psychopathology exam 2

chapter 5,6, and 7

polygenetic influences on anxiety

the corticotropin releasing factor (CRF) that actiavates the HPA axis, which is the main organizer of the body’s response to stress

neurotransmitters that contribute to anxiety

GABA, noradrenergic, serotonergic

how do neurotransmitters contribute to anxiety?

when the neurotransmitter goes down, anxiety goes up

flight vs flight system

panic circuit, alarm response of the limbic system

behavioral inhibition system (BIS)

recieves danger signals from the brian stem and septal-hippocampal system, when this thing has high activity, sensitivity to anxiety increases

how are brain circuits shaped by the environment?

when someone becomes reliant on a substance (e.g. nicotine), their body becomes reliant on that. because of this, the risk for developing anxiety is much higher

what are social contributions to anxiety?

genetics, observing other with SAD, early traumatic events, parenting styles, isolated upbringing, brain structure, and societal expectations

biological vulnerability

heritable contribution to negative affect; glass half empty, irritable, driven; diathesis

specific psychological vulnerability

physical sensations are potentially dangerous; anxiety about health, nonclinical panic; learning

generalized psychological vulnerability

sense that events are uncontrollable/unpredictable; tendency toward lack of self-confidence, low self-esteem, inability to cope; beliefs

what disorder is anxiety usually comorbid with

depression, increased risk of suicide

generalized anxiety disorder clinical description

-shift from possible crisis to crisis

-worry about minor, everyday concerns

-can have sleep disturbance and irritability

-leads to behaviors like procrastination and overprepartaion

generalized anxiety disorder DSM-5-TR diagnositc criteria

-excessive anxiety and worry occuring more days than not for at least six months

-difficulty controlling worry

-causing other physical symptoms

-clinically significant distress or impairment

-not due to substance use or medication, not better explained by another disorder

causes of generalized anxiety disorder

inherited tendency, neuroticism (personality trait that describes the tendency towards negative feelings), always on the look out for threats, energy suck, burnout

treatments for generalized anxiety disorder

drugs- antidepressants or benzodiazepines

CBT and relaxation techniques

diagnostic criteria for panic disorder

-recurrent, unexpected panic attacks

-at least one attack has been followed by significant worry or maladaptive change in behavior

-not attributable to substance use or better explained by another disorder

diagnostic criteria for panic attacks

-palpitations, pounding heart, or accelerated heart rate

-sweating

-trembling or shaking

-feeling of choking

-chest pain or discomfort

-nausea or abdominal distress

-feeling dizzy, unsteady, light-headed or faint

-chills or heat sensations

-parathesias (tingling or prickling)

-derealization

-fear of losing control or going crazy

-fear of dying

clinical description of panic attacks

expected or unexpected, abrupt experience of intense fear with physical and cognitive syptoms

clinical description of panic disorder

-unexpected panic attacks with worry, anxiety, or fear of another attack that persists for a month or more

-interoceptive avoidance

-use and abuse of drugs and alcohol

-can have with or without agoraphobia

interoceptive avoidance

avoidance of situaitons or activites that produce sensations of physical arousal similar to those occuring during a panic attack or intense fear response

treatment for panic

benzodiazepines, SSRIs

exposure-based treatment (panic control treatment), reality testing, relaxation and breathing skills

onset and course for generalized anxiety disorder

chronic, insidious onset in childhood or adolescence

onset and course for panic

chronic, acute onset in young adulthood

what has high comorbidity with panic disorder

agoraphobia and substance use

clinical description of agoraphobia

fear or avoidance of situations ro events that comes with not being able to escape or get help in the event of panic symptoms

typical avoidance

unfamiliarity in enclosed spaces typically evokes high degrees of anxiety and fear, so these places are avoided at all costs

diagnostic criteria for agoraphobia

-marked fear/anxiety for two or more: public transportation, open or enclosed spaces, standing in line, being outside the home alone

-avoids these situations

-always provokes fear

-anxiety is disproportional and excessive

-clinically significant distress

-not better explained by another disorder

clinical description for specific phobias

-extreme and irrational fear of a specific object or situation

-feared situation almost always provokes anxiety

-significant impairment or distress

diagnostic criteria for specific phobias

-fear or anxiety around a specific object or situation

-phobic object or situation almost always provokes immediate fear or anxiety

-phobic object/situation is actively avoided and out of proportion to danger

-more than 6 months

-clinically significant distress

-not better explained by another disorder (e.g. trauma response)

