PSYCH 270 UMICH - Unit 3 Exam

Psychophysiological (Psychosomatic) Disorders

true physical illness influenced by psychological factors

Mind and Body

same, different, & same again

- hippocrates - emotions such as anxiety can exacerbate sickness

- galen - influence of personality (e.g. melancholic) & illness

- descartes - "I think, therefore I am" (mind-body dualism, pineal gland)

- modern view - mind & body are one

Stress as a Consequence of a Stressor (Stimulus)

major life events (e.g. death of a loved one, divorce)

chronic hassles (and uplifts)

- excessive or multiple workload (e.g. "June Bug Epidemic")

Stress = Change in Major Life Experiences

transitional stress - associated with conflict across important development periods

acculturative stress - associated with conflict assimilating or maintaining one's racial or ethnic identity (confounded with low SES)

Stress = Stimulus x Appraisal

Lazarus & Folkman

step 1: primary appraisal

- do I perceive the event as: harmful? threatening? challenging?

step 2: secondary appraisal

- what coping resources do I have available?

What Determines Stress?

stimulus specificity

- different stressors - different responses (e.g. getting 100 on your exam --> joy; getting a 0 on your exam --> sadness)

individual response specificity

- unique responding style of the individual, which may be due to learning and/or biological factor (e.g. for happy-go-lucky Ed...)

- personality characteristics (e.g. optimism, hardiness, self-esteem)

- Langer & Rodin's study: personal control & mortality rates

individual x stimulus specificity

- exposure + response

How Does Stress Influence Illness?

increases in high-risk behaviors (e.g. smoking, drinking, parasuicidal behaviors, etc.)

increase in illness reporting

- college student's disease - heightened admissions to health services just before exams begin or assignments are due

changes in the immune system

- psychoneuroimmunology - examines how the immune system mediates the link between stress & illness

-- focuses on the effectiveness of lymphocyte (T cells, B cells, natural killer [NK] cells) to mount an attack on foreign substances or antigens

-- full mediation model: stress --> immune system --> physical illness

-- typically, research is based on "healthy" samples

Essential Hypertension

chronic high blood pressure without known physical cause

- differences as a function of race/ethnicity and sex

Asthma

chronic inflammatory disease of the airways in the lungs

- attacks precipitated or exacerbated by emotional and interpersonal factors (e.g. family dysfunction)

Coronary Heart Disease (CHD)

blockage in arteries (atherosclerosis) leading to heart attack or cardiac arrest

- influence of cardiovascular reactivity

- type A behavior pattern & risk for CHD (identifying the "real" danger of type A behavior)

- type A and type B behavior pattern (1970s)

Type A and Type B Behavior Pattern (1970s)

type A - aggressiveness, competitiveness, hostility, time pressure, and constant striving for achievement

type B - relaxed and not subject to time pressure

Two Type A's (1990s)

benign - competitiveness and striving for achievement

unhealthy - hostility and irritability

Tension Headaches

due to muscle contraction in neck & head

Migraine Headaches

due to possible neurological & hormonal factors

- rate is typically twice as great in women than in men

Obesity

- defined by societal/cultural norms (e.g. DSM-III considered being 20% overweight to be a hallmark of obesity)

- possible causes include genetic predisposition, decreased metabolism, greater responsiveness to food stimuli

- importance of dieting & exercising to control weight

Sleep Disorder

as many as 1 out of 4 Americans suffer from a sleep disorder

primary sleep disorders (typically for at least a month)

- insomnia - problems in initiating or maintaining sleep

- hypersomnia - excessive sleepiness

- narcolepsy - sudden irresistible episodes of sleep, "sleep attacks"

-- sleep paralysis - total loss of muscle tone (possible link with alien abductions??)

Mood Disorders

- depression & mania in mild & temporary forms are considered "normal" if not adaptive (e.g. depressive realism)

- nature and duration of episode determines diagnosis and tx

Depressive Episode

some of the key sx's include:

- feelings of hopelessness/helplessness

- anhedonia

- change in appetite, sleep, and behavior

- feelings of guilt/shame

- thoughts of suicide

Manic Episode

can last a few days to months, and end abruptly

- hypomanic episode - when less than 1 week

some key sx's include:

- elevated mood

- inflated self-esteem

- decreased sleep

- increased talkativeness, hyperactivity, and reckless behavior

Major Depressive Disorder

- w/o manic episodes

- referred to in Ancient Greek times as melancholia (black bile)

1. prevalence is about 4% in men and 6% in women

2. most common outpatient diagnosis for adults (?)

3. notable risk factors

- sex differences:

-- women are 2x more likely to be diagnosed with MDD than men

-- sex differences emerge after 15 years of age (hormones as causal factors?)

-- sex differences in coping with depression (insight focused [rumination] vs. action-focused [substance use, aggression])

- personality factors such as perfectionism

- sociocultural differences

-- sex differences between men & women are less pronounced in Amish & college students

- biological factors

Bipolar Disorder

1. involves both manic & depressive episodes

2. differs from MDD

- bipolar is less common

- bipolar appears to run in families (biological influence?)

