Queen's University - PSYC 236 - Final Exam

1. Which of the following statements describes Wakefield's concept of mental disorder

a. A disorder causes a biological disadvantage

b. A disorder is simultaneously biological and social

c. Dysfunction is a scientific and factual term based on sociocultural standards that refers to the failure of an internal mechanism to perform a function for which it was designed

d. The concept of disorder combines statistical deviance with a value judgement

e. Harmful is a value term referring to the consequences that occur to the person because of the dysfunction and these consequences are deemed negative by evolutionary biology

b. A disorder is simultaneously biological and social

There is some similarity between illness anxiety disorder and ______________.

a. Panic disorder

b. Conversion disorder

c. Depression

d. Psychogenic pain

e. Dissociative amnesia

a. Panic Disorder

According to Dr. Robert Sapolsky (interviewed in the Radiolab podcast on stress), rats that are exposed to stress (an electrical shock) have fewer negative health outcomes when given which of the following means of coping with stress?

a. The rat can go attack another rat after being shocked

b. The rat can chew on a piece of wood after being shocked

c. The rat can predict when the shock is coming by seeing a light that precedes the shock

d. The rate can press a lever that was previously associated with control over the shock but now does nothing to lessen the intensity of the shock

e. All of the above

E. All of the above

5. If a person's medical illness appears to be in part psychological, the diagnosis is ___________.

a. Somatic symptom disorder

b. Fictious disorder

c. Psychophysiological disorder

d. Psychological factors affecting physical condition

e. Psychosomatic disorder

d. Psychological factors affecting physical condition

According to the model of the binge-purge cycle, purging is _______ reinforced because ______________.

Negatively; reduces feelings of guilt

Addiction produced by __________ is thought to be even greater than that produced by other addictive substances

Tobacco (Nicotine)

On which of the following Big Five personality traits do people with ASPD have a LOW score?

Conscientiousness

Define clinical psychology and explain why clinical psychology is a science. Define three areas of clinical psychology practice and describe how the scientific method is implemented in each.

Define clinical psychology

- Science of human behaviour applied to real-world concerns with mental health and well-being

- Application of psychological science/science of human behaviour applied to mental health/mental disorder/mental illness etc.

Why is clinical psychology a science?

- Application of the scientific method to mental health

- Could also say hypothesis generation, hypothesis testing, hypothesis evaluation instead of "scientific method" but need to have all 3 - Uses theory to generate predictions

Define three areas of clinical psychology practice and describe how the scientific method is implemented in each

- Research: Using scientific method for understanding etiology of mental disorder/evaluating efficacy of treats/etc.

- Assessment: Using assessment tools that are psychometrically sound - show reliability and validity

- Diagnosis: Using a diagnostic system with good validity and reliability informed by research

- Treatment: Using empirically supported treatments; following defined protocols; gathering data during treatment and using to inform treatment decisions

You are a Clinical psychology student on placement. Your client describes that they have been feeling tired and unwell. Exhibited a loss of interest in their hobbies. They oversleep and have missed several days of work. They feel a general sense of unease or tension daily.

Identify 3 potential diagnoses, explain why you are considering them, explain what information you would need to differentiate between the diagnoses described in part A

1. MDD

- 4/9 symptoms

- Needs to last 2 years

2. PDD

- Need to confirm depressive episode with post-partum onset

3. SAD

- Need to confirm depressive episode and seasonal pattern

4. Bipolar I or Bipolar II

- In current depressive episode

- Query any experience of mania or hypomania

5. GAD

- Need to know how long symptoms lasted for, presence of excessive worry, three or more symptoms of anxiety

6. Somatic Symptom Disorder

- How long symptoms have lasted and are they recurrent; are there other somatic symptoms; is there excessive worry about health/diagnosis; how much time/energy is being devoted to health concerns; does the client have a medical diagnosis?

Discuss the psychological and sociocultural factors that contribute to the etiology of addictive disorders. Name, describe, and the factor. How will that factor influence someone to develop a substance use or gambling disorder?

Sociocultural Factors

- Social Learning Theory

- Affects scripts

- Affects expectancies

- Affects norms

- Acculturation

- Refers to the process and degrees of adapting to the dominant culture among individuals who have emigrated

- Ex. Hispanic Americans

- Gender Roles

Psychological Factors

- Substance expectancies

Kali worked at a fast-food restaurant. Two weeks ago, they and their co-workers were forced into the freezer at gunpoint. Kali feared for their life. Their boss terminated their employment because he argued that Kali had not taken proper security measures to prevent the robbery. Since the event, Kali has had difficulty expressing emotions, has nightmares about the robbery, feels disconnected from their environment, and is constantly on guard. They are particularly hypervigilant when they take their children to a fast-food restaurant. Which diagnosis best applies to Kali's symptoms?

a. Adjustment Disorder

b. PTSD (post-traumatic stress disorder)

c. Acute stress disorder

d. Generalized anxiety disorder

e. PTSD, acute subtype

c. Acute stress disorder

- For clinical diagnoses, pay attention to the time scale of the symptoms!

