Psychopathology Test 2

Gender Dysphoria

The incongruence between a person’s assigned (natal) gender and their subjective experience of gender, causing distress

• 3x more common in natal males than females

When does gender dysphoria typically begin?

Childhood

Many people with gender dysphoria in childhood do not have it later in life

Many report being ______ relative to gender identity

Heterosexual

DSM-5 Criteria for children

Children must have 6 out of 8 symptoms for at least 6 months, causing significant distress often caused by other people and their responses

DSM-5 Criteria for adolescents and adults

Must have 6/8 symptoms persistent for at least 6 months, causing significant distress often caused by other people and their response. uncomfortable living as natal gender in adulthood

Prevalence of gender dysphoria

3 times more common in natal males than natal females.

Brain differences

MTF transsexuals has the typical female number of neurons in the bed nucleus of the stria terminalis

FTM transexuals had the typical male number

Neuron in the bed nucleus of the stria terminalis

What neuron was the focus of a study of brain differences in transexuals

Testosterone

Studies have found boys are more likely than girls to engage in rough-and-tumble play and have higher activity level

• Natal boys with gender dysphoria do not have as high as an activity level

• Natal girls with gender dysphoria more likely to have a high activity level and engage in rough-and-tumble play

Facial photograph study

College students more likely to rate boys with gender dysphoria as “cute, pretty etc.” than the boys without

Treatment for Gender Dysphoria (Psychological)

• Help them understand themselves and their options

• Goals for living publicly as the opposite gender

  • Address potential reactions from others

• Info about medical and surgical options

  • Treatment for other needs (depression, anxiety)and provide support for social transition, including coping strategies for navigating societal challenges.

• Help understand whether they want to live as the opposite gender (If they feel more like self)

Treatment for Gender Dysphoria (Social)

• Family therapy

  • Communication and education for family members to better understand and support

• Group therapy

  • Meet other people going through the same thing

  • Discuss relationship issues/problems that arise from living as the opposite gender

Treatment for Gender Dysphoria (Neurological)

• Offered last but in conjunction with other therapies

• Hormone therapy

  • Women: lower voice, stop menstruation, begin facial hair growth

  • Men: Enlarge breasts, redistribute fat to hips and bottom

• Sex reassignment surgery

  • Alter breasts and genitals

  • Facial surgery (less common)

  • More effective for men-women (Difficult to create satisfactory stimulation)

  • Up to 10% of people regret it

Paraphilic Disorders

Intense and persistent sexual interest in things that are different from normal sexual stimulation or normal physically mature consenting human partners leading to distress or impaired functioning.

Distress in paraphilic disorders ____________

Does not need to be on the individual, it can be distressing to other people

Diagnosing paraphilic disorders

Must be persistent for at least 6 months

Must cause distress

Must impair functioning, but does not need to be overall

Almost exclusively men

Exhibitionistic Disorder

Arousal from exposing genitals to a nonconsenting person.

Frotteuristic Disorder

Arousal form non-violent physical contact with a nonconsenting person (touching someone's genitals on the bus)

Pedophilic Disorder

Arousal from sexual activity with a prepubescent child.

Sexual Masochism Disorder

Arousal from the act of being humiliated or made to suffer.

Sexual Sadism Disorder

Arousal from giving psychological/physical pain -> causing someone else to suffer

• Arousal/actions cause distress

• Nonconsenting persons has been subjected to the acts

Fetishistic Disorder

Arousal from the use of nonliving objects (like shoes) or non-genital body parts (like feet) used to achieve/maintain sexual arousal with a partner or alone

Transvestic disorder

Arousal from dressing in clothes for the opposite gender and experiencing distress based on the enjoyment of it

Difference between gender dysphoria and transvestic disorder

Individuals with transvestic disorders do it for sexual arousal, their gender identity is their natal gender

Sexual Dysfunction

Characterized by problems in the sexual response cycle, including lack of desire, arousal difficulties or performance

Stages of the sexual response cycle

1. Excitement: stimulation leading to sexual arousal and bodily changes

2. Plateau: bodily changes that occur become more intense and then level off

3. Orgasm: involuntary contractions of genitals, ejaculation for men

4. Resolution: Period of relaxation, release from tension, for men: refractory period (another orgasm is not possible)

Sexual desire/arousal disorders

Female sexual interest/arousal disorder

Male hypoactive sexual desire disorder

Erectile disorder

Orgasmic disorders

Female orgasmic disorder

Delayed ejaculation

Premature ejaculation

Sexual pain disorder

Genito-pelvic pain/penetration disorder

Female sexual interest/arousal disorder

Persistent/recurrent lack of or reduced sexual interest or arousal

Could include no interest in sexual activity, no sexual thoughts/fantasies, no pleasure from sexual activity or a lack of physical arousal

