Psyc 101 Final Exam Loeb (Chapter 14)

Diagnosis

involves distinguishing one illness from another

Etiology

the apparent causation and developmental history of an illness

Prognosis

a forecast about the probable course of an illness

Generalized anxiety disorder

a chronic, high level of anxiety that is not tied to any specific threat.

Specific phobia

involves a persistent and irrational fear of an object or situation that presents no realistic danger.

Panic disorder

is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly.

Agoraphobia

a fear of going out to public places

Obsessive-compulsive disorder (OCD)

is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).

Posttraumatic stress disorder (PTSD)

involves enduring psychological disturbance attributed to the experience of a major traumatic event.

Concordance rate

indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder.

Dissociative disorders

a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity.

Dissociative amnesia

a disorder characterized by retrospectively reported memory gaps

these gaps involve an inability to recall personal information, usually of a traumatic or stressful nature

Dissociative identity disorder (DID)

involves a disruption of identity marked by the experience of two or more largely complete, and usually very different, personalities.

The name for this disorder used to be multiple personality disorder

Major depressive disorder

people show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure.

Anhedonia

a diminished ability to experience pleasure.

Bipolar disorder

is marked by the experience of both depressed and manic periods.

Schizophrenia

a disorder marked by delusions, hallucinations, disorganized thinking and speech, and deterioration of adaptive behavior.

Delusions

false beliefs that are maintained even though they clearly are out of touch with reality.

Hallucinations

sensory perceptions that occur in the absence of a real, external stimulus or are gross distortions of perceptual input.

Expressed emotion

the degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved attitudes toward the patient.

Autism, or autism spectrum disorder (ASD)

is a neurodevelopmental disorder characterized by deficits in social interaction and communication and restricted, repetitive interests and activities.

Personality disorders

a class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning.

Antisocial personality disorder

marked by impulsive, callous, manipulative, aggressive, and irresponsible behavior.

Borderline personality disorder

marked by instability in social relationships, self-image, and emotional functioning.

Narcissistic personality disorder

marked by a grandiose sense of self-importance, a sense of entitlement, and an excessive need for attention and admiration.

Eating disorders

severe disturbances in eating behavior characterized by preoccupation with weight concerns and unhealthy efforts to control weight.

Anorexia nervosa

involves intense fear of gaining weight, disturbed body image, refusal to maintain a normal weight, and use of dangerous measures to lose weight.

Bulimia nervosa

habitually engaging in out-of-control overeating, followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise.

Binge-eating disorder

distress-inducing eating binges that are NOT accompanied by the purging, fasting, and excessive exercise seen in bulimia.

What are Psychological Disorders/Psychopathology?

• Psychological Disorders/Psychopathology (whether overt, physical behavior or mental processes)

• currently, medical model is favored: psychopathology as an illness

• advantages:

- diagnosis

- etiology: factors which cause and/or maintain the psychopathology

- prognosis aka treatment

• criticisms:

- continued stigma

- biogenetic explanations have both increased and decreased the stigma

- is it actually an illness in the same sense that diabetes or flu are illnesses?

prevalence

percentage of people within a population who have a specific mental disorder

lifetime prevalence

the percentage of people in the population who have had a disorder at some point in their lives

onset

the chronological age at which symptoms of a disease or disorder first appear in an individual

Criteria of Psychopathology

• 3 D's:

1. Deviance

2. Dysfunction (i.e. maladaptive behavior)

3. Distress

• subjective assessments

• Q: if assessment of abnormality is subjective, do errors occur?

- Absolutely!

- greater consensus for some diagnoses whose symptoms are more obvious and/or common (e.g. schizophrenia, depression, & bipolar illness)

- less consensus on other diagnoses (e.g. dissociative identity disorder)

DSM-V (American Psychiatric Association)

• what has been considered "psychopathological" has changed over the years...

• normal vs. psychopathology, NOT psychopathology vs. supernatural behavior

• supernatural causes of psychopathology have been considered (mostly by laypeople) throughout history

i. e.g. trephination

• research and politics

• categorical (vs. dimensional)

• ↑ #s of diagnoses - what do you think is going on?