- Because it's only been two weeks, we can't diagnose PTSD

What major differences do autistic individuals exhibit?

- Social interactions

- Communication

- Interests and Activities

- Adaptive Behaviours

Autism Spectrum Disorder symptoms occur before age ____ and are _____________.

3; Persistent

What differences in social interaction do autistic individuals exhibit?

- Few non-verbal behaviours (eye contact, smiling, frowning, gesticulating)

- Challenges developing relationships with peers

- Challenges in reciprocal social interactions

- Differences in Theory of Mind

What differences in communication do autistic individuals exhibit?

- Later acquisition or total absence of spoken language

- Challenges initiating and maintaining conversations

- Lack of make-believe play or imitation of others

- Unusual language - perservations, echolalia, pronoun reversal

What differences in activities and interests autistic individuals exhibit?

- Preoccupation with certain activities and interests

- Stereotyped and repetitive movement

- Less typical use of objects

- Preoccupation with parts of objects vs. the whole

What are examples of stereotyped and repetitive movements in autistic individuals?

- Hand flapping

- Head banging

What causes preoccupation with parts of objects vs. the whole in autistic individuals?

- Neurocognitive variations in global vs. local processing

What does the study by Koldewyn et al., 2013 show?

- Children with autism showed a reduced preference to report global properties of a stimulus when given a choice

- Autistic childrens' ability to process global properties when instructed to do so was unimpaired

- Findings supported prior claims that autistic people show a disinclination, not a disability, in global processing

What is the first part of the DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD)?

a. Persistent deficits in social communication and social interaction across multiple contexts as manifested by the following, currently or by history:

1. Deficits in social-emotional reciprocity

2. Deficits in nonverbal communicative behaviours used for social interaction

3. Deficits in developing, maintaining, and understanding relationships, ranging

- Need to specify current severity: Severity is based on social communication impairments and restricted patterns of behaviour

What is the second part of the DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD)?

b. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following, currently, or by history:

1. Stereotyped or repetitive motor movements, use of objects, or speech

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behaviour

3. Highly restricted, fixated interests that are abnormal in intensity or focus

4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment

- Need to specify current severity: Severity is based on social communication impairments and restricted patterns of behaviour

What is the third part of the DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD)?

c. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed capacities or may be masked by learned strategies in later life

What is the fourth part of the DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD)?

d. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

What is the fifth part of the DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD)?

e. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay

Why should a clinician be careful when diagnosing ASD, as opposed to intellecutal disability developmental disorder or global developmental delay?

- Intellectual disability and autism spectrum disorder frequently co-occur

- To make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level

What are the three levels of severity for autism spectrum disorder (ASD)?

1. Level 1 - "Requiring Support"

2. Level 2 - "Requiring Substantial Support"

3. Level 3 - "Requiring Very Substantial Support"

Describe the Level 1 severity level for Autism Spectrum Disorder (ASD)

Level 1 - Requiring Support

Social Communication

- W/o supports in place, deficits in social communication cause noticeable impairments

- Difficulty initiating social interactions

- Clear examples of atypical or unsuccessful responses to social overtures of others

- May appear to have decreased interest in social interests

Restricted, Repetitive Behaviours

- Inflexibility of behaviour causes significant interference w/ functioning in one or more contexts

- Difficulty switching between activities

- Problems of organization + planning hamper independence

Describe the Level 2 severity level for Autism Spectrum Disorder (ASD)

Level 2 - Requiring Substantial Support

Social Communication

- Marked deficits in verbal and nonverbal social communication skills

- Social impairments apparent even with supports in place

- Limited initiation of social interactions

- Reduced or abnormal responses to social overtures from others

Restricted, Repetitive Behaviours

- Inflexibility of behaviour

- Difficulty coping with change

- Other restricted/repetitive behaviours appear frequently enough to be obvious + interfere with functioning in a variety of contexts

- Distress and/or difficulty changing focus or action

Describe the Level 3 severity level for Autism Spectrum Disorder (ASD)

Level 3 - Requiring Very Substantial Support

Social Communication

- Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning

- Very limited initiation of social interactions

- Minimal response to social overtures from others

Restricted, Repetitive Behaviours

- Inflexibility of behaviour

- Extreme difficulty coping with change

- Other restricted/repetitive behaviours markedly interfere with functioning in all spheres

- Great distress/difficulty changing focus or action

What does the study by Valk et al. (2021) show?

