psychopathology exam 2

anxiety

a vague sense of being in danger involving terror, fear, dread, worry, or uneasiness. It is an integral part of human experience.

the two primary symptoms of psychopathology

depression and anxiety

the role of context in anxiety disorders

anxiety disorders involve anxiety that is not warranted by the current context

trait anxiety

refers to a person’s stable tendency to experience anxiety across various situations

state anxiety

a temporary (anxious) reaction to a specific situation

generalized anxiety disorder (GAD)

Disproportionate, uncontrollable, ongoing anxiety and worry about multiple events, occurring most days for six months or more. Often described as "free-floating anxiety".

major criteria for generalized anxiety disorder

Difficulty controlling the worry. Requires three or more symptoms: restlessness or edginess, irritability, fatigue, poor concentration, muscle tension, and sleep problems. Causes significant distress or impairment.

panic disorder

Recurrent, unexpected panic attacks.

major criteria for panic disorder

At least one month of continual concern/worry about having additional attacks, or at least one month of dysfunctional behavior change associated with the attacks (e.g., avoiding new experiences). Panic attacks include at least four symptoms such as palpitations, shortness of breath, trembling, chest pains, dizziness, and feeling of unreality.

specific phobia

Marked, persistent, disproportionate fear of a specific object or situation, usually lasting at least six months.

major criteria for specific phobia

Exposure provokes intense anxiety/immediate fear. The situation is avoided. Causes significant distress or impairment.

social anxiety disorder

Pronounced, disproportionate, repeated anxiety about being scrutinized in social situations. The focus is on being negatively evaluated by or offensive to others. Typically lasts six months or more.

major criteria for social anxiety disorder

The situation is avoided. Exposure to the social situation almost always produces anxiety. Causes significant distress or impairment.

obsessive compulsive disorder (OCD)

Presence of obsessions (recurrent, intrusive, unwanted thoughts, urges, or images requiring effort to stop) and/or compulsions (repetitive behaviors or mental acts). The obsessions cause intense anxiety, and the compulsions are done to prevent something or reduce distress.

major criteria for obsessive compulsive disorder

Obsessions/compulsions feel excessive or unreasonable, cause great distress, take up much time, and interfere with daily functions. Common themes for obsessions include dirt/contamination, violence/aggression, orderliness, religion, and sexuality. Compulsions often take the form of cleaning, checking items, or seeking order/balance.

obsessive compulsive related disorders (OCRDs)

These patterns are similar and closely related to OCD, characterized by obsessive-like concerns that drive individuals to repeatedly and excessively perform specific patterns of behavior greatly disrupting their lives.

major criteria for obsessive compulsive related disorders

The four patterns assigned to this group are hoarding disorder (feeling compelled to save items, resulting in clutter), trichotillomania (repeatedly pulling out hair), excoriation (repeatedly picking at skin), and body dysmorphic disorder (preoccupation with a belief in a particular defect or flaw in physical appearance).

Most common group of disorders

Anxiety disorders are the most common mental disorders in the United States

Gender differences in anxiety disorders

For generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder, women are at least twice as likely as men to experience the disorders. Transgender and nonbinary individuals are also more likely to develop generalized anxiety disorder and panic disorder than cisgender people.

Class differences in anxiety disorders

People with low incomes are more likely to experience generalized anxiety disorder (almost twice as high a rate), as well as panic disorder and social anxiety disorder.

behavioral causes of anxiety disorders

Phobic reactions are often acquired through classical conditioning. This involves associating a previously neutral stimulus with a fear response. Fears can also be learned through modeling (observation and imitation). Once acquired, the fear is maintained by avoidance of the feared object or situation. This avoidance prevents the individual from learning the object is harmless. In operant conditioning terms, this avoidance is maintained by negative reinforcement.

behavioral treatments of anxiety disorders

The major approach is exposure treatment. Systematic Desensitization: Clients learn to relax while gradually facing feared objects or situations. This involves teaching relaxation training and creating a fear hierarchy. Exposure can be in vivo (actual confrontation) or covert (imagined confrontation). Flooding: Clients are exposed intensely to feared objects or situations without gradual buildup or relaxation training, often utilizing exaggerated covert descriptions, forcing them to see the object/situation is harmless. Response Prevention: Primarily used for OCD, clients are exposed to objects or situations that trigger anxiety/obsessions but are instructed to resist performing the usual compulsive behaviors.

