin color

dissociative disorders

• Dissociative amnesia

• Dissociative identity disorder

• Depersonalization-derealization disorder

Dissociative Amnesia

1. Person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting.

2. Leads to significant distress or impairment

3. Symptoms are not caused by a substance or medical condition

localized dissociative amnesia

most common, loss of all memory of events from a limited time period example: soldier in intense combat may not remember an entire week of battle

dissociative fugue

(an extreme version of dissociative amnesia) could flee to another country and forget who they are completely

Dissociative Identity Disorder (DID)

• Person experiences a disruption to his or her identity, as reflected by at least two separate personality states or experiences of possession

• Person repeatedly experiences memory gaps regarding daily events key personal information, or traumatic events, beyond ordinary forgetting

DID is controversial because

• Difficult to assess (by definition, DID is generally beyond the person's awareness)

• Rarely diagnosed in mental health settings

• Mostly found in North America

Treatment for dissociative amnesia and DID

• Generally a psychodynamic approach

• For both disorders, patients are helped to recognize the nature of their disorder, become aware of the distinct identities (for DID), and recover gaps in their memory

Depersonalization-Derealization Disorder

• Depersonalization-derealization disorder is characterized by persistent or recurrent experiences of depersonalization (disconnection from oneself), derealization (disconnection from the world around you), or both.

• Can make the world seem like it’s not real or as if things aren’t taking place

somatic

relating to the body, physical symptoms or worry about physical symptoms

somatic disorders

• Illness anxiety disorder

• Somatic symptom disorder

• Conversion disorder

• Factitious disorder (imposed on self and imposed on another) used to be called Munchausen’s

illness anxiety disorder

• Preoccupation with thoughts or high anxiety about having or getting a significant illness

• Absence of substantial somatic (physical symptoms)

• Unduly high number of health-related behaviors or dysfunctional health-avoidance behaviors

• Concerns continue to some degree for at least 6 months

illness anxiety disorder most often begins

in early adulthood, late teens or 20s

illness anxiety disorder treatment

• CBT

• Exposure and response prevention, going to therapy instead of doctor

• Some benefit from anti-depressant or anti-anxiety medication

somatic symptom disorder

• At least one upsetting or repeatedly disruptive and significant physical (somatic) symptom

• An unreasonable number of thoughts, feelings, and behaviors regarding the nature or implications of the physical symptoms

• Physical symptoms usually continue to some degree for more than 6 months

somatic symptom disorder treatment

CBT, evaluate person’s thoughts and evidence they’ve collected

conversion disorder

• An individual experiences neurological-like symptoms that don’t have a known medical cause

• Can include tics, seizure-like activity

• Usually beginning in late childhood and young adulthood; often appears suddenly during extreme stress

• Not consciously wanted or purposely produced

• Could be conversion of stress or trauma into physical pain

• Also called “functional neurological (symptom) disorder”

conversion disorder prevalence

less than 1%

Factitious Disorder (imposed on self)

• False creation of physical psychological symptoms, or deceptive production of injury or disease, even without external rewards

• Presentation of oneself as ill, damaged, or hurt

• Often referred to as Munchausen syndrome

Factitious Disorder (imposed on another)

• False creation of physical or psychological symptoms, or deceptive production of injury or disease, in another person, even without external rewards

• Often parent to child

• Presentation of another person (victim) as ill, damaged, or hurt

• Often referred to as Munchausen syndrome by proxy

causes of factitious disorder

Precise causes not well understood (e.g., maybe depression, unsupportive parental relationships during childhood, and/or an extreme need for social support?)

treatment for factitious disorder

Clinicians have been unable to develop dependably effective treatments for this disorder

eating disorder types

anorexia, bulimia, binge eating disorder

Anorexia Nervosa (AN)

• Individual purposely takes in too little nourishment, resulting in body weight that is very low and below that of other people of similar age and gender

• Very fearful of gaining weight or repeatedly seeks to prevent weight gain despite low body weight

• Distorted body perception, places inappropriate emphasis on weight or shape in judgements of themselves, or fails to appreciate the serious implications of their low weight

prevalence of anorexia

affects about 1% of people, 75% are women

anorexia recovery

Very serious illness. Many people recover, though a substantial number of folks can become so seriously ill that they die from medical problems, or by suicide

main difference between anorexia and bulimia

people with anorexia have a significantly low body weight.

Bulimia Nervosa (BN)

1. Repeated binge eating episodes (excessive eating within a short period, thousands of calories)

2. Repeated performance of ill-advised compensatory behaviors (e.g., forced vomiting, laxative use) to prevent weight gain (purging)

3. Symptoms take place at least weekly for a period of 3 months

4. Inappropriate influence of weight and shape on appraisal of oneself

prevalence of bulimia

1% of people, 80% are women

Binge Eating Disorder (BED)

• Recurrent binge eating episodes that include at least three of these features:

  • Unusually fast eating

  • Absence of hunger

  • Uncomfortable fullness

  • Secret eating due to sense of shame

  • Subsequent feelings of self-disgust, depression, or severe guilt

• Along with:

  • Significant distress

  • Weekly binge-eating episodes over the course of 3 months

prevalence of binge eating disorder

affects 3% of people, 65-75% are female

theories of eating disorder causes

• Multidimensional perspective used (e.g., many risk factors exist, and more factors present = greater likelihood of developing a disorder) 

• Cognitive behavioral factors (e.g., inaccurate labeling of internal sensations or misperceptions of body)

• Depression + other MH conditions (e.g., OCD)

• Biological factors (e.g., genetic risks)

main treatment goals for eating disorders

1. Correct dangerous eating patterns

2. Address broader psychological and situational factors that have led to and maintain the eating problem

anorexia nervosa immediate treatment aims

regain lost weight, recover from malnourishment, and eat normally again

For long-lasting change of anorexia:

motivational interviewing, CBT, family-based therapies. Medications may also be used

GAD prevalence

6%

specific phobia prevalence

13%

agoraphobia prevalence

1.3%

OCD prevalence

2.3%

fight or flight response

an automatic survival mechanism activated by the brain's amygdala and the sympathetic nervous system when danger is perceived

common triggers of PTSD

combat, disasters, accidents, illnesses, victimization

why do therapists use different treatment methods for somatic disorders

because these conditions stem from a complex mix of physical, psychological, and neurological factors. no single root cause fits every patient, so practitioners tailor their approaches based on theoretical training, the specific origin of the symptoms, and whether the issue is driven by thought patterns, unreleased trauma, or deep-seated emotional conflicts.

why is a multicultural view necessary for treatment of somatic disorders

both bodily and psychological reactions are often influenced by one’s culture, and overlooking this can lead to misdiagnosis.

which population displays the most somatic reactions in the face of stress

Hispanic people

in which cultures is the transformation of personal stress into somatic complaints the norm

china, japan, arab countries, latin america

Autonomic Nervous System (ANS)

Stress activates the Sympathetic Nervous System (the "fight-or-flight" response). This releases hormones like adrenaline, which increase heart rate and blood pressure. Chronic activation strains the cardiovascular system.

personality traits related to physical health

Certain personality types, such as "Type A" (highly competitive, impatient, and hostile), are linked to a higher risk of heart disease. Conversely, optimism is often associated with better health outcomes and longevity.

poverty related to physical health

Financial strain causes chronic "survival" stress. It also limits access to healthy food, safe housing, and quality healthcare, creating a compounding negative effect on physical health.