Considering Toxic Chemicals in the Etiology of Autism

- Gestational exposures to some neurotoxic and endocrine-disrupting pesticides increase the chances of an autism diagnosis or autism-related behaviours in children

- Evidence is emerging that other toxic chemicals are associated with autism or autism-related behaviours, notably phthalates --> ubiquitous chemicals that cause a decrease in testosterone

What is Asperger's Disorder?

- Social Differences Similar to Autism

- Significantly later language acquisition or differences in expression

- Cognitive variations

- Stilted speech

- Eccentricities

- Social identity: "Aspies"

- No longer featured in the DSM

What are some controversies surrounding the DSM-5 changes surrounding ASD?

- The removal of Asperger's as a diagnosis threatens the unique identity of the Asperger's community

- Greater stigma associated with autism

- Personal Costs: Having to undergo unecessary treatment and education interventions

- Societal Costs: Moving educational and therapeutic resources away from those who need them most

What treatment is given to autistic individuals?

- Applied Behaviour Analysis (ABA)

- Early Intensive Behavioural Intervention (EIBI)

Describe how Early Intensive Intervention (EIBI) works

- Focuses on cognitive, communication, and behavioural difficulties

Describe the effectiveness of Early Intensive Behavioural Intervention (EIBI)

- Effectiveness: Reductions in challenging behaviours in 80-90% of cases

- Early intervention is key

- Greatest gains in first 12 mo

- Not all kids benefit

Intellectual disability (Intellectual developmental disorder) is indicated by differences in __________________ and __________________.

Intellectual Functioning; Adaptive Functioning

Describe the differences in intellectual functioning that diagnose individuals with intellectual developmental disorder

Differences in:

- Reasoning

- Problem Solving

- Planning

- Abstract Thinking

- Judgement

- Academic + Experiential Learning

Describe the differences in adaptive functioning that diagnose individuals with intellectual developmental disorder

- Difficulty living without ongoing support

- Affecting functioning in one or more activities of daily life (e.g., communication, social participation, independent living) across multiple environments (e.g., home, school, community)

Intellectual Developmental Disorder is onset during ________________.

- Childhood

What are two examples of challenging and changing norms for neurodivergent individuals?

- Deinstitutionalization

- World Down Syndrome Day (March 21)

What is a definition of gender/sex?

- "Gender/sex refers to phenomena, features, and whole people where gender and sex intertwine, both could be relevant, and/or the two cannot be disentangled easily or at all, as with whole women, men, and gender/sex-diverse people and many aspects tied to them" - Van Anders (2022)

How does the minority stress hypothesis apply to LGBTQ+ mental health?

- Minority Stress Hypothesis: Stigmatized groups often experience unique challenges that increase risk for psychopathology

- Direct and indirect effects of discrimination increase risk for psychopathology generally

- LGBTQ+ youth can experience unique challenges from discrimination that may increase rates of psychopathology

How does stigma, prejudice, and discrimination of LGBTQ+ people create a hostile and stressful social environment that causes mental health problems?

- Increased exposure to traumatic and stressful events (e.g., violence and threat of physical violence; ridiculed and ostracized by family)

- Expectations and vigilance for stressful events (e.g., anxiety about walking home at night; coping with transphobic workplace)

- Internalization of negative social attitudes (e.g., internalized homophobia, transphobia)

- Fear of persecution

How did same-sex sexuality stop being considered a mental disorder?

- Evelyn Hooker's (1957) work on debunking the pathologizing of same-sex sexuality

- Community activism in the 60s and 70s

What is gender dysphoria?

- Birth-assigned sex and gender does not reflect a person's true gender identity

- Causes the person distress (dysphoria)

What controversy surrounds gender dysphoria in the DSM-5?

- Controversy over the retention of gender dysphoria in the DSM-5

- Likened to inclusion of homosexuality in the DSM II

- However, there is an argument that removal from the DSM could make medical + supportive care inaccessible for trans folks

What psychological practice is used with people experiencing gender dysphoria?

- Focus on counseling and supporting the client

- Trans-affirmative clinical practice

- Goal is to counsel on ways to resolve gender dysphoria

- Follows World Professional Association of Transgender Health Guidelines Standards of Care

In cases of gender dysphoria, hormone therapies and affirming medical procedures are associated with _____________ outcomes

- Positive

What is gender euphoria?