cognitive causes of anxiety disorders

Anxiety stems from schemas that lead to distorted or negative automatic thoughts. In GAD, these include maladaptive assumptions such as believing one must be loved by everyone or that failure is catastrophic. Misinterpretations (or cognitive distortions) include fixing on threats, over-estimating severity, under-estimating coping capacity, and valuing worry (metacognitive theory). In panic disorder, panic-prone people misinterpret normal bodily sensations as signs of a medical catastrophe.

cognitive treatments of anxiety disorders

Focused on correcting dysfunctional thought patterns. Psychoeducation: Educating clients about their disorder, such as the role of worrying in GAD or the actual causes of bodily sensations in panic disorder. Restructuring/Modifying Schemas: Therapists guide clients to modify schemas and distorted thoughts. This includes helping clients recognize the flaws in their assumptions and automatic thoughts, challenge maladaptive beliefs, and reinterpret experiences. For panic, clients learn to apply more accurate interpretations during stressful situations to short-circuit the panic sequence.

biological causes of anxiety disorders

Involves irregular functioning of brain circuits involved in fear. The autonomic nervous system (ANS) sets the features of arousal in motion (the fight-or-flight response). For GAD, the fear circuit (including the prefrontal cortex, anterior cingulate cortex, insula, and amygdala) is excessively hyperactive, and low activity of the inhibitory neurotransmitter GABA may contribute to this excessive communication. For panic disorder, the panic circuit (including the amygdala, hippocampus, locus coeruleus, etc.) is hyperactive. Irregular activity of norepinephrine and serotonin are prominent in these fear/panic circuits.

biological treatments for anxiety disorders

Benzodiazepines: Drugs such as alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium). These drugs travel to receptor sites that normally receive GABA and increase GABA's ability to bind, thus stopping neurons from firing. Antidepressants: These drugs are widely prescribed and are thought to increase the activity of neurotransmitters like serotonin and norepinephrine, helping to improve the functioning of the fear/panic circuits. Beta Blockers and Biofeedback.

stressor

an event creating a demand or threat. this includes annoying everyday hassles (like traffic), turning-point events (like marriage or college graduation), long-term problems (like poverty, discrimination, or poor health), or traumatic events (such as major accidents, assaults, or disasters).

stress response

the physiological and psychological reaction to a stressor.

trauma

an emotionally overwhelming experience. Specifically, an event in which a person is exposed to actual or threatened death, serious injury, or sexual violation.

major stress pathways

the sympathetic nervous system (SNS) and the Hypothalamic-Pituitary-Adrenal Axis (HPA)

fight-or-flight response

Arousal features are set in motion by the hypothalamus, which activates the autonomic nervous system (ANS) and the endocrine system via two main routes.

sympathetic nervous system stress pathway

a group of ANS fibers that work to quicken the heartbeat and produce other changes experienced as fear or anxiety. These nerves directly stimulate body organs (e.g., increasing heart rate) and indirectly stimulate the adrenal medulla (part of the adrenal glands). When stimulated, the adrenal medulla releases the chemicals epinephrine (adrenaline) and norepinephrine (noradrenaline), which act as hormones travelling through the bloodstream to further produce arousal.

hypothalamic-pituitary-adrenal axis stress pathway

The hypothalamus signals the pituitary gland to secrete the adrenocorticotropic hormone (ACTH), sometimes called the body’s "major stress hormone". ACTH, in turn, stimulates the adrenal cortex, which triggers the release of stress hormones called corticosteroids, including cortisol. These hormones travel to various body organs, further producing arousal reactions.

posttraumatic stress disorder (PTSD)

is diagnosed following exposure to a traumatic event (death, serious injury, or sexual violation). Symptoms must last more than a month.

major criteria for posttraumatic stress disorder

must display at least one symptom per category, unless otherwise noted. categories are intrusive re-experiencing, avoidance, negative changes in cognitions and mood, increased arousal or reactivity, and dissociative symptoms.

Intrusive Re-experiencing

Repeated, uncontrolled, distressing memories; repeated and upsetting trauma-linked dreams; dissociative reoccurring experiences such as flashbacks (reliving the event); significant upset or pronounced physiological reactions when exposed to trauma-linked cues.

Avoidance

Continually avoids trauma-linked stimuli, activities, thoughts, feelings, or conversations.

Negative Changes in Cognitions and Mood

Being unable to remember key features of the event; experiencing repeated negative emotions; feeling detached from other people; losing interest in previously enjoyable activities; having difficulty experiencing positive emotions (joy, love).