• e.g. caffeine intoxication, tobacco use disorder, disruptive mood dysregulation disorder (tantrums seen in youngsters), ETC.

• medicalizing everyday behavior?

Anxiety disorders

marked feelings of apprehension or anxiety

Obsessive-Compulsive & Related Disorders

presence of obsessions and/or compulsions

Trauma- and Stressor-Related Disorders

disorders due to exposure to trauma

Dissociative disorders

disorders due to separation of consciousness

Major Depressive Disorder & Bipolar Disorders

disorders marked by emotional disturbances

Schizophrenia Spectrum & other Psychotic Disorders

disorders marked by a break from reality (e.g. hallucinations, delusions)

Neural Developmental Disorders

conditions with onset in developmental period

Personality Disorders

enduring maladaptive inner experience and behaviors

Feeding and Eating Disorders

disturbance of eating or eating-related behaviors

Types of Anxiety Disorders

1. Generalized Anxiety Disorder

2. Specific Phobia

3. Panic Disorder

4. Agoraphobia

5. Differentiation

Generalized Anxiety Disorder

▪ chronic anxiety not tied to a specific threat

▪ Associative features

• in general, 2/3 sufferers are females

• prevalence: 19% of population

Note:

when you see percentages being given (e.g. prevalence is 19% of population for anxiety disorders), we're not so interested in you memorizing the specific number as we are in whether the percentage is considered to be small (like 1%) or fairly large (like 19%). So what you should take away from the prevalence rate of anxiety disorders is that anxiety disorders affect a fairly larger portion of the population than other psychopathologies (and, in fact, is one of the most common psychopathologies, along with Major Depressive Disorder).

Specific Phobia

▪ irrational fear of a specific object or situation

• animal type phobias

• natural environment type phobias

• situational type phobias (e.g. claustrophobia)

• blood/injection/injury type phobias

o drop in blood pressure

• other

Panic Disorder

▪ sudden, overwhelming anxiety

• palpitations, sweating, shortness of breath, chest pain, nausea, derealization, fear of losing control, fear of dying, chills or hot flashes

Agoraphobia

▪ fear of going out in public

▪ may occur with panic disorder or a variety of other disorders

Differentiation

self-awareness and stronger self-identity

(hint: think of either unique collection of symptoms and/or differences in intensity and/or duration of symptoms)

Associative Features of Anxiety Disorders

o 2/3 female

o Prevalence: 19% of population

o Onset: late adolescence or early adulthood, depending on type

Etiology of Anxiety-related disturbances

biological & psychological factors

o biological

▪ hereditary studies - concordance rates

▪ modest heritability

▪ neurotransmitters

• e.g. GABA (anxiety), 5-HT (OCD)

o psychological

▪ conditioning & learning

- acquired via classical conditioning, maintained via operant conditioning (for more than just phobias)

- biological preparedness (Seligman): we learn some fears more readily than others

- evolved module for fear learning (Ohman & Mineka) : further develops how/in what way we learn some fears more readily than others

- Those with panic disorder and PTSD tend to overgeneralize (classical conditioning) stimuli which trigger anxiety.

▪ maladaptive cognitive patterns

- misinterpret harmless situations has harmful

- focus excessive attention on threats

- selectively recall threatening situations

- impairment of executive functioning in some who have OCD

▪ stress

- may precipitate and/or exacerbate disorders

Obsessive-Compulsive and Related Disorders: Obsessive-Compulsive Disorder

• presence of intrusive thoughts (obsessions) OR uncontrollable urges to engage in ritualistic behaviors (compulsions)

• obsessions are often about inflicting harm on others, personal failures, suicide or sexual acts

• awareness is variable (some know it's unusual, others feel it's completely rational)

• prevalence: 2-3% of population

• mean onset: 19-20 yrs. of age

• corre. with ↑ suicide risk

• males: females = equitable

Trauma- and Stressor-Related Disorders: Posttraumatic Stress Disorder

• anxiety disorder due to exposure to major traumatic event

o exposure to traumatic events is much more common than once thought; majority have been exposed to one or more traumatic events

