Behavior Disorders Exam 2

CH 5,6,7

Fear

• immediate alarm reaction to danger (emotion)

• protects us by activating response from autonomic nervous system (increased heart rate and blood pressure) which along with the sense of terro, motivates us to escape (flee) or attack (fight)

Anxiety

• mood state charaterized by marked negative affect and bodily symptoms of tension in which a person apprehensively anticipates future danger/misfortune. 

• Anxiety may involve feelings, behaviors, and physiological reponses

• can be good because teaches us to be more prepared but too much anxiety can be bad 

Yerkes-Dodson Law Bell Curve

• relationship between stress and task performance

• inverted U model of arousal 

• Peak level of performance with intermediate level of stress/arousal. Too much/little = poorer performance 

Panic Disorder

• recurrent, unexpected panic attacks followed by 1+ month of concern/worry or behavior change

• 4.7% lifetime 

Agoraphobia 

• fear of avoidance of situations in which escape may be difficult or help might not be avaliable if have panic symptoms 

• 1.3% 

Generalized anxiety disorder

• excessive or unreasonable worry that is difficult to control 

• 5.7%

Social anxiety disorder

• fear of negative evaluation in social situations 

• 12.1% 

Selective mutism

• lack of speech in one or more settings in which speed is socially expected

• 0.5%

Seperation anxiety disorder

• fear of harm to self or attachment figure that will cause separation 

• 4.1%

Specific phobia

• specific object or situation (blood-injection-injury, situational, environment, animal) 

Posttramatic Stress Disorder (PTSD)

traumatic event followed by set of intrusion, avoidance, cognitive/mood, and arousal/reactivity symptoms

Acute stress disorder

similar to PSTD but occurs within 1st month after trauma

Prolonged grief disorder

intense longing for or preoccupation with a person who died 1+ yearsago 

Adjustment disorder

milder anxiety or depressive reaction to life stress

Attachment disorders

before age 5, unable or unwilling to forms attachments with caregivers

Obsessive Compulsive Disorder

obsessions and or compulsions that are time consuming or imparing

Body Dysmorphic Disorder

preoccupation with an imagined defect in appearance 

Hoarding Disorder

persistent difficulty discarding or parting with possessions, regardless of actual value

Trichotillomania

hair pulling disorder

Excoriation

skin picking disorder

What is the obsession associated with symmetry/exactness/”just right”?

• needing things to be aligned/symmetrical just so

• urges to do things over and over until they feel “just right” 

What is the compulsion associated with symmetry/exactness/”just right”?

• putting things in a certain order 

• repeating rituals 

What is the obsession associated with cleaning/contamination?

• germs

• fear of germs or contaminants

What is the compulsion associated with cleaning/contamination?

• repetitive or excessive washing

• using gloves, masks to do daily tasks

What is the obsession associated with forbidden thoughts/actions (aggressive, sexual, religious)? 

• fears, urges to harm self or others

• fears of offending God 

What is the compulsion associated with forbidden thoughts/actions (aggressive, sexual, religious)? 

• checking

• avoidance

• repeated requests for reassurance 

Etiology

onset and course of disease 

Anxiety disorders have an ____ age of onset

early 

How long does anxiety last?

• chronic course

• can last a long time if you don’t get treatment 

What are the rates of comorbidity of anxiety and related disorders?

• high

• 55% to 76% 

What are the commonalities of comorbidity of anxiety and related disorders?

• features

• vulnerabilities 

What are comorbidity of anxiety and related disorders linked to?

physical disorders

Suicide attempt rates of comorbidity of anxiety and related disorders is high in…

Panic Disorder and Body Dysmorphic Disorder 

What are the three vulnerabilities that contribute to anxiety and related disorders?

• biological

• specific psychological 

• generalized psychological 

Biological vulnerability

• heritable contribution to negative affect

• genetic influences on heightened amygdala or HPA axis reactivity 

• behavior inhibition 

Specific Psychological vulnerability

• Ex: physical sensations are potentially dangerous

• anxiety sensitivity (for panic disorder) 

Generalized psychological vulnerability

• sense that events are uncontrollable/unpredictable 

• low perceived self-competence

• belief that the world is a dangerous place

• belief that you cannot handle stress 

Behavioral inhibition

• temperament trait characterized by a hesitancy to interact with novel people and situations

• BI is a stable trait hat increases risk for anxiety disorders, particularly social anxiety disorder