4 types of phobias

natural environment, animal, situational, mutilation/medical treatment

natural environment phobia

heights, storms, water

can cluster together

associated with real danger

childhood onset

animal phobia

may be associated with real danger

onset typically childhood

situational phobia

fear of a specific situation (e.g. flying or dying)

no uncued panic attacks

fear centers around risks of the situation, not of having a panic attack in that situation

onset typically early adulthood

mutilation/medical treatment

blood-injection-injury phobia

decreased heart rate and blood pressure when seeing blood injections or injury

fainting

inherited vasovagal response

onset normally in early childhood

causes of specific phobias

direct or vicarious experience, information transmission

treatments for specific phobias

CBT exposure therapy that can work in days and relaxation

clinical description for social anxiety disorder

-extreme/irrational concern about being negatively evaluated by other people

-can manifest as shyness

-significant impairmment and/or distress

-avoidance of feared situations or endurance with extreme distress

-subtype: only in perfromance situations

onset and course for social anxiety disorder

onset usually 13, can be chronic

causes of social anxiety disorder

generalized psychological and biological vulnerability

treatments for social anxiety disorder

medications: beta-blockers (performance-based), benzodiazepines, SSRIs, S-clycloserine

CBT and exposure therapy

OCD clinical description

intrusive and nonsensical obsessions that manifest as recurrent and horrific thoughts, images, or urges that can be about contamination, hurting others, doubting, etc with attempts to resist or elimate the obsession

compulsions (thoughts or actions) that provide temporary relief from obsessive thoughts

diagnostic criteria for OCD

-prescence of obsessions, compulstions, or both

-obsessions/compusions are time-consuming

-not due to substance use or better explained by another disorder

obsessions

need for symmetry, forbidden thoughts or actions

compulsions

-checking

-ordering

-arranging

-washing/cleaning

onset and course of OCD

chronic, insidious onset from childhood to 30s

causes of OCD

-generalized biological vulnerability

-early life experiences and learning

-notion that thoughts are dangerous or unacceptable

-thought-action fusion (causal relation between thoughts and outcome)

treatments for OCD

SSRIs (high relapse rate), cingulotomy

CBT exposure and ritual prevention therapy

tic disorder

involuntary movements or vocalizations, can co-occur with OCD patients and can be used as compulsive behavior

body dysmorphic disorder clinical description

preoccupation with some imagined or small defect in apppearance (can be comorbid with OCD)

diagnostic criteria for body dysmorphic disorder

-preoccupation with one or more defects in physcial appearance that are small and not obervable to others

-repetitive behavior

-preoccupations cause significant distress

-body preoccupations not better explained by another disorder

onset and course of body dysmorphic disorder

lifelong course with insidious onset in early adolescene- early 20s

treatment for body dysmorphic disorder

SSRIs

exposure and response prevention

hoarding disorder

excessively collecting and keeping items with minimal value leading to a cluttering and disruption of living space, waxes and wanes over time

trichotillomania

hair pulling as a self-soother

excoriation

compulsive skin-picking

treatment for excoriation

behavioral habit treatment

clincial description of PTSD

-trauma exposure

-continued re-experiencing

-avoidance

-emotional numbing

-reckless or self-destructive behavior

-interpersonal problems

>1 month

acute stress disorder

post-traumatic symptoms <1 month

diagnostic criteria for PTSD

-exposure to actual or threatened event

-presence of one of more intrusional symptoms

-persistent avoidance of stimuli associated with traumantic event

-negative alterations in cognitions and mood associated with traumatic event

-marked alterations in arousal and activity associated with the traumatic event

-sleep disturbance

-significant distress

-not attributable to substance use

traumatic exposure

experiencing or witnessing an event in which death, serious injury, or sexual violation occured or was threatened to the self or someone else, learning about a violent event occuring to a close loved one, extreme exposure to details of a traumatic event

onset and course of PTSD

acute onset, chronic

causes of PTSD

trauma intensity, generalized biological and psychological vulnerability, poor social support (greater risk when exposed to trauma)

treatment for PTSD

SSRIs, psychedelics?

CBT exposure therapy, increasing social support, psychoanalytic therapy (catharsis)

racial trauma vs PTSD

people who experience racial trauma cannot stop microaggressions and systematic racism

symptoms of attachement disorders

-disturbed and developmentally inappropriate behaviors in children

-child is unable or unwilling to form normal attachemtns with caregiving adults

-result of inadequate or neglectful care in early childhood

-anxious or depressive reactions to life stress

-milder than PTSD or acute stress disorder

-occurs in reaction to life stressors

-clinically significant distress or impairment

reactive attachement disorder

abnormally withdrawn and inhibited behavior

less receptive to support from caregivers

disinhibited social engagement disorder

abnormally low inhibition in children

prolonged grief disorder diagnostic criteria

-death of a person who was close to the bereaved individuals at least 12 months ago (6 for chidren and adolescents)

