Psychopathology Midterm 2

Somatic symptom disorder

Have something but you think its a lot worse than it is

Diagnosis for somatic symptom disorder (2)

1. Somatic symptoms

2. Excessive thoughts / feelings related to symptoms

Treatment for somatic symptom disorder (2)

Used to use psychoanalysis

CBT shown little effect

Illness anxiety disorder

Don't have something but think you have something or will develop something serious

Diagnosis of illness anxiety disorder (5)

• Excessive worry

• Minimal somatic symptoms

• High health anxiety

• Maladaptive health behaviours

• Duration of at least 6 months

Functional neurological symptom disorder

Presenting that you have a problem that you don't

Possible characteristics of functional neurological symptom disorder (5)

• Functional seizures

• Functional sensory symptoms

• Paralysis

• Functional movement disorders

• Functional speech disorders

Diagnosis of functional neurological symptom disorder (2)

• one or more symptoms of altered voluntary motor or sensory function

• Evidence of incompatibility between symptoms and recognized medical condition

Functional neurological symptom diagnosis according to Freud

Person has conflict that are repressed to a point where it manifests as physical symptoms

Obsessive compulsive disorder

Cycle of unwanted thoughts and repetitive behaviours

Obsessions

Intrusive, persistent thoughts that trigger anxiety, can't control them, aware they're irrational

4 common obsessions

• Cleaning / contamination

• Symmetry/ order

• Forbidden thoughts

• Hoarding 

Compulsions

Repetitive behaviour in response to an obsession, try to reduce a feared outcome, relief it is only temporary

Howie Mandel and OCD

Cleaning / contamination obsession, also suffers from anxiety and depression

Causes of OCD (3)

Genetics , learning, unconscious

Treatments for OCD (3)

• SSRIs - good but relapse when stopped

• Exposure and ritual prevention - exposed to feared thoughts and rituals are prevented

• CBT - focus on importance and control, and overestimation of threat

Factitious disorder

Act as if they're sick when they're not, usually for sick role or reassurance

Body dysmorphic disorder

Obsessive focus on perceived flaws in one's appearance

Diagnosis of body dysmorphic disorder (2)

• preoccupations with perceived flaws in physical appearance

• Performs acts in response to concerns

Treatment of BDD (2)

• most is plastic surgery

• Limited evidence for psychological help or SSRIs

Hoarding disorder (3 characteristics)

Excessive acquisition of things, difficulty discarding anything, live in excessive clutter

Treatment of hoarding disorder 

CBT seems promising, although limited info available on any treatment due to ppl believing they do not have a problem

Trichotillomania

The urge to pull out ones own hair from anywhere on the body

Excoriation

Repetitive and compulsive picking of the skin leading to tissue damage

Diagnosis of trichotillomania (2)

• must engage in repetitive pulling hair our behaviour leading to noticeable hair loss

• Must have made repeated attempts to stop

Diagnosis of excoriation (2)

• causes visible skin lesions from picking

• Make repeated attempts to stop 

possible treatments of trichotillomania and excoriation (2)

• Habit reversal training

• Taught to be more aware of behaviour

Disease conviction 

Difficult to shake belief that you have a disease that you dont, core feature of illness anxiety disorder 

Psychological factors affecting medical condition definition

Somatic condition where psychological characteristic affects diagnosed medical condition (such as asthma being exacerbated by anxiety)

malingering

Deliberate faking of a physical psychological disorder motivated by gains

Facticious disorder imposed on another

When one makes someone deliberately sick to get attention or pity

Thought action fusion 

In OCD, the thought is as bad as the action, or that the thought can cause the outcome 

Post traumatic stress disorder 

A reaction to the traumatic event that leads to symptoms such as reexperiencing event or having mood changes or avoidance behaviour  

Acute stress disorder

Similar to PTSD but with symptoms that occur immediately after the trauma and last for a brief period

Adjustment disorders

The development of emotional or behavioural symptoms in response to an identifiable stressor

Reactive attachment disorder

Disorder diagnosed in children that stems from lack of caregiving

Characterized by inhibited social and emotional responsiveness

Disinhibited social engagement disorder

Childhood disorder following early social neglect from caregivers

Characterized by overly familiar behaviours with strangers

Prolonged grief disorder

Persistent and pervasive grief response that continues to cause significant distress and impairment long after the death of a close individual

Occupations with more PTSD risk (2)