Increased Arousal or Reactivity

Displays conspicuous changes in arousal or reactivity, such as excessive alertness (hyperalertness), being easily startled, having trouble concentrating, or having sleep disturbances.

Dissociative Symptoms

If prominent, these may include feeling dazed, having memory trouble, experiencing depersonalization (body/self feels unreal), or derealization (environment feels unreal). This specific pattern is labeled PTSD with dissociative symptoms.

gender differences in posttraumatic stress disorder

Women are at least twice as likely as men to experience stress disorders. Transgender and nonbinary people are at least twice as likely as cisgender people to develop these disorders.

class differences in posttraumatic stress disorder

People with low incomes are more likely to experience stress disorders.

Trauma types that lead to posttraumatic stress disorder

Any traumatic event, but some are particularly likely triggers: victimization, combat, disasters, accidents, and illness (threat of harm or death)

risk factors for posttraumatic stress disorder

trauma severity and frequency, stress pathway reactivity, sustained arousal/stress hormones, psychological factors, poor social support, and childhood stressors.

treatments for posttraumatic stress disorder

anxiety medication/antidepressants, exposure therapy (most helpful), cognitive processing therapy, and trauma processing.

dissociation

a form of psychological separation. It occurs when one part of a person’s memory or identity becomes separated from other parts of their memory or identity. Symptoms may include feeling dazed, having trouble remembering things, or having a sense of depersonalization or derealization.

dissociative amnesia

Inability to recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting and not caused by physical factors.

major criteria for dissociative amnesia

The loss of memory interferes mostly with personal material (episodic memory), while procedural memory and abstract memory remain intact. May be localized (most common, loss of memory in a limited period), selective (some but not all events in a period forgotten), generalized (loss extends to times long before the trauma), or continuous (forgetting continues into the present). An extreme form is dissociative fugue, where the person forgets their identity and flees to a new location.

Dissociative Identity Disorder (DID)

Experiences a disrupted identity with two or more distinct personality states (subpersonalities or alternate personalities).

major criteria for dissociative identity disorder

Repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events. Each subpersonality may have a unique set of memories, behaviors, thoughts, and emotions. Switching (transition between personalities) is usually sudden and may be dramatic, often triggered by a stressful event. Subpersonalities can differ dramatically in characteristics, abilities, preferences, and even physiological responses (e.g., blood pressure, brain activity patterns).

role of trauma in dissociative disorders

generally triggered by traumatic events. Dissociative Amnesia is often triggered by combat, natural disasters, or childhood abuse. DID is thought to be motivated by traumatic childhood events, particularly abusive parenting. More than 70% of people with DID report physical and/or sexual abuse in childhood.

psychodynamic treatments of dissociate disorders

These disorders are caused by repression (the most basic ego defense mechanism) used to fight off anxiety. DA is a single episode of massive repression, while DID results from a lifetime of extreme repression. Treatment involves guiding clients to search their unconscious to bring forgotten experiences back to consciousness.

behavioral treatments for dissociative disorders

One theory suggests that people prone to DDs have rigid and narrow state-to-memory links. Each memory is tied exclusively to a specific state of arousal; when arousal changes, memory is inaccessible, leading to amnesia or different subpersonalities. Another theory suggests DDs are a form of self-hypnosis, where individuals hypnotize themselves to forget horrifying experiences. Treatment for DA often includes hypnotic therapy (hypnotherapy) to guide recall of forgotten events.

competing models in dissociative identity disorder

The debate includes the posttraumatic model (DID results from severe childhood trauma and coping/repression) and the sociocognitive model (DID is caused by social reinforcement and meaning making). An extreme view is the iatrogenic model, which suggests the disorder is unintentionally produced by practitioners through subtle suggestions, hypnosis, or rewarding dissociative symptoms.

Evolution of disorder in the US, influence of media, and DSM III inclusion on rates

The number of people diagnosed with DID increased dramatically in the 1980s and 1990s, then decreased in the twenty-first century. This dramatic change in rates suggests that the rise may be linked to intense clinical interest, media influence, and the possibility that cases were unintentionally induced by therapists.

Fallibility of memory

False memories can be created in a laboratory setting. Memory is highly fallible.

Trauma is common in dissociative individuals and remembered

Childhood sexual abuse is prevalent among DID patients. This trauma is often recalled in clear detail.