• can be identified in infants as young as 4 months old 

Mowrer’s Two Factor (or Two Process) Model

explains the origins of phobias in terms of combo of classical and operant conditioning

Classical conditioning

• responsbible for initial learning, associating a previous neutral stimulus with fear

• development of anxiety

Operant conditioning

• reinfornces the fear because every time someone avoids the feared stimuli, they feel calmer 

• maintence of anxiety 

CBT

• Emotions - what we feel affects how we think and act

• Thoughts - what we think affects how we feel and act

• Behaviors - what we do affects how we think and feel

Habituation

exposure get easier over time

In exposure hierarchy, what can be added?

cognitive component by asking people to predict the outcome ahead of time and then, after nothing bad happens, emphasizing the discrepancy between the expected and actual outcome

Bipolar-1

• 1 manic episode

• may be followed by hypomanic/major depressive episode 

Bipolar-2

• 1 hypomanic and 1 major depressive episode

• no manic episode 

Cyclothymia 

• freq hypomanic and depressive symptoms

• over 2 year period (not as severe as bipolar disorder)

• symptoms present for at least half the time (1 year)

• no period without symptoms for more than 2 months

Dysthymia

• persistent depressive disorder

• more than 2 years 

• depressed mood most of the day on more than 50% of days

• no more than 2 months symptom free

Mood disorders

involve gross deviations in mood

Major depressive episode

• extremely depressed mood and or loss of interest or pleasure (anhedonia) 

• lasts most of the day, nearly every day, for at least 2 weeks 

What are some additional symptoms associated with major depressive episode?

• indecisiveness

• feelings of worthlessness

• fatigue 

• appetite change

• restlessness or feeling slowed down

• sleep disturbance 

Recurrent

one or more major depressive episodes seperated by periods of remission

Clinical features of major depressive episode

• reccurent episodes more common than single episodes

• risk of recurrence increases with each additional episode

What are some specifiers associated with major depressive episode

• peripartum onset and seasonal pattern (seasonal affective disorder) 

• specifies when it happens

Double depression

an individual experiences both persistent depressive disorder and episodes of major depression 

Manic episode

• elevated, expansive mood for at least one week (or less if hospitalized) 

• impairment in normal functioning

• Ex: inflated self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easily distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behavior 

Hypomanic episode

shorter, less severe version of manic episodes

Mixed features

mood episode with symptoms reflecting both valences (manic and depressive)

DSM-5 Bipolar I disorder

alternations between major depressive episodes and manic episodes

DSM-5 Bipolar II disorder

alternations between major depressive episodes and hypomanic episodes

DSM-5 Cyclothymic disorder

alternations between less severe depressive and hypomanic periods

DSM-5 Premenstural dysphoric disorder

• depressive disorder that follows menstrual cycles 

• symptoms are slightly different than for MDD

DSM-5 Disruptive mood dysregulation disorder

• persistent irritability/anger (>1 year) and temper outbursts 

• only diagnosed in kids/adolescents (age 6-18) 

Epidemiology of depressive disorders

• risk increases in adolescence and young adulthood, decreases in middle adulthood, increases again in old age

• U shaped pattern

What is the worldwide lifetime prevalence of major depressive disorder?

16%

Who is more likely to have major depression?

• women are twice as likely

• starts in adolescence (pubertal timing, interpersonal stress) 

Who is more likely to have bipolar disorder? 

equally affect men and women 

There is a similar prevalence across subcultures, but experience of symptoms may vary. How?

Higher prevalence among Native Americans: Four times the rate of the general population

What are environmental influences that affect manic depressive disorder? 

• loss of relationship, status, job, etc

  • targeted rejection seems to be a particular risk factor 

• relation between negative events and depression is transactional over time

  • stress and depression increase 

What buffers the impact of stress? 

social support 

What enviornmental influences are focused on for mania?

• goal attainment events

• Ex: getting a new job, finishing finals, etc 

What do family studies reveal about manic depressive disorder and bipolar disorder ?

• children of parents with MDD are 3-6x more likely to develop MDD

• family history of bipolar associated with increased risk od bipolar and unipolar depression 

What do twin studies reveal about manic depressive and bipolar disorder?