• first responders

• Military members

Dissociation in PTSD

Feeling detached from one’s body or surroundings during the trauma

Narrative exposure therapy 

Working with the patient to eventually tell their story where the PTSD stemmed from 

PTSD reexperienced symptoms

• intrusive thoughts

• Nightmares

• Flashbacks

• Emotional distress

PTSD avoidance symptoms

• avoidance of reminders

• Avoiding thoughts and feelings

PCL-5 scores

Whether an individual can further be treated for PTSD, a score of 31 or higher suggests they should

EDMR 

Eye movement desensitization and reprocessing, recalling traumatic memories where eye movement is trying to reduce the emotional charge associated with those memories 

Diagnosis of acute stress disorder

Symptoms of PTSD with a duration of 3 days-1month after event

Diagnosis of adjustment disorder (2)

• exposure to a stressor

• Development of emotional or behaviour symptoms

Treatment of adjustment disorder (4)

• psychotherapy - CBT, supportive counseling or problem solving therapy

• Psychoeducation - educating ppl about their reactions and coping mechanisms

• Stress management techniques

• Medication - can be used for co-occurring symptoms like anxiety or depression 

Diagnosis of reactive attachment disorders (3)

• history of severe neglect of caregivers

• Child displays pattern of: minimal social/emotional responsiveness, limited positive affect, emotions like sadness and irritability 

• Behaviours observed before age 5 and persist for at least a year

Treatment of reactive attachment disorder

• attachment based therapy

• Parent or caregiver training

• Environmental intervention

• Psychosocial support

Diagnosis of disinhibited social engagement disorder (4)

• shows pattern of behaviour of reduced reticence to unfamiliar behaviour and overly familiar behaviour 

• Behaviour initiated in early childhood 

• Behaviour is associated with severe neglect or inconsistent care

• Persist for at least 6 months

Treatment of disinhibited social engagement disorder

Attachment and relational therapies

Environmental stabilization

Parental training/education

Long term support

Diagnosis of prolonged grief disorder (4)

• intense yearning for deceased person

• Preoccupation of thoughts of person 

• For at least a year

• At least 3 symptoms such as emotional numbness, marked sense of disbelief, intense emotional pain, difficulty reintegrating 

Difference between prolonged grief and major depression

Prolonged grief - intense longing of deceased involving phases of emotional reactions centered on attachment

Major depression - persistent low mood/interest, not necessarily tied to a specific loss or attachment

Treatment of prolonged grief (5)

• specialized grief therapy

• Imaginal revisiting

• Narrative therapy

• Encouraging ongoing bonds

• Goal creating

Dissociative identity disorder

The presence of at least two personality states/alters in one person

Multiple identities

Distinct personalities each with its own behaviours, memories and ways of perceiving the world

Trajectory of DID

• onset - symptoms in childhood/adolescents, often following traumatic events

• Progression - can remain stable or fluctuate in intensity

• Diagnosis - often diagnosed in adulthood when symptoms become severe or they seek treatment with comorbid issues

Depersonalization -derealization disorder 

Derealization (feeling of unreality or emotional connnection or distorted perception) and depersonalization (detachment from oneself or cognitive disengagement etc.)

Common causes or triggers of depersonalization-derealization(5)

• severe stress

• Panic attacks

• Substance use

• Mental health conditions

• Medical issues

Dissociative amnesia

Inability to recall important personal info that can arrive after a traumatic event

Types of dissociative amnesia

• selective amnesia

• Generalized amnesia

Selective amnesia 

Person remembers some but not all events from around traumatic events

Generalized amnesia

Individual forgets entire life history including identity

dissociative fugue

Dissociative amnesia where memory loss is around a specific incident like an unexpected trip

• may find themselves in a new place unable to remember how they got there

• Usually to leave an intolerable situation

Flashback

When memories occur very suddenly and the survivor finds themselves relieving the event

Dissociative trance disorder

Altered state of consciousness where the person believes that they’re possessed by spirits

Autohypnotic model

Ppl who are suggestible may be able to use dissociation as a defence against extreme trauma 8

Bulimia nervosa 

Episodes of binge eating followed by compensatory behaviours to prevent weight gain 

Diagnosis of bulimia (3)

• recurrent episodes of binge eating

• Compensatory behaviours such as induced vomiting, laxatives, excessive exercise

• Occurs at least once a week for 3 months

Possible health risks of bulimia (6)