• lifetime prevalence: 7-8+% of population

• high levels of stress & adversity during childhood and intense reactions to the traumatic event itself may ↑ chances of developing PTSD

Types of Dissociative Disorders

1. Dissociative Amnesia

2. Dissociative Identity Disorder (formerly known as multiple personality disorder)

Dissociative Amnesia

▪ a disorder characterized by retrospectively reported memory gaps

▪ loss of extensive personal information

▪ subtype: dissociative fugue (a temporary state where a person has memory loss (amnesia) and ends up in an unexpected place)

Dissociative Identity Disorder (formerly known as multiple personality disorder)

▪ coexistence of two or more personalities (not to be confused with schizophrenia)

▪ expressed amnesia for the other personalities but other memory tests suggest awareness of the other personalities

▪ alters may be very different from the original personality

▪ transitions may be sudden

▪ ↑ # of diagnoses over the years - overdiagnosis by a few clinicians

Etiology of Dissociative Disorders

o Stress - but why does stress affect some people in this way and not others?

o iatrogenic (relating to illness caused by medical examination or treatment)

o severe emotional trauma during childhood

▪ ability to dissociate?

▪ but lack of independent verification

o very controversial; etiology is very unclear

Depressive Disorder's Diagnostic criteria

o (5 or more)

o persistent sadness and/or loss of interest in previously pleasurable things (i.e. anhedonia)

o weight loss or weight gain

o insomnia or hypersomnia

o psychomotor retardation or agitation

o fatigue

o feelings of worthlessness or guilt

o can't concentrate

o recurrent thoughts of death

Associative features of Depressive Disorders

o Onset: around puberty & highest incidence around 20s (your chapter says differently - but ignore)

▪ earlier onset = worse severity and prognosis

o 40-50% have recurrences: avg. of 5-6 episodes

o Average duration: 6 mos.

o Tends to be episodic but some have persistent depression for many years; corre. with ↑ risk of physical health problems and ↑ mortality risk

o Lifetime prevalence: 13-16% (at least 40 million people in the US)

o Cohort effect

▪ But some suggest this is inflated to include normal sadness in response to severely stressful situations

o women 2x greater: men

▪ genetics unlikely

▪ tied to reproductive cycle/hormones?

▪ greater stress & adversity (environmental factors)

▪ rumination (repetitive thinking or dwelling on negative feelings and distress and their causes and consequences)

Bipolar & Related Disorder's Diagnostic criteria:

o at least one manic episode (persistently elevated, expansive or irritable mood, lasting at least 1 week)

o (3 or more)

o inflated self-esteem/grandiosity

o decreased need for sleep

o more talkative

o flight of ideas/racing thoughts

o distractibility

o psychomotor agitation and/or ↑ goal-oriented behavior

o excessive involvement in pleasurable activities

Associative features of Bipolar and Related Disorders:

o Prevalence: 1% of population

o women: men = equitable

o Onset: late teens or early 20s

A mention about mood dysfunction and suicide

o 10th leading cause of death; 45,000 deaths per year

▪ perhaps underestimation

o suicide attempts (25): suicides (1)

o attempts: women (3-4x): men

o successful: men (4x): women

o 90% likely have a type of psychological disorder

▪ 50-60% may be major depressive & bipolar disorders

▪ ↑ severity of depression → ↑ chance of suicide

o difficult to predict (e.g. hopelessness)

o tips to prevent

▪ suicide talk - take seriously and ask if they are contemplating

▪ provide empathy & support

▪ identify & clarify the crucial problem

▪ do not promise to keep the person's suicidal ideations a secrete

▪ in acute situation, do not leave the suicidal person alone

▪ encourage professional consultation (e.g. 24-hour hotline)

