PSYC 3082 Exam 2

How is it similar to other anxiety disorders with regard to criteria?

Requires exposure to an event resulting in extreme fear, helplessness, or horror

Symptoms of PTSD:

- Chronic worry
- inability to sleep
- exaggerated startle response
- hyper arousal
- hyper vigilance

Criteria of PTSD:

• Criteria A: Requires exposure to an event resulting in extreme fear, helplessness, or horror (during the event and after)
• Criteria B: Person continues to re-experience the event (e.g.: intrusive memories, nightmares, night terrors, flashbacks)
• Criteria C: Avoidance of cues that serve as reminders of the traumatic event
• Criteria D: Emotional numbing and interpersonal problems are common. Anger, depression, detachment, etc...
• Criteria E: Physiological hyperarousal

Subtypes of PTSD:

• Acute PTSD: Diagnosed 1-3 months post-trauma
• Chronic PTSD: Diagnosed after 3 months post-trauma
• Delayed onset PTSD: Onset of symptoms 6 months or more post-trauma

Treatment for PTSD:

• Cognitive-Behavior Therapies (highly effective): Prolonged Exposure, Cognitive Processing Therapy, EMDR
• Anxiety Medications
• Treatments/therapies also effect brain chemistry

Causes of PTSD:

- Intensity of the trauma and one's reaction to it (i.e., true trauma)
- Uncontrollability and unpredictability
- Extent of social support, or lack thereof post-trauma
- Direct conditioning and observational learning

Duration of symptoms is 1 to 3 months of post-trauma

Acute PTSD

Duration of post-trauma symptoms is more than 3 months

Chronic PTSD

Onset of symptoms 6 months or more post-trauma

Delayed onset PTSD

Most effective treatment/therapy for PTSD is:

effective brain chemistry

• Diagnosed immediately after trauma (0-1 month)
• Same symptoms as PTSD
• Symptoms go into remission on their own after several months
• Similar disorder to PTSD

Acute Stress Disorder

Contributing Factors to Development of PTSD:

• Intensity of trauma
• Uncontrollability and unpredictability
• Extent of social support (or lack thereof)
• Direct conditioning and observational learning

Intrusive and nonsensical thoughts, images, or urges that one tries to resist or eliminate; irrational and unwanted

Obsessions

Thoughts or actions to suppress the thoughts and provide relief

Compulsions

Anxiety disorder involving unwanted, persistent, intrusive thoughts and impulses, as well as repetitive actions intended to suppress them

Obsessive Compulsive Disorder (OCD)

Causes of OCD:

- Parallel the other anxiety disorders
- Early life experiences and learning that some thoughts are dangerous/unacceptable
- Thought-action fusion - Tendency to view the thought as similar to the action

Medical Treatment for OCD:

- Clomipramine
- Luvox
- Other SSRIs
- Psychosurgery (cingulotomy) is used in extreme cases

Pyschological Treatment for OCD:

• Cognitive-Behavior Therapy (exposure & response prevention
• Combining medication with CBT does not work as well as CBT alone

related to one's body or the perceptions of one's body or health, and there is noidentifiable medical condition causing the physical complaints

Somatization Disorder

meaning body

soma

• Strong disease conviction - convinced they have a disease (not concerned about develop
ing a disease)
• Severe anxiety (worry) focused on the possibility of having or developing a serious disease
• Medical reassurance does not help

Hypochondriasis

Cause of Hypochondrias:

• Cognitive perceptual distortions - misinterpret bodily sensations of minor illness as threatening
• Family history of illness (People in family have developed serious illness before)

Treatment for Hypochondrias:

- Challenge illness-related misinterpretations
- Provide more substantial and sensitive reassurance
- Treat anxiety (Stress management and coping strategies)

Integrative model of causes of hypochondriasis:

disorder involving extreme and long-lasting focus on multiple physical symptoms for which no medical cause is evident

Somatoform Disorder

Clinical Description for Somatization Disorder:

- Extended history of physical complains before age 30
- Concerned over the symptoms themselves, not what they might mean, as in the case with hypochondriasis
- Symptoms become the person's identity
- Numerous visits to physicians
- Substantial impairment in social or occupational functioning

Causes of Somatization Disorder:

• Familial history of illness
• Weak behavioral inhibition system

Treatment for Somatization Disorder:

- Stress management; pain management techniques
- Reduce the tendency to visit numerous medical specialists
- Assign "gatekeeper" physician
- Reduce supportive positive consequences of talk about physical symptoms
remove secondary gain (babying, staying home, sick leave, attention)

Physical malfunctioning, such as blindness or paralysis, suggesting neurological impairment but with no organic pathology to account for it. (Occurs more in females, triggered by a severe stressor such as loosing a loved one)

Conversion Disorder

Clinical Description of Conversion Disorder:

• Physical malfunctioning without any physical or organic pathology
• Malfunctioning often involves motor-sensory areas(sometimes involuntary)
• Person shows "la belle indifference" - little concern for their loss of functioning
• KEY: Unable to find physical cause

Causes of Conversion Disorder:

- Freudian psychodynamic view: unconscious represses this trauma
- Emphasis on the role of trauma, conversion, and primary/secondary gain
- Detachment from the trauma and negative reinforcement seem critical

Treatment for Conversion Disorder:

• Difficult to treat
• Attend to trauma
• Remove sources of secondary gain
• Reduce supportive consequences of talk about physical symptoms

Disorder in which as many as 100 personalities or fragments of personalities coexist within one body and mind.

Dissociative Identity Disorder

Clinical Description of Dissociative Identity Disorder:

- Involves adoption of several new identities- a different personality, name, eating habits, style of dress, sexual orientation, likes/dislikes, different gender
- Identities display unique sets of behaviors, voice, and posture
- Defining feature is dissociation of certain aspects of personality

Unique Aspects of DID:

- Alters
- Host
- Switch

Refers to the different identities or personalities in DID

Alters

The identity that seeks treatment and tries to keep identity fragments together

Host

Often instantaneous transition from one personality to another

Switch

Causes of Dissociative Identity Disorder:

• History of horrible unspeakable child abuse
• Evolves as a coping mechanism

Treatment for Dissociative Identity Disorder:

• Focus on reintegration of identities
• Aim is to identify and neutralize cues/triggers that provoke memories of trauma/dissociation

Average age of onset for Major Depression:

25 years old

Average length of Major Depressive episode if left untreated is about:

9 months

Up to _______ will experience an episode of Major Depressive Disorder.

1 in 5

About _______ of the adult population will experience Major Depressive Disorder.

5-7%

________people who experience a single episode of major depressive disorder go on to experience a recurrent episode

80%

group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression

Mood disorders

Loss of pleasure/interest in usual activities

Anhedonia

Defining Features of Major Depression:

• Must experience major depressive episode: extremely depressed mood state lasting at least two weeks
• Must have 6 of 8 additional symptoms:
o Cognitive Symptoms
• Excessive crying/feelings of wanting to cry, difficulty concentrating and forgetfulness, changes from previous functions, difficulty making decisions, emotions, thoughts of death, dying, or suicide
o Vegetative or somatic symptoms
• Eating patterns: significant increase or decrease in appetite
• Changes in sleep patterns: mainly insomnia or hyper insomnia
o Anhedonia - loss of pleasure/interest in usual activities
• Loss of energy or excessive lethargy; decreased motivation

Etiology of Depression:

• Neurobiological Influences
o Low serotonin levels
o Elevated cortisol levels
• Stressful Life Events

Relates to a perceived lack of control over negative life events; perception that one doesn't have control over these events and therefor they are depressive; leads to a depressive attributional style: internal, stable, global negative attribution

Learned Helplessness

negative outcomes are one's own fault

Internal attributions

belief or perception that future negative events will continue to be one's own fault