Male hypoactive sexual desire disorder

Persistent/recurrent lack of erotic/sexual fantasies, an absence of desire for sexual activity

Can be generalized (all situations) or situational (one person)

Erectile disorder

Arousal disorder where there is difficulty obtaining/maintaining an erection until the end of sexual activity or a decrease in erectile rigidity

Female orgasmic disorder

Woman’s normal sexual excitement does not lead to orgasms, or they are less intense

Must be persistent/recurrent and not due to a lack of stimulation

Can be generalized (all situations) or situational (one person)

Delayed ejaculation

Delayed or absence of ejaculation

involves ejaculating with a partner (masturbation is normal)

Typically involves problems ejaculating during vaginal intercourse

Premature ejaculation

Ejaculation occurs within 1 minute of penetration and before wishing for it to happen

Don’t feel a sense of control, becomes apprehensive about future encounters

Genito-pelvic pain/penetration disorder

Only women

Pain, fear, anxiety about vaginal penetration or intercouse

Vaginismus may occur

Vaginismus

Recurrent/persistent involuntary spasms of the muscles of the outer 1/3 of the vagina that interfere with intercourse

Tendency in treating sexual dysfunctions

Tends to use medication like Viagra, but this would not help if the problem is psychological

Psychological treatment for sexual dysfunctions

• Educating patients about human sex response

• Develop strategies to counter negative thoughts, beliefs and attitudes that interfere

• Focus on increasing one’s view of self

• Teaching couples better communication, intimacy and relationship skills

Intellectual Disability

A neurodevelopmental disorder characterized by cognitive abilities significantly below normal, with impaired functioning in daily life.

• Deficits begun before the age of 18 and typically IQ of 70 or less

4 levels of intellectual disability

1. Mild (most common)

2. Moderate 

3. Severe

4. Profound (least common)

Teratogens

Harmful substances and/or stimuli that affect fetal development and can increase the risk of intellectual disability

• Ex) Drugs, cigarettes, medications etc

Fetal Alcohol Syndrome

A condition in a child resulting from exposure to environmental toxins during pregnancy causing a smaller head due to smaller frontal lobes leading to deficits in planning, carrying out tasks and impulse control, along with other physical differences in the face

Environmental toxins

Mercury, lead, pesticides, alcohol, viruses etc.

Exposure during the 1st trimester can interfere with fetus’s central nervous system development

Genetic abnormalities

Down syndrome, fragile X syndrome, Rett’s disorder

Boys often more affected since girls have another X chromosome to help buffer negative effects

Stereotyped behavior

• Repetitive behaviors that don’t serve a function

  • Ex) Body rocking, hand flapping, jumping, finger fluttering etc.

Self-injurious behaviors

• Actions that cause harm to the individual

  • Ex) Hitting one’s head on the wall, hitting self, biting self, skin picking etc.

Treating intellectual disabilities

Prevention: avoiding teratogens at all costs, tests for PKU, banning lead

Help people function as independently as possible: Improving skills, teaching sign language, IEPs, inclusion

Autism Spectrum Disorder

Neurodevelopmental disorder characterized by deficits in communication and social interaction skills as well as stereotyped behaviors and narrow interests

Qualities of children with ASD

More/less reactive to sensory stimuli

Engage in repetitive play/behaviors: routines are important

Display stereotyped behaviors

Neurological factors of ASD

Connections and communication among brain areas are abnormal -> Frontal lobes do not communicate effectively with other areas of the brain

The Shapes Video

3 shapes moving around the screen, moving in and around each other, interacting with each other

• Healthy controls (No ASD) see the shapes as fighting each other: Anthropomorphizing

• People with ASD see them as bumping into each other: No emotions conferred

What causes the differences in the groups of the shapes video

Healthy controls process the video using the fusiform gyrus: responsible for processing emotion in faces, and why we anthropomorphize inanimate objects

People with ASD process the video using the inferior temporal gyrus: responsible for processing objects

• Less activity in the fusiform gyrus, so there is no emotional explanation

Brain region responsible for processing emotion in faces

fusiform gyrus

Brain region responsible for processing objects

inferior temporal gyrus

Cognitive deficits in ASD

Difficulty shifting attention, difficulty with mental flexibility, leading to difficulties transitioning from one activity to another and the tendency to focus on details rather than the big picture