-persistent grief symptoms to a clinical significance: intense yearing or longing, preoccupation with thoughts and memories of the deceased person

-duration and severity clearly exceed the norms

-identity disruption

-sense of disbelief

-avoidance

-intense emotional pain

-difficulty reintegreating into life

-emotional numbness

-feelings of meaninglessness

-intense lonliness

somatic symotim disorder diagnostic criteria

one or more somatic symptoms that are distressing or result in significant disruption

-excessive thoughts, feelings, and behaviors related to somatic symptoms or associated health concerns that are:

• disproportionate and persistent thoughts about the seriousness of one’s symptoms

• high level of health-related anxiety

• excessive time and energy devoted to these symptoms or health concerns

>6 months

onset and course for somatic symptom disorder

chronic course, adolescent onset

illness anxiety disorder diagnostic criteria

-preoccupation with fears of having or acquiring a serious illness

-somatic symptoms are not present or, if they are, their intensity is mild

-high level of anxiety about health, easily alarmed by health status

-excessive health-related behaviors (repeated body checks and maladaptive avoidance)

>6 months

-not better explained by another disorder

illness anxiety disorder course and onset

onset in early or middle adulthood, chronic course

conversion disorder

physical malfunctioning without any physical organic pathology to explain

factitious disorder

purposely faking physical symptoms to get attention, can impose disorder onto another

malingering

physical symptoms are faked for the purpose of achieving a concrete objective

depersonalization/derealization disorder

recurrent epsiodes in which a person has sensations of unreality of one’s own body or surroundings that dominate and interfere with life functioning, has to include both

depersonalization/derealization disorder diagnostic criteria

• recurrent experiences of depersonaliation, derealization, or both

• reality testing is intact

• symptoms cause significant distress

• not result or substance use

• not better explained otherwise

• cognitive deficits in attention, short term memory, spatial reasoning

• easily distractible

• difficulty absorbing new information

• reduced emotional responding

what is comorbid with depersonalization/derealization disorder?

anxiety and mood disorders

onset and course of depersonalization/derealization disorder

onset in childhood or adolescence, lifelong, chronic course

treatment for depersonalization/derealization disorder

research is scarce, nothing solid, placebo worked on prozac

dissociative amnesia diagnostic criteria

• inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting

• the symptoms cause clinically significant distress or impairment

• the disturbance is not attributable to the physiological effects of a substance, neurological, or medical conditon, not better described

onset and course of dissociative amnesia

actue onset in adulthood, quick dissipation

causes of dissociative amnesia

trauma and stress can be triggers, little is known

dissociative fugue

• unable to remember how or why one has ended up in a new place

• during this episode, person travels or wanders, sometimes assuming a new identity in a different place

dissociative identity disorder (DID) clinical description

dissociation of personality so that several (about 10) new identities are formed with unique features

dissociative identity disorder diagnostic criteria

• two or more distinct personality states, “posession”

• recurrent gaps in the recall of everyday events, personal information, and/or traumatic event

• clinically significant distress

• not a normal part of a broadly accepted cultural or religious practice

• not attributed to substance use or another medical condition

alters

different identities or personalities

host

the identity that keeps the other identites together

switch

quick transition from one personality to another

can dissociative identity disorder be faked?

yes, sometimes subconciously

onset and course of dissociative identity disorder

childhood onset, lifelong and chronic course

causes of dissociative identity disorder

severe, chronic (childhood) trauma, offers an opportunity to escape, biological vulnerability

treatment for dissociative identity disorder

CBT: reintegration of identities, identify the triggers that provoke switches, must relive the early trauma and regain control, hypnosis?

false memories

false memories can be created by abuse of the power of suggestion, people can be conditioned to think they have repressed memories but can be proved to be false

risk factors for suicide

suicide in the family, low seratonin, preexisiting psychological disorder, alcohol and drug use and abuse, stressful life events, humiliation, past suicidal behavior, plan and access to lethal methods, impulsivity

suicide contagion

a person is more likely to commit suicide after hearing about someone else committing, social media can worsen this by sensationalizing/romanticizing suicide and describing lethal methods

suicide prevention techniques

putting physical barriers to lethal methods, clinicial-patient safety plan, CBT, increasing cognitive flexibilty (decreasing impulsivity), social support, talking about it (esp when someone seems at risk)

suicide statistics

11th leading cause of death in USA

3rd among teens

2nd among college students

12% of college students will consider

gender differences in suicide

females will attempt more, but males will die more than females (use more lethal methods)

unipolar mood disorder

only one extreme of mood is experienced (e.g. only depression or only mania)