Evidence for false and/or distorted memory

Many clinicians believe that "recovered memories" (especially those surfacing during therapy) are illusions (false images) inadvertently created during therapy, particularly when special recovery techniques like hypnosis are used. Studies found that clients whose therapists raise the possibility of repressed memories are 20 to 29 times more likely to eventually experience abuse memories. Conversely, research also indicates that trauma can occur and victims have no memory of it.

mood

refers to feelings of elation or sadness. Most people's moods are understandable reactions to daily events and do not greatly affect their lives.

Core Features of Major Depressive Episode

is defined by displaying five or more symptoms of depression for a period of two or more weeks, including depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day.

major related symptoms of major depressive disorder

must include at least three or four additional symptoms: Significant weight change or appetite change, Daily insomnia or hypersomnia, Daily agitation or decreased motor activity, Daily fatigue or lethargy, Daily feelings of worthlessness or excessive guilt, Daily reduction in concentration or decisiveness, Recurrent thoughts of death, suicide planning, or attempt. In extreme cases, the episode may include psychotic symptoms (loss of contact with reality, such as delusions or hallucinations).

core features of manic episode

requires displaying an exceptionally high or irritable mood, increased activity or energy, for at least one week, for most of every day.

major related symptoms of manic episode

must include at least three additional symptoms: Inflated self-esteem or grandiosity, Decreased need for sleep, Increased talkativeness or rapidly shifting ideas, Distractibility, Heightened activity or movements, and Excessive pursuit of risky and potentially problematic activities.

hypomanic episode

is like a manic episode but less severe. The key distinction is that it results in no clear social or occupational impairment.

major depressive disorder

Unipolar depression. Requires one or more major depressive episodes. There must be no history of manic or hypomanic episode.

persistent depression disorder

Unipolar depression (major or mild). Symptoms of major or mild depression must occur for at least 2 years. During this time, symptoms are not absent for more than two months at a time. No history of mania or hypomania.

Bipolar I Disorder

Depression and Mania/Mixed. Defined by the occurrence of a full manic episode. Major depressive episodes or hypomanic episodes may precede or follow the manic episode. May include mixed features (displaying both manic and depressive symptoms within the same episode).

Bipolar II Disorder

Depression and Hypomania. Requires the presence or history of major depressive episode(s) and the presence or history of hypomanic episode(s). There is no history of a manic episode.

Cyclothymic Disorder

Less severe mood changes. Numerous periods of hypomanic symptoms and mild depressive symptoms continuing for two or more years. These symptoms are interrupted occasionally by normal moods that may last for only days or weeks.

Gender differences in Mood Disorders and possible explanations

For severe unipolar depression, women are at least twice as likely as men to have episodes. Explanations include: Artifact theory, Life stress theory, Body dissatisfaction explanation, Lack-of-control theory (Learned Helplessness), and Rumination theory.

Note: In contrast to unipolar depression, bipolar disorders are equally common in women and men.

Artifact theory

Suggests clinicians may fail to detect depression in men, who might mask symptoms behind anger.

Life Stress theory

Proposes women are subject to more stress than men, including poverty, discrimination, and a disproportionate share of responsibility for child care.

Body dissatisfaction explanation

Suggests societal pressure for thinness leads girls/women to be more dissatisfied with their bodies, increasing depression risk.

Lack-of-control theory (Learned Helplessness)

Proposes women may feel less control over their lives and are, on average, more likely to be victims of various types of victimization, which produces a sense of helplessness.

Rumination theory

Findings indicate women are more likely than men to ruminate when feeling low, making them more vulnerable to clinical depression.

biological causes of mood disorders

genetic vulnerability, Monoamine Hypothesis, and Brain Circuits

monoamine hypothesis

Strongly linked to low activity of norepinephrine and serotonin. This is likely complicated by interactions with other neurotransmitters like glutamate.

Brain Circuit Dysfunction

Dysfunction in a depression-related circuit including the prefrontal cortex, hippocampus, amygdala, and subgenual cingulate (Brodmann Area 25). Hippocampus is undersized, amygdala activity is high, and communication between structures is problematic. The HPA axis is also overly reactive to stress, causing excessive cortisol release.

biological treatments of mood disorders

Tricyclics, MAOIs (Monoamine Oxidase Inhibitors), SSRIs/SNRIs, Lithium (Bipolar), ECT (Electroconvulsive Therapy), TMS (Transcranial Magnetic Stimulation), and Ketamine-based drugs (e.g., esketamine) 

Tricyclics

Block the reuptake mechanisms of key neurons that use serotonin or norepinephrine. This allows these neurotransmitters to remain in the synapse longer and properly stimulate receiving neurons.