- Countering the narrative of gender expansive lives as distressing and dysphoric

- Affirming actions contribute to experience of gender euphoria, supporting mental health and wellbeing of gender expansive people

What affirming actions contribute to the experience of gender euphoria?

- Using the correct pronouns

- Inclusivity

- Appearance affirmation

Why do we care about good sexual functioning?

- Lower sexual functioning has effects on:

- Mood

- Distress

- Quality of Life

- Effects on Intimate Relationships

- Associations with Sexual Trauma

What are the three subtypes of sexual desire and arousal disorders?

1. Sexual Interest/Arousal Disorder (Female)

2. Hypoactive Sexual Desire Disorder (Male)

3. Erectile Disorder

What are the three subtypes of orgasmic disorders?

1. Delayed Ejaculation (Male)

2. Orgasmic Disorder (Female)

3. Premature ejaculation (Male)

Lifetime prevalence rates for sexual complains are higher for _______________ than _______________.

Cisgender women; cisgender men

Gender/sex variations are expected because:

- Different anatomy and physiology

- Different experiences of their sexualities

- Different reproductive roles

- Different social roles, stereotypes, expectancies, and myths in most cultural contexts

What is sexual response?

- Sexual response (arousal/desire) is an emotional state triggered by internal/external sexual cues

Describe the physiological cues of sexual response

- Pattern of physiological response distinct from global autonomic nervous system activation

- Genital vasocongestion/engorgement

Describe the emotional cues of sexual response

- Positive, negative, and ambivalent affect

Describe the cognitive cues of sexual response

- Attention to sexual cues

- Activation of sexual memory

- Perception and appraisal of sexual response

- Anticipation of sexual rewards

State several different models of sexual response

1. Linear Model

2. Toates' (2009) Incentive Motivation Model

3. Basson's (2000) Circular Sexual Response Cycle

Describe the linear model of sexual response

- Presents experiencing sexual arousing in distinct phases

- Describes motivation as "spontaneous sexual desire"

What are the problems with the linear model of sexual response?

- Doesn't talk about what happens at the beginning

- How does this all get started? Where does motivation come from?

- Describes motivation as "spontaneous sexual desire" which is just wrong

Why is the term "sex drive" somewhat misleading?

Sex drive --> NOT A DRIVE!

- DRIVE implies motivation that emerges from an internal regulatory mechanism signaling a deficit in life-sustaining needs

- Sex doesn't work this way; an individual won't die without sex

Describe Toates' (2009) Incentive Motivation Model of sexual response

- Three different aspects:

1. Implicit/Explicit Cognitive Affective Processing

2. Arousal

3. Desire

- Desire emerges from the activation of sexual response

- State triggered by sexual cues (not a personality trait)

Describe the 3 Ps Model for the etiology of sexual dysfunctions

1. Predisposing Factors

2. Precipitating Factors

3. Perpetuating Factors

Describe predisposing factors for sexual dysfunctions

- Early sexual experiences

- (Lack of) education about sexuality and sexual health

- Childhood sexual abuse

- Parental environment/influence

- Health-related behaviours like smoking

- History of sexual violence

Describe precipitating/associated factors for sexual dysfunctions

- Relationship distress

- Major life changes such as parenthood

- Peri/menopause

- Surgery or physical illness

- Medications (e.g., SSRIs)

- Sexual violence

- Mental disorder (e.g., anxiety, mood disorder)

Describe perpetuating factors for sexual dysfunctions

- Lack of knowledge/myths

- Negative attitudes

- Performance anxiety

- Cognitive interference/distraction

- Psychological distress

- Lifestyle factors (e.g., health, stress)

- Poor communication

- Relationship distress

- Feminist perspectives: heteronormative sexual scripts

What are the diagnostic criteria for sexual interest/arousal disorder?

- Need 3/6 sx for 6 mo.

1. Absent/reduced sexual interest

2. Absent/reduced sexual thoughts

3. No/reduced sexual initiation

4. Absent/reduced sexual excitement/pleasure

5. Absent/reduced sexual response

6. Absent/reduced sexual sensations

Cultivation of _________________ increases sexual concordance

- Mindfulness

What therapy is used to help treat sexual interest/arousal disorder?

- Mindfulness Based Cognitive Therapy (MBCT)

Elaborate on how Mindfulness Based Cognitive Therapy helps treat Sexual Interest/Arousal Disorder

- Mindfulness-based skills target sexual connection to the body

- STEP (sex education and therapy) addresses knowledge gaps and offers support

- Improvements in sexual desire (SIDI), reduction in sexual distress (FSDS) for both

A study examined change in sexual concordance as a function of treatment (MBCT vs. STEP). What were the results?