3. bipolar type I (mania is dominant) vs. bipolar type II (depression is dominant)

Chronic Mood Disorder

at least 2 years

1. dysthymia - mild persistence of depressive sx's (again, significant sex differences are present)

2. cyclothymia - mild persistence of bipolar sx's (cycling between manic and depressive)

Mood Disorder Comorbidity

sx's of depression is highly related to anxiety (can be as high as 50% based on some studies)

Clark & Watson's (1991) Tripartite Model

- Depression --> Anhedonia (low positive affect, e.g. disinterest, low motivation)

- Common --> High Negative Affect (e.g. feelings of distress, fear, worry, negative cognitions, pessimism, low self-esteem)

- Anxiety --> Heightened Physiological Arousal (e.g. heart palpitations, trembling, shortness of breath)

Suicide

suicide is linked to depression (especially through feelings of hopelessness)

Suicide Prevalence

- 2020: 12th most common cause of death in US (3rd for adolescents [next to accidents & homicide])

- for every 8 who attempt, 1 commits suicide

Committing Suicide: Sex Differences in the US

- women are 3x more likely to attempt than men

- men are 3x more likely to complete than women

Some Common Myths (Suicide)

- people "fake" suicide attempts to get sympathy

- talking about suicide will lead to it (there is greater evidence of the benefits of talking)

Other Related Behaviors (Suicide)

- parasuicidal behavior - any risky behavior that can "easily" lead to death

- euthanasia ("good" death) - assisted suicide, typically involved in cases related to chronic illness

- non-suicidal self-injury (NSSI) - listed for further study in DSM-5

Predicting Suicide

1. antecedent is often a stressor (feelings of unbearable pain); suicide is preceded by "exit" events

2. hopelessness; lack of social support

3. need to consider danger of elevated mood/energy

4. other related factors (e.g. age, race/ethnicity)

Psychodynamic Perspective

depression is due to reactivated loss, anger turned inward

Humanistic/Existential Perspective

depression is a response to inauthenticity; fear of being alone; suicide as an inauthentic response to the absurd

failure to confront and accept the finitude of existence

Behavioral Perspective

extinction/reduction in reinforcement

social behavior is aversive to others (Coyne's social interaction model)

Cognitive Perspective

thoughts of hopelessness; negative self-schema

- Penn Optimism Project - promoting resiliency in children

Sociocultural Perspective

cultural/religious influences

- suicide in Japan: Seppuku (hara-kiri); kamikaze pilots

Biological Perspective

seasonal affective disorder (just biological?)

Personality Disorders

long standing maladaptive patterns of thought & behavior that impair functioning or emotional well-being

problems:

- categories are not reliable

- assumptions that personality traits or dispositions are stable & enduring

Eccentric or Odd Personality Disorders

paranoid personality disorder

schizotypal personality disorder

schizoid personality disorder

Paranoid Personality Disorder

1. chronic pan situational (i.e. in almost all situations) suspiciousness (e.g. "I know my friend works for the FBI and is investigating me" vs. "I know my friend can't be trusted")

2. related sx's

- chronic scanning of environment

- impairment of functioning

- view that problem resides in others

Schizotypal Personality Disorder

subclinical expression of schizophrenic-like sx's, including oddities in speech, behavior, thinking, & perception ("My dead mother is in the room" vs. "I feel as if my dead mother was in the room")

Schizoid Personality Disorder

1. restricted range of emotions & a strong preference for social isolation

2. lack capacity to experience deep emotions or form meaningful social attachments

3. compared to schizotypal, schizoid can be functional in society

Dramatic Personality Disorders

borderline personality disorder

histrionic personality disorder

narcissistic personality disorder

Borderline Personality Disorder

1. lack self-identity (get it from others)

2. both distrustful & dependent on others

- splitting - seeing others as either all good or bad

3. impulsive & often self-destructive

4. lack adequate control of intense emotion (e.g. anger)

5. commonly diagnosed PD

Histrionic Personality Disorder

1. exaggerated self-dramatization to manipulate

2. shallow relationships

3. self-absorbed

- often found in women

Narcissistic Personality Disorder

1. grandiose sense of self-importance ("god-like complex") combined with feelings of inferiority and low self-esteem

2. related sx's

- bragging of talent

- very demanding of others

- desire admiration vs. concern

Anxious Personality Disorders

avoidant personality disorder

dependent personality disorder

obsessive-compulsive personality disorder (OCPD)

Avoidant Personality Disorder

1. social withdrawal due to fear of rejection (similar to schizoid, but withdrawal is due to fears of humiliation rather than desire)

2. difficult to distinguish avoidant disorder from social phobia

Dependent Personality Disorder

1. excessive dependence on others

- unable to make their own decisions

- fear abandonment, often become prone to self-abuse (e.g. dependency often involved in domestic abuse)

2. overlap w/borderline, but less disabling

Obsessive-Compulsive Personality Disorder (OCPD)

1. excessive preoccupation with trivialities at the expense of spontaneity & effectiveness