Stable attributions

belief that negative events will disrupt many life activities

Global attributions

Treatment for Major Depression:

• SSRIs
• Therapy

Alternations between full manic episodes and depressive episodes

Bipolar I Disorder

Defining Features of Bipolar I Disorder

• Alternations between full manic episodes and depressive episodes
• Person must experience a manic episode
o Manic Episode
• High energy levels
• Euphoric, extremely positive mood
• Racing thoughts
• Easily excited
• Pressured (rapid) speech
• Spontaneous/impulsive
• May be reckless
o HAVOC on the person's life

Alternations between major depressive episodes and hypomanic episodes; Typically able to function but causes slight problems

Bipolar II Disorder

similar to mania but less severe

Hypomania

Chronic (at least 2 years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes.

Cyclothymic Disorder

Defining features for Cyclothymic Disorder:

• Chronic low grade bipolar disorder
• Chronic, Long Lasting, Low Grade mania or hypomania with depression.
• Pattern must last for at least 2 years (1 year for children and adolescents) People should be treated for fear of developing a more severe bipolar disorder.

Mood disorder involving persistently depressed mood, with low self-esteem, with-drawl, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than two months

Dysthymia

Defining Features for Dysthymia:

• Chronic, low-grade depressed mood
• Defined by persistently depressed mood that continues for at least 2 years
• Early Onset: Before age 21 (early 20s), greater chronicity, poorer prognosis
• Late Onset: Typically in the early twenties, but AFTER 21

Most ____________ Persons are ___________, Not All __________ Persons are ___________.

Most Depressed Persons are Anxious, Not All Anxious Persons are Depressed

Sleep and Circadian Rhythms:

o Hallmark of most mood disorders
o Those who are depressed enter REM sleep much faster than those who are not.
o Those who are depressed experience less deep sleep, if any.

- Type of Cognitive Error
- Overemphasize the negative

Arbitrary Inference

- Type of Cognitive Error
- Generalize negatives to all aspects of a situation

Overgeneralization

Medication Treatments for Mood Disorders:

• Tricyclics - rarely used (very lethal); Block reuptake or norepinephrine and other neurotransmitters
• MAO Inhibitors - Block Monoamine Oxidase
• Monoamine oxidase is an enzyme that breaks down serotonin/norepinephrine
• Slightly more effective than tricyclics
• SSRIs
• Lithium - most commonly used for mania (drug of choice for bipolar disorder)

• RARE and for SEVERE depression for those who are treatment resistant
• Side effects: few and include short-term memory loss

Electroconvulsive Therapy (ECT)

Psychosocial Treatment for Mood Disorders:

•Cognitive Therapy
- Addresses cognitive errors in thinking
- Also includes behavioral components
• Interpersonal Psychotherapy
- Focuses on problematic interpersonal relationships

Eighth Leading Cause of Death in the United States

Suicide

What races participate in suicide the most?

Whites and Native Americans

Suicide rates are increasing particularly in?

Adolescents and elderly

________ are more successful at committing suicide than ___________.

Males are more successful at committing suicide than females

_________ attempt suicide more often than __________.

Females attempt suicide more often than males

50% of people with _____________ attempt suicide

Bipolar disorder

________ have been linked with suicide in adolescents

SSRIs

Factors that Increase the Risk for Suicide:

- Suicide in the Family
- Low Serotonin Levels
- A Psychological Disorder
- Alcohol Use and Abuse
- Past Suicidal Behavior
- Experiencing a Shameful/Humiliating Stressor
- Publicity About Suicide and Media Coverage

• Shared Biological Vulnerability
- Overactive neurobiological response to stress
• Exposure to Stress
- Stress activates hormones that affect neurotransmitter systems
- Stress turns on certain genes
- Stress affects circadian rhythms
- Stress activates dormant psychological vulnerabilities (i.e., negative thinking)
- Stress contributes to sense of uncontrollability
- Fosters a sense of helplessness and hopelessness
• Social and Interpersonal Relationships/Support are Moderators