• electrolyte imbalances

• Dental erosion and cavities

• Severe dehydration 

• Gastrointestinal problems 

• Sore throat, voice changes, swollen salivary glands

• Menstrual irregularities

Anorexia nervosa

An intense fear of gaining weight while having a distorted perception of body size

William Gull

Coined anorexia nervosa, treated ppl by carefully refeeding them with medical supervision

Subtypes of anorexia

Restricting type - effort made to limit quantity of food consumed

Binge eating/purging type - commit behaviours to rid the body of consumed food

Common risks of anorexia nervosa (6)

• nutritional deficiencies

• Heart problems

• Bone loss

• Hormonal changes

• Brittle hair/nails

• Possibly life threatening with extreme thinness/weakness

Diagnosis of anorexia (4)

• restricted food intake leading to low body weight 

• Intense fear of gaining weight even though currently underweight

• Distorted body image

• lack of recognition of seriousness of current body weight 

Binge eating disorder

Recurrent binge episodes occurring at least once a week for 3 weeks

Has no compensatory behaviours

Binge eating episodes are associated with 3 of the following 5:

• eating faster than normal

• Eating until uncomfortably full

• Eating large amounts when not hungry

• Eating alone out of embarrasement

• Feeling disgusted/guily of oneself

Health risks of binge eating disorder (3)

• obesity

• Hypertension

• Cardiovascular disease

Suicide prevalence in eating disorders vs standard population

Bulimia is highest suicide rate then anorexia nervosa then non specified eating disorder

What activities are eating disorder prevalence elevated in?

Activities that have an emphasis on thinness, such as dancers, gymnasts or figure skaters

Effects of exercise and activity anorexia (2)

• excessive physical activity can cause loss of appetite

• Some ppl with excessive activity can reduce the positive incentive value of eating

Psychological factors of eating disorders (5)

• Diminished sense of personal control

• Low self esteem

• Perception of being overweight

• Perfectionism

• Mood intolerance 

Emotional eating

Way to suppress or soothe negative emotions

Example triggers for emotional eating

• relationship conflicts

• Work or other stressors

• Fatigue

• Financial pressures

• Health problems

How media increases weight discrimination (2)

• perpetuates weight based stereotypes

• Often depicts overweight in a negative light 

Target of treatment for eating disorders (6)

• weight restoration

• Arresting distorted body image

• Reducing distorted eating behaviours

• Treating comorbid eating disorders

• Improving emotional regulation and coping skills

• Establishing healthy relationships and social functioning

Drug treatments for eating disorders (2) and drug conclusion

• Prozac is good but doesnt prevent relapse

• SSRIs good for bulimia

Medications are most helpful when used together with psychological treatments

Maudsley model of family therapy

10-20 sessions over 6-12 months, best approach for adolescents, parents are used as a support team focusing on healthier relationships

phases of Maudsley model of family therapy

• phase 1 - weight restoration

• Phase 2 - returning control of eating to child while making sure progress is maintained

• Phase 3 - establishing healthy identity where child develops sense of identity and reintegrates normal family relationships

Possible treatment for bulimia (5)

• CBT-E - alter dysfunctional thoughts/attitudes

• CBT - change eating habits 

• IPT - improve interpersonal functioning

• Behaviour therapy - change eating habits

• Family therapy 

Treatment of binge eating disorder (3)

• some antidepressants

• Appetite suppressants

• Anticonvulsant medications 

Body mass index

Mesure of a persons weight relative to height

BMI of obesity vs overweight

Obesity - BMI above 30

Overweight - BMI between 25-29.5

Medical issues of obesity (7)

• high cholesterol

• Increased hypertension

• Increased probability of heart disease

• Increased arthritis

• Increased probability of diabetes

• Increased risk of cancer

• Reduced life expectancy of 5-20years

prevalence of eating disorders (2)

• more prevalent in ethnic minorities except asians 

• Mor prevalent in men than women 

Anhedonia

not able to feel pleasure

Diagnosis of major depressive disorder (need at least one of the first two)

• depressed mood nearly every day

• Diminished interest in almost all activities

• Significant weight change

• Psychomotor agitation or retardation

• Fatigue/loss energy

• Feelings of worthlessness

• Diminished ability to think/concentrate

• Recurrent thoughts of death/suicide ideation

MDD with anxious 

Person with MDD experiences anxiety symptoms such as feeling tense/restless or difficulty concentrating DUE to worry 

MDD with mixed features

Depressive symptoms are present with some symptoms of mania/hypomania