- Both groups show positive effects

- Greater positive effect among the MBCT group

Is sexual concordance a mechanism of change in sexual functioning?

- Sexual concordance is associated with higher sexual desire among those with SIAD and with increases in sexual desire immediately after treatment

- Change in sexual concordance is associated with reduced sexual distress

What is a pharmacological treatment for arousal/desire difficulties?

- PDE-5 inhibitors (e.g., VIagra, Cialis) for low arousal

- Increase genital vasocongestion in cisgender women but don't affect subjective experience of arousal

The study conducted by Brotto et al. (2021) on MBCT vs. STEP had what results?

- For MBCT and STEP, levels of arousal and desire were similar

- For reduction in distress, MBCT > STEP

What is the DSM-5 definition of paraphilia?

Intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners

What are concerns about the DSM-5 definition of paraphilia?

- Concerns about pathologizing language

- Paraphilia vs. kink

The DSM-5 definition of paraphilic disorder contains these criterion:

a. Criterion A - Paraphilia

b. Criterion B - Distress

- Paraphilia that currently causes distress or impairment to the individual

OR

- Paraphilia that causes personal harm or risk of harm to others when acted upon

- At least 6 mo. duration

- Manifests as thoughts, urges, sexual fantasies, sexual gratification through masturbation, acting out sexual behaviours

How do paraphilic disorders develop?

- Sexual interest usually starts in adolescence

- Becomes stronger/more specific with age

- Can involve aggression, victimization

How are paraphilic disorders distributed among men/males and women/females?

- Overwhelmingly among men/males

- In women/females, traditionally thought to only emerge with a personality disorder

- Knowledge of gender expansive people's experience is limited

What are the personality/psychological features of paraphilic disorders?

- Socially anxious, isolated, low self-confidence

- Obsessive preoccupation

- Behaviours disrupt relationships

What are some likely reasons for a referral for someone with a possible paraphilic disorder?

- Individual is concerned about sexual interests

- Relationship problems

- Partner or family member is concerned

- Forensic (charges, family court)

What are some comorbid and differential diagnoses of paraphic disorders?

- Obsessive-Compulsive Disorder (intrusive thoughts)

- Bipolar Disorder or Dementia (Hypersexual behaviour)

- Schizophrenia: Auditory Hallucinations

What are 7 forensically relevant paraphilic disorders?

1. Pedophilic/Hebephilic Disorder

2. Coercive Sexual Sadism Disorder (ICD-11)

3. Exhibitionistic Disorder

4. Voyeuristic Disorder

5. Frotteuristic Disorder

6. Somnophilic Disorder

7. Zoophilic Disorder

What is the offending behaviour with pedophilic/hebephilic disorder?

- Sexual contact with minors

What is the offending behaviour with coercive sexual sadism disorder?

- Sexual assualt

- Usually causing suffering/bodily harm

What is the offending behaviour with exhibitionistic disorder?

- Nonconsenting display of genitals

- Indecent exposure

What is the offending behaviour with voyeuristic disorder?

- Nonconsensual observing of others

What is the offending behaviour with frotteuristic disorder?

- Sexual assualt

What is the offending behaviour with somnophilic disorder?

- Sexual assault against sleeping/unconscious people

Zoophilic Disorder

- Sexual behaviours with animals

What treatment is used for individuals with paraphilic disorders?

- Cognitive Behavioural Therapy

- Targets attitudes, thoughts, behaviours, and emotions associated with problematic sexual behaviour

- Identify situations that put individuals at risk and develop coping strategies

What is a key component of CBT for sex offenders?

- Relapse Prevention Treatment

- Increases motivation to not reoffend

- Identify precursors to offending

- Develop coping and avoidance skills to deal with precursors

- Develop self-regulation skills

- Responsibility and victim empathy

What are the two broad categories of childhood disorders?

1. Externalizing Problems

2. Internalizing Problems

In childhood disorders, there are disorders of ______________ and disorders of _______________.

Undercontrolled behaviour; overcontrolled behaviour

What are examples of the uncontrolled behaviour disorders of childhood disorders?

Ex. Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity (ADHD), Conduct Disorder (CD)

What are examples of the overcontrolled behaviour disorders of childhood disorders?

Ex. Separation Anxiety Disorder (SAD), Generalized Anxiety Disorder (GAD), Disruptive Mood Dysregulation Disorder (DMDD)

What are the relative ages of onset for aggression-related disorders?

- Oppositional Defiant Disorder (ODD): Early childhood (6-8 yrs), sometimes earlier

- Conduct Disorder (CD): Adolescence (10-17 yrs)

- Antisocial Personality Disorder (ASPD): Adulthood (18 yrs+)