Theory of mind

Theory about other people’s mental states (beliefs, desires, feelings) that we use to predict how others will feel/act in different situation

• People with ASD have a hard time viewing the world from someone else’s perspective

Communication deficits in ASD

• Difficulty recognizing faces and emotions

• Difficulty recognizing facial and vocal expressions

• Trouble with back-and-forth conversations

• Lack of interest in other people

• Do not look at people’s eyes, focus on the mouth instead

Early childhood signs of ASD

• Children do not respond to parents voices

• Do not respond to their name

• Do not make eye contact

Treating ASD

No cure, so treatment focuses on improving social/communication skills and behaviors

• Best outcomes if treatment begins as early as possible

• Treatments are individualized to best suit the needs of the individual

Specific Learning Disorder

Well below average skills interfering with school/work performance in:

• Reading - dyslexia -> Difficulty with accuracy, speed or comprehension of reading

• Writing -> Poor spelling, significant grammatical or punctuation errors, or problems writing clearly and keeping writing organized

• Math -> difficulty understanding the relationships between numbers, memorizing math facts, accurately and fluently making calculations and reasoning effectively about math problems

Based on age, general intelligence, cultural group, gender, education level

Which specific learning disorder has been studied the most?

Dyslexia

Neurological factor of dyslexia

Brain systems involved in auditory processing do not function as well as they should, converting visual input to sounds

Conduct Disorder

Childhood psychological disorder characterized by violation of basic human rights or others or of social norms that are appropriate to the child’s age

4 categories of conduct disorder

1. Aggression to people or animals

2. Destruction of property

3. Deceitfulness or theft

4. Serious violation of rules

DSM-5 requirements for conduct disorder

• Min of 3/15 behaviors listed in the past 12 months and at least 1 in the past 6 months

• Does no require distress for diagnosis

• If the symptoms persist past the age of 18, diagnosis changes to antisocial personality disorder

Adolescent-onset type of conduct disorder

• Not likely to be violent towards people -> Minor theft, public intoxication, property offences

• An exaggeration of normal teen behaviors

• Still maintain relationships with peers

Childhood onset type of conduct disorder (Without callous and unemotional traits)

• Not callous, show emotions and remorse

• Aggression is usually a reaction to threats

• Difficulty regulating normal emotions

• More emotional distress

• More likely to misread social cues

• More likely to act impulsively

Childhood onset type of conduct disorder (With callous and unemotional traits)

• Are callous, unemotional, do not feel guilt/remorse

• Insensitive to punishment, low levels of fear, increased aggression, do not internalize social norms or develop conscience

• Less likely to recognize sadness in others

Oppositional Defiant Disorder (ODD)

Characterized by a pattern of angry/irritable mood, argumentative/defiant behavior and vindictiveness

Confrontational: Arguing with authority figures, annoying others on purpose, refusing to comply with authority figures/adults

Disruptive behaviors of ODD

• Generally directed towards authority figures (parents, teachers etc)

• Not usually violent, and do not usually cause severe harm

• Often only in specific situations with well-known adults

• Mostly verbal

Attention-Deficit/Hyperactivity Disorder (ADHD)

Characterized by inattention, hyperactivity, and impulsivity that impairs functioning in at least two settings.

Not intentionally violating the rights of others

Why are girls likely to be underdiagnosed with ADHD?

less behavioral problems, less rambunctious behavior, more inattention, often mistaken for other disorders such as depression

Hyperactive/Impulsive type ADHD

Disruptive behaviors, accidents, rejections from peers

Inattentive type of ADHD

• Academic problems

• Issues with executive functioning -> trouble shifting/maintaining attention

Combined type of ADHD

Behaviors from the hyperactive/impulsive and inattentive type categories

Brain function in ADHD

Smaller than normal frontal lobe → issues related to executive functioning (making and following plans, maintaining attention)

• Less dopamine than healthy controls

Why is there an increase of illicit substance use in those with ADHD?

Many illicit substances increase release of dopamine, which may have an even greater effect on those with ADHD due to having less naturally occurring in the brain

Treatments for ADHD

Stimulants: Increase attention and reduce the general activity level and impulsive behavior

• Disrupts the process of dopamine, resulting in more in the synapse to help to correct the lower levels of dopamine

• Also improve functioning of impaired brain regions

Amphetamines

Treat ADHD by promoting more dopamine release in the brain to increase the overall levels

Methylphenidates

Treat ADHD by interfering with the reuptake of dopamine, leaving more in the synapse to increase overall levels