Integrative Theory

Out-of-control eating episodes, or binges, followed by self-induced vomiting, excessive use of laxatives, or other attempts to purge

Bulimia Nervosa

Most common subtype of bulimia (e.g., vomiting, laxatives, enemas)

Purging subtype

Bulimia subtype (e.g., excess exercise, fasting)

Nonpurging subtype

Defining Features of Bulimia Nervosa:

• Binge Eating - hallmark of bulimia
o Binge: eating excess amounts of food at one sitting
• Eating is perceived as uncontrollable
• Compensatory behaviors
o Purging - self-induced vomiting, diuretics, laxatives, enemas, etc.
o Excessive exercise (non-purging type)
• Most are within 10% of their target body weight
o Body image isn't nearly as distorted as with anorexia

- Anorexia subtype
- Limit caloric intake via diet and fasting

Restricting subtype

- Anorexia subtype
- About 50% of anorexics; Engage in binge eating and purging like bulimia, but also severely underweight and have a distorted bodily view

Binge-eating-purging subtype

Treatment for Bulimia Nervosa:

• Antidepressants can help reduce binging and purging behavior
• Cognitive-behavior therapy (CBT) is the treatment of choice; focuses on changing eating habits and changing attitudes about weight and shape
• Interpersonal psychotherapy results in long-term gains similar to CBT

Person eats nothing beyond minimal amounts of food, so body weight sometimes drops dangerously.

Anorexia Nervosa

Treatment for Anorexia Nervosa:

• Psychological Treatment:
o Weight restoration
o Education, behavioral, and cognitive interventions
o Often Involves Family
• Nutritional counseling, out-patient CBT (preferred one)

Defining Features of Anorexia Nervosa:

• Severe Weight Loss (15% or more below expected weight)
• Intense Fear of Obesity and losing control over eating
• Show relentless pursuit of thinness, often beginning with dieting

Causes of Bulimia and Anorexia:

• Cultural imperative for thinness translates into dieting
• Standards of ideal body size change as much as clothes
• Low sense of personal control and self-confidence
• Food restriction often leads to a preoccupation with food
• In addition to sociocultural pressures, casual factors include possible biological and genetic vulnerabilities (run in families), psychological factors (low self-esteem), social anxiety (fear of rejection), and distorted body image (relatively normal weight individuals view themselves as fat and ugly).

Repetitive eating of inedible substances; Both occur more in people with developmental disabilities.

Pica

Chronic regurgitation and re-swallowing of partially digested food; Both occur more in people with developmental disabilities.

Rumination Disorder

Who typically suffers from Anorexia?

• Females and
• White
• From middle-to-upper middle class families
• Average intelligence

Psychological dissatisfaction with biological gender, or a disturbance in the sense of identity as a male or female. The primary goal is not sexual arousal but rather to live the life of the opposite gender.

Gender Identity Disorder

Clinical Overview of Gender Identity Disorder:

• Person feels trapped in the body of the wrong sex
• Assume the identity of the desired sex
o Has to do with physical identity, not sexual behavior

Treatment for Gender Identity Disorder:

• Sex Reassignment - 30% report satisfaction
• Involve realigning the persons psychological gender with their biological sex

Long-term recurring, intense sexually arousing urges, fantasies, or behavior involving the use of nonliving, unusual objects, which cause distress or impairment in life functioning.

Fetishism

Defining Features of Fetishism:

• Sexual attraction to nonliving objects
- Required to become physically aroused
• Numerous targets of fetishistic arousal, fantasy, urges, and desires

Sexual arousal with the act of cross-dressing

Transvestic Fetishism

Inflicting pain or humiliation to attain sexual gratification
• Pain not desired by other person
• May be unable to maintain an erection without causing harm to another

Sexual Sadism

Suffer pain or humiliation to attain sexual gratification

Sexual Masochism