▪ research studies find that suicide survivors regret their attempt

Etiology of Depressive and Bipolar Disorders

1. Genetic vulnerability

2. Neurochemical and neuroanatomical factors

3. Cognitive factors

4. Interpersonal roots

5. Stress

1. Genetic vulnerability of Depressive and Bipolar Disorders

▪ Large ↑ concordance rate for MZ twins

• 65-80% of variance for bipolar disorder

• 40% of variance for bipolar disorder

▪ Predisposition not determination

▪ Actual manifestation may be different among family members

2. Neurochemical and neuroanatomical factors of Depressive and Bipolar Disorders

▪ NE & 5-HT (but other monoamine neurotransmitters have been implicated as well)

▪ ↓ volume of hippocampus/↓ neurogenesis assoc. with depression

• Stress → ↑ HPA(C) activity → ↓ neurogenesis in hippocampus? → ↓ hippocampal volume?

▪ Hyper-reactivity of the amygdala

▪ Hypo-reactivity of the reward system

▪ Correlation or causal?

3. Cognitive factors of Depressive and Bipolar Disorders

▪ Learned helplessness

▪ Reformulated learned helplessness theory - pessimistic explanatory style (esp. internal, global)

▪ Rumination

• May explain differences in gender rates

• May also contribute to generalized anxiety disorder, eating disorders, substance-abuse disorders

▪ Hindsight bias

▪ Correlation or causal? Can it be both?

4. Interpersonal roots

▪ Poor social skills → punishing social experiences → worse mood/depression

5. Stress

▪ Can trigger onset of depression and bipolar

▪ With more occurrences, stress plays less of a role

Schizophrenia Spectrum and Other Psychotic Disorder's Diagnostic criteria:

o (needs 2 or more of the following )

▪ delusions

• Thoughts broadcast or outside thoughts inserted into them

• Persecution (80%)

• Grandeur

▪ hallucinations

• Auditory (70%)

Positive symptoms

▪ disorganized speech/thought

• "loosening of associations" or even "word salad"

▪ grossly disorganized or catatonic behavior

▪ negative symptoms

• affective flattening (lack of emotional response to the given situation)

• alogia (lack of conversation)

• avolition (total lack of motivation)

o We no longer use subtypes (paranoid, catatonic, disorganized, undifferentiated) - why?

because only 2 of the subcategories were being used and the rest were not

Associative Features of Schizophrenia Spectrum and Other Psychotic Disorders

• Onset:

o Males: mid-20s

o Females: later 20s/early 30s, possibly also peri-menopausal age

o Earlier onset → worse prognosis and ↑ risk of suicide or early death (e.g. variety of physical diseases)

• Lifetime prevalence: 1% of US population

Neural Developmental Disorder's Diagnostic criteria:

example: Autism Spectrum Disorder

• Note: Autism and Asperger's Syndrome are both under the same umbrella

• Conditions with onset in developmental period

• Diagnostic criteria:

o Social communication and interaction deficits in multiple contexts

o Repetitive/restrictive behaviors and/or interests

Associative Features Neural Developmental Disorders

o 30-40% may not develop speech; others may have unusual characteristics of speech (e.g. echolalia (word repetition))

o possible extreme reactions to relatively minor changes in environment

o 1/2 have sub-normal IQ scores

o Onset: symptoms generally appear between 15-18 mos.

o Diagnosis usually at a young age (e.g. before age 2-3)

o Prevalence: 1.5%

o 80% of cases are males; females may have more severe impairments

o Outcomes:

▪ 20% good (high level of independence)

▪ 31% fair (some independence but support/supervision still necessary)

▪ 48% poor (residential supervision or hospital care needed)

▪ Increasing #s are entering college and workforce

Etiology of Neural Developmental Disorders

o Genetic

o Brain abnormality

▪ e.g. brain enlargement by age 2 yrs. (overgrowth in various areas of cortex), beginning possibly prenatally

o Study suggesting mercury involvement has been deemed fraudulent

Associative features of Personality Disorders

Personality Disorders:

• enduring maladaptive inner experience and behaviors

• milder than the acute (non-personality) disorders but persistent

o Onset: often first noticed during adolescence and early adulthood

o Lifetime prevalence: 10%

o Associated with decreased life expectancy (18-19 years)

