Psychopathology Final

Dissociation (Week 6)

State of feeling disconnected from one’s experience, feeling unreal or dreamlike

Results in lack of memory

Commonly occurs when person has had severe shock or threat

Dissociative Disorders (Week 6)

Characterized by

• Severe or persistent memory

• Dissociation to the point of distress and dysfunction

Depersonalization-Derealization Disorder (DDD) Per (Week 6)

Depersonalization

• Sense of being disconnected from one’s body

• Emotional state is numb, dizzy, or foreign

Depersonalization-Derealization Disorder (DDD) Re (Week 6)

Derealization

• Sense of being disconnected from reality

• Objects and people seem artificial, unfamiliar, or even dead

Risk Factors and Treatment (DDD) (Week 6)

Long-lasting threat to one’s well-being

• E.g. kidnapping, war, child abuse

Mindfulness Training

• Focuses on being present, “in the moment”

Dissociative Amnesia (Week 6)

Inability to recall important info (usually stressful) about one’s life

• Not caused by injury or drugs

Dissociative Amnesia (Localized and Generalized) (Week 6)

Loss of memory for specific time, usually just after trauma

Loss of memory for whole period(s) of one’s life

Dissociative Amnesia (Selective and Continuous) (Week 6)

Loss of memory for some but not all events during a traumatic time period

Loss of memory for events continuing into the present

Dissociative Fugue (Week 6)

Acute (immediate, severe) form of dissociative amnesia

Usually triggered by extreme stress or trauma

Involves forgetting most of life until the fugue state began

• Client often travels to new location

• Believed to be form of self-protective “hard reset”

Complete recovery usually occurs within a few weeks

Dissociative Identity Disorder (DID) (Week 6)

Occurs when person experiences repeated and severe traumas during childhood (most often severe child abuse)

Classified as a culture-bound disorder

The right answer is simple: listen to clients

• Where research will take us in 25 years

• Until we can understand DID, it’s hard to know how to treat DID

Client usually presents with

• Dissociation

• Severe, debilitating memory deficits

  • Must be far worse than normal forgetfulness

  • Must not be explainable by drug/alcohol use, traumatic brain injury, or other disability

Sub-Personalities (DID) (Week 6)

Distinct from client having felt sense of changing over time, or of wanting to be different

Memory continuity exists within each sub-personality, but not between sub-personalities

Transitions between must be involuntary

Theory (DID) (Week 6)

Theorized to be way of protecting self from distressing childhood through “cordoning off” memories of trauma into one subpersonality

Before Three Faces of Eve: 3 - 4 cases in recorded history

After Three Faces of Eve: ~1.5% of U.S. population, ~0% of population in non-English speaking countries

Culture-Bound Disorder (Week 6)

Any mental illness that occurs only in one culture, and appears to be influenced by being raised in that culture

Many of these also reflect norms that are unfair or stigmatizing against certain groups within a culture

None of these are less real because they only occur in some cultures

• Ex. Hemophilia only affects those of European descent, and rarely ever women

Examples:

• Koro: anxiety disorder specific to Malaysia that manifests as debilitating fear the genitals are withdrawing into the body and will disappear

• Amok: manic state specific to Java that involves running across long distances and attacking anyone one sees, past the point of physical exhaustion (can be deadly)

• Anorexia nervosa: fear of gaining weight specific to U.S. (and places with exposure to U.S. culture) that leads to unhealthy patterns of eating and negative health effects

Latrogenesis (Week 6)

Literally “physician-originated”

• iatro = doctor, physician

• genesis = origin, beginning

Latrogenic Illness

• Injury or sickness caused by medical treatment

Latrogenesis Common Factors (Week 6)

Side effects from drugs

• E.g. vomiting from taking ibuprofen

Re-traumatization as a result of incompetent psychiatry

• E.g. a client whose PTSD worsens after her therapist says she’s exaggerating her symptoms

Latrogenesis Worst-case for DID (Week 6)

That therapists are causing this disorder to develop by asking about it

• Would mean that

  • Clients made to develop condition that threatens quality of life

  • Some clients made to remember abuse that never occurred

  • Growing rates of DID reflect slack training for “life coaches” and other unlicensed mental health careers

  • 100s of people traumatizes by therapy itself

Yentl Syndrome (Week 6)

Comes from a movie (Yentl) about a woman who must pretend to be a man to get medical education

Principle holds that:

• The more a person’s illness resembles the symptom pattern of a cisgender man

  • The more accurate their diagnosis, the higher-quality their care

Most infamously applies to heart attacks going undiagnosed in critically ill female patients

Also applies to medical standards such as

• BMI: height-weight ratio makes no sense if person had hips and breasts

• Autism: lack of eye contact, repeated motions, infodumping, and other “classic” symptoms present more in boys than girls

• PTSD: nightmares, rage, flashbacks, all more common in men

State Dependent Learning (Week 6)

Arousal

• Amount of emotional intensity

• If too high, can prevent memory formation

Example:

• Client is abused as a child

  • Client experiences extremely intense negative emotionality

• Client experiences intense negative emotionally as an adult

  • Client is “thrown into” self who experiences abuse

Hypnosis (Week 6)

State of being disconnected from reality, open to suggestion, dream-like

Can result in loss in memory

Self-Hypnosis (Week 6)

Defensive mechanism to cope with trauma

• Example: Client says “this threat isn’t real, it’s just a dream” until self-persuades this is true

Traumatic Disorders (Week 6)

Pattern of psychopathology that develops after an experience that

• Involves threat or harm to one’s person

• Causes extreme fear

• Contains possibility of witnessing or experiencing assault or death

Traumatic Disorder Causes (Week 6)

Environmental Factors

Internal Factors

Social Support (Environmental Factors) (TD) (Week 6)

Takes one person to offer support

• Minimal Post-Traumatic symptoms

• Has a recovery

• Ex: Car Accident - people giving support to the person can prevent a traumatic experience

• When nobody acknowledges or supports a person, it can create a post-traumatic experience

  • Can cause Acute Stress Disorder

  • Post-Traumatic Stress Disorder

Intentionality (Environmental Factors) (TD) (Week 6)

The intentions of a person can affect the outcome/recovery of the person being attacked or hurt

• Higher Risk of PTSD

  • Being beaten or stabbed

  • Surviving a sexual assault

  • Mass Shooting

  • Abusive relationships

• Lower Risk of PTSD

  • Experiencing a painful medical procedure

  • Surviving a car accident

  • Natural disaster

  • Grief following a loss

Brain-Body Stress Routes (Internal Factors) (TD) (Week 6)

Variability in degree of response to stressful or emotional events

If person is predisposed to have extreme stress response to negative events

• Greater risk for trauma-related disorders

Stress Circuit (Internal