• MDD: 37% genetic, rest is non-shared enviornment

• heritability of bipolar is higher

• various disorders have shared genetic influences

Negative inflectional style

• cognitive influence

• attributes the causes of negative events to (internal), stable, and global factors (Ex: the reason I failed the test is that I’m stupid)

• associated with Learned Helplessness 

Beck’s Negative Cognitive Triad

• cognitive influence 

• negative views of self, world, and future

Rumination

• cognitive influence 

• passively thinking about why you are depressed without any active problem solving or distraction 

What is a symptom of MDD and (hypo) mania

sleep disturbance

How does sleep affect Manic Depressive Disorder?

• sleep can be either less (insomnia) or more (hypersomnia)

• either way, person feels exhausted 

How does sleep affect mania?

• the person sleeps much less and feels rested]

• when assessing (hypo) mania, this is the question attention is mostly paid to 

Lithium carbonate

• treatment of choice for bipolar disorder 

• considered a mood stabilizer because it treats depressive and manic symptoms

• toxic in large amounts

• does must be carefully monitored

• effective for 50% of patients 

Electroconvulsive therapy

• effective for severe medication-resistant depression

• brief electrical current applied to the brain leading to seizure

Side effects of Electroconvulsive therapy

headaches, memory loss that may be permanent

Transcranial magnetic stimulation

• uses magnets to generate a precise localized electromagnetic pulse

• less effective than ECT for medication-resistant depression

• few side effects: occasional headaches 

Cognitive-behavioral therapy 

• addresses errors in thinking

• also includes behavioral component including behavioral activation (focusing specifically on “pleasure” and “mastery” events) 

Interpersonal psychotherapy

focused on improving problematic relationships

Psychosocial treatment for bipolar disorder

• psychotherapy helpful in managing the problems (rx: interpersonal occupation) that accompany bipolar disorder

• family therapy can be helpful

• medication (usually lithium) is first line of treatment 

Nearly everyone with depression who is treated with antidepressants will benefit from them 

False: although medication is important in the treatment of depression, only about half of people benefit from it 

People with bipolar disorder need lithium or another mood stabilizer but do not benefit from psychotherapy

False: medication is considered the gold standard treatment for bipolar disorder, but psychotherapy is also helpful

Relapse prevention is important in the treatment of mood disorders

True: Because both bipolar disorder and major depressive disorder tend to recur, relapse prevention is particularly important

Psychotherapy for depression may focus on improving problematic relationships or encouraging participation in valued activities

True: There are a number of psychotherapeutic approaches to treating depression, including interpersonal psychotherapy, which focuses on improving interpersonal relationships, and behavioral activation therapy, which involves scheduling valued and enjoyable activities

Binge eating

• eating excess amounts of food in a discrete period of time 

• eating is perceived as uncontrollable 

• may be associated with guilt, shame, or regret or particularly stressful times

• may hide behavior from family members

• foods consumed are often highin sugar, fat, or carbs 

Bulimia nervosa 

• purging

• excessive exercise

• fasting or food restriction 

What are the associated medical features of bulimia nervosa?

• most people are within 10% of normal body weight

• purging can result in severe medical problems 

What are the associated psychological features of bulimia nervosa?

• most people with bulimia nervosa are overly concerned with body shape

• fear of gaining weight

• most people with bulimia nervosa have comorbid psychological disorders 

Bulimia nervosa: facts and stats

• majority are women - 90%

• Some binge eating symptoms are relatively common in men

• incidence among males is increasing, 0.8% bulimia, 2.9% BED

• 6 to 7% of college women suffer from bulimia at some point 

• onset typically in adolescence

• tends to be chronic if left untreated 

Anorexia Nervosa

• extreme weight lost is the hallmark of anorexia

• restriction of calorie intake below energy requirments

• intense fear of weight gain accompanied by body image distortion

• two subtypes: restricting and binge-eating-purging 

Associated medical features of Anorexia Nervosa

• starving bdy borrows energy from internal organs, leading to organ damage including cardiac damage

• most deadly mental disorder due to physical consequences and suicide risk 

What are common psychological disorders associated with Anorexia Nervosa?

• 70% of people with anorexia are depressed at some point

• higher than average rates of substance misuse and OCD 

Anorexia Nervosa Facts and Stats

• majority are white females

• from middle to upper-middle class families

• develops around early adolescence

• more chronic and resistant than bulimia

• lifetime prevalence approximately 1%

• develops in non-Western women after they move to Western countries (cross-cultural factor) 

Binge Eating Disorder (BED)

• characterized by binge deating without associated compensatory behaviors

• associated with distress and or functional impairment (ex: health risk, feelings of guilt)

• excessive concern with weight or shape may or may not be present