Three categories of Personality Disorders

o Anxious/fearful

o Odd/eccentric

o Dramatic/impulsive

Antisocial Personality Disorder

o Reject widely accepted social norms/exploit others

o Males > females

o Rarely experience genuine affection for others

o May be charismatic

Borderline Personality Disorder

o Instability in social relationships, self-image and emotions (poor control over emotions)

o Females > males

o Fears of abandonment

o Black and white thinking

o alternate between idealizing and devaluing people

o ↑ risk of self-injurious behavior and suicide

Narcissistic Personality Disorder

o Grandiose sense of self, sense of entitlement, excessive need for attention/admiration

o Extremely vulnerable self-esteem

Etiology of Personality Disorder

o genetic and environmental factors (e.g. like other disorders)

o e.g. APD - dysfunctional family, erratic discipline, parenting neglect, parenting model of exploitive behavior. BPD - early trauma

Anorexia Nervosa

o Diagnostic criteria:

▪ Restriction of energy intake resulting in less than minimally normal weight

▪ Intense fear of gaining weight/getting fat

▪ Disturbed body image

▪ Can be restricting-type or binge-eating/purging type

o Associative features:

▪ Usually do not realize there is a problem

▪ Co-morbidity is common (e.g. depression, anxiety)

▪ Medical problems may arise: e.g. amenorrhea, GI issues, too low blood pressure, osteoporosis, metabolic disturbances

▪ Sudden death due to cardiac arrest is possible

▪ 10-fold elevation in premature death

▪ 90-95% are females

▪ Onset: 15-19 yrs.

▪ Prevalence: 1%

Bulimia Nervosa

o Diagnostic criteria:

▪ Recurrent binge eating with sense of lack of control, also fear gaining weight

▪ Recurrent inappropriate compensatory behaviors

o Associative features:

▪ vomiting only decreases caloric intake by less than 50%; laxatives and diuretics have minimal impact

▪ normal weight common

▪ Medical problems: cardiac arrhythmias, dental problems, metabolic issues and GI issues

▪ More likely to recognize the pathology

▪ Correlated with ↑ risk of death (though not as great as with AN)

▪ 90-95% are females

▪ Onset: 15-21 yrs.

▪ Prevalence: 1.5%

Binge-Eating Disorder

o Diagnostic criteria:

▪ Eating a larger than normal amount of food in a discrete period of time.

▪ Sense of lack of control over eating

▪ Often associated with 3 or more of the following:

• eating more rapidly than normal

• eating until uncomfortably full

• eating large amounts when not physically hungry

• eating alone b/c of embarrassment over how much one is eating

• feeling disgusted with self, depressed or guilty afterwards

o Associative features

▪ frequently overweight

▪ stress can be a trigger

▪ 60% are females

▪ Prevalence: 3.5%

Etiology of Feeding and Eating Disorders

o Genetic

▪ Some predisposition, particularly for AN (but not as much research data available)

o Personality

▪ Anxiety, negative emotionality, neuroticism

o Emotion regulation

▪ Perfectionism (esp for AN)

o Cultural

▪ Western ideal of thinness equating to attractiveness

▪ Roman vomitoriums!

o Role of Family

▪ Endorsing western ideals of thinness

▪ Modeling of maladaptive eating behaviors

▪ (peers can influence as well)

▪ early abuse (sexual, physical) → ↑ risk of eating disorder

o Cognitive factors

▪ rigid, all-or-none thinking

▪ maladaptive beliefs

▪ correlation or cause?

Other considerations:

• Early-life childhood stress (vs. during adolescence or adulthood) in adult disordersincreasingly implicated

o May modify the HPAC axis

o But...avoiding the victim mentality can be beneficial to the individual, e.g. Not blaming your parents for everything in your life. You are now an adult, you can choose...

• genetic overlap among major disorders

o Researchers have wondered for many years whether there was a "common thread" running down several different disorders...

o Schizophrenia and bipolar disorder genetic overlap = high

o Schizophrenia and depression genetic overlap = moderate

o Schizophrenia and bipolar disorder genetic overlap = moderate

o Schizophrenia and autism genetic overlap = low