Monoamine Oxidase Inhibitors (MAOIs)

Slow the body's production of the enzyme monoamine oxidase (MAO), which ultimately increases the activity level of norepinephrine and serotonin throughout the brain.

SSRIs/SNRIs

Similar to tricyclics, they act on the neurotransmitter reuptake mechanisms. SSRIs selectively increase serotonin activity; SNRIs increase both serotonin and norepinephrine activity.

Lithium

A mood-stabilizing drug that is highly effective for treating and preventing manic episodes. May affect a neuron’s second messengers and increase the production of proteins that prevent cell death, improving cell health and functioning.

Electroconvulsive Therapy (ECT)

Two electrodes pass electricity through the brain to induce a seizure. A safe and effective treatment for unipolar depression, particularly for severe cases unresponsive to other methods.

Transcranial Magnetic Stimulation (TMS)

Coil sends a current into the prefrontal cortex. Appears to increase neuron activity in this often underactive structure of the depression-related circuit.

Ketamine-based drugs

Alleviates depression quickly (within hours). Works by increasing the activity of glutamate in the brain, improving connectivity in the depression-related circuit.

cognitive causes of mood disorders

negative cognitive triad and negative automatic thoughts

Negative cognitive triad

Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways. This is based on maladaptive attitudes (e.g., "I must be perfect in every way").

Negative automatic thoughts

A steady train of unpleasant, automatic thoughts (e.g., "I'm worthless") that suggest inadequacy and hopelessness.

cognitive treatments for mood disorders

Cognitive restructuring (Beck’s cognitive therapy): A four-phase approach focusing on guiding clients to recognize and change negative cognitive processes. Clients monitor, evaluate, and restructure thoughts by documenting them (often via apps) and systematically challenging the reality and logic behind them (e.g., challenging arbitrary inferences or minimization of positive events). The goal is to correct the maladaptive attitudes and style of interpretation. Third wave approaches teach clients to observe and accept negative cognitions as "mere events of the mind" rather than trying to eliminate them.

behavioral causes of mood disorders

Reduced reinforcement: A decline in the number of positive rewards (especially social rewards) leads people to perform fewer constructive behaviors, accelerating the spiral toward depression. Learned/Attributional Helplessness: People become depressed when they think they no longer have control over rewards/punishments in their lives and that they are responsible for this helpless state. The attributional version specifies that this occurs if the lack of control is attributed to an internal, global, and stable cause.

behavioral treatments for mood disorders

Behavioral Activation (Increased reinforcement): Works systematically to increase the number of constructive and rewarding activities in a client's life. This includes (1) reintroducing pleasurable activities, (2) consistently rewarding nondepressive behaviors and withholding rewards for depressive behaviors, and (3) helping clients improve their social skills.

psychodynamic causes of mood disorders

Exaggeration of normal response to loss: Clinical depression is viewed as similar to grief. Failure to accept loss causes the mourner to regress to the oral stage (total dependency). They symbolically merge their identity with the lost person and direct feelings of sadness and anger toward themselves (introjection). May also be caused by symbolic loss.

psychodynamic treatments for mood disorders

Working through the loss, anger, and dependency: Therapists encourage clients to search their unconscious through free association and interpretation of transference, dreams, and resistance. The goal is to bring the underlying issues (unconscious grief over real or imagined losses, compounded by excessive dependency) to consciousness so they can be worked through.

Most Effective Treatments for mood disorders

Cognitive-behavioral therapies, Antidepressant drugs (MAOIs, tricyclics, SSRIs, SNRIs), and interpersonal psychotherapy.

Tension between reality and perception

Eating disorders are characterized by a profound tension between the actual and perceived status of the individual. This tension specifically relates to perceptions of body size/shape, attractiveness/beauty versus imperfection/flaws, and the management of nutrition intake and the elimination or depletion of ingested calories.

the role of context in eating disorders

Cultural (and subcultural) contexts are important in the manifestation of these disorders. Western society widely equates thinness with health and beauty, leading to thinness becoming a national obsession, which contributes to the rise in these disorders.

core criteria for anorexia nervosa

The individual must display purposeful, restricted energy intake resulting in a significantly low body weight that is below that of other people of similar age and gender.

related symptoms of anorexia nervosa

An individual experiences an intense fear of or behavior preventing weight gain despite their low weight. They possess a distorted body perception, allow their self-evaluation to be inappropriately influenced by body weight or shape, or deny the serious implications of their low weight.

restricting type of anorexia nervosa

Individuals reduce their weight by strictly restricting their food intake.