2. often seen as "workaholics" who are not able to make decisions or meet deadlines

3. often seen after a traumatic event

Antisocial Personality Disorder

1. a predatory attitude toward people

- prevalence is about 1% in women & 4-6% in men

- antisocial behavior typically involves criminal acts

- perseveration - persistent repetition of the same thought or behavior

(strong sociocultural correlates for violent behaviors)

Major Characteristics of Antisocial Personality Disorder

1. history of illegal or social deviant behaviors before age 15 & continuing to adulthood

2. failure to meet important responsibilities (e.g. work, family relations)

3. irritability & aggression

4. disregard for truth

Antisocial Behavior & Psychopathy

psychopath - biologically caused

- more recently, the term sociopath has been used, which assumes the role of social conditions

Domestic Violence

DSM-IV used "partner abuse", DSM-5 uses "intimate partner violence" to label violence between people who are romantically involved

- women almost always the victims & men the perpetrators, especially for violent acts (e.g. homicides)

Impulse Control Disorders

1. intermittent explosive disorder - aggressive & unprovoked outbursts in which a person assaults others or destroys property

2. kleptomania - compulsive stealing

3. pyromania - fire-setting for pleasure

4. pathological gambling

5. trichotillomania - compulsive pulling of one's scalp, facial or body hair

Substance Use Disorder

background - psychoactive drugs are substances that alter psychological state

evolving nature of conceptualizing substance use problems

- addiction - body requires drug to feel good (clearest sign of severe problem)

- psychological dependence

- psychological and physical consequences

DSM-IV: Distinguished Between Substance Abuse and Substance Dependence

prior belief that dependence was always more dysfunctional than abuse

DSM-5: Spectrum of Substance Use Disorder (11 sx's)

1. from abuse to addiction

- impaired control (e.g. unable to stop, craving)

- social problems (e.g. neglecting responsibilities, criminal behavior)

- risky use (e.g. continued use despite problems, use in dangerous situations)

- physical dependence (e.g. tolerance, withdrawal w/o substance)

2. levels of severity (2-3 sx's = mild to 6-11 sx's = severe [addiction present])

Alcohol Use Disorder

alcoholism was officially recognized as a disease by the American Medical Association in 1957

alcohol (NOT THE MOST) widely used psychoactive drug in our society (caffeine is)

1. 2019 survey:

- 70% of 18+ drank in past year

- 26% of 18+ who drink engage in binge drinking

2. two windows of vulnerability

- between 12-21, peaking between 18-25

- late middle age

Binge-Drinking

more than 4 or 5 drinks at a time on at least 3 occasions during the previous two weeks (about 50% of college students typically meet this criteria)

Social Costs of Alcohol Abuse

1. economic costs related to alcohol use (around $121 billion)

- decreased work productivity

2. drinking and driving

- effect of alcohol depends on blood alcohol level

- in most states, a blood alcohol level over 0.08% is standard for legal intoxication

- blood alcohol level depends on gender, weight, & body fluid

Persona Cost of Alcohol Abuse

1. immediate effects

- a depressant that might initially act as a stimulant

** change in mood & behavior

** decreased judgment

** decreased anger control

** tension relief

2. long term effects

- psychological

** maladaptive coping

** lowered self-esteem

** decreased functioning

- physiological

** ulcers

** liver cirrhosis

Development of Alcohol Dependence

- linked to daily/binge drinking

- men are more prone than women (15% vs. 9%)

- racial/ethnic difference

** Native Americans are at greater risk for alcohol problems

- religious differences

** Catholics have higher rates of alcohol problems than Protestants

Treatment of Alcohol Dependence (extreme end of AUD)

1. detoxification

2. multimodal (e.g. individual therapy, occupational therapy, job counseling)

3. support groups: alcoholics anonymous

- regular meetings ("90 meetings in 90 days"; sponsor system & 12 steps ("once an alcoholic, always an alcoholic"); can & cannot control; higher power)

- high drop-out rate

4. relapse prevention - identifying important cues/triggers (what to avoid)

- anticipation of setbacks

5. antabuse - produces acute sensitivity to alcohol, makes person sick

Smoking (Tobacco Use Disorder)

smoking & smokers

1. smoking accounts for at least 480k deaths from cancer each year in US (30% all cancer deaths); loss of up to 10 years due to hx of smoking

2. smoking increases likelihood of using other drugs (gateway)

3. anti-smoking movement (1964)

- ban ads on radio & TV; warning labels

- from 45% (1954) to 13% (2020)

4. vaping trend among kids, teens, and young adults (CDC found 99% of all e-cigarettes contained nicotine)

Factors Associated with Nicotine Dependence

1. want to stop smoking but can't

2. paradoxical effects of nicotine - stimulant that calms

- stimulate nervous system

- calming effect

3. synergistic effects of smoking

- thin (vs. normal weight) smokers have been found to be at greater risk for mortality, but being thin alone is not linked to greater mortality

4. learning and addiction?

- behavioral view --> smoking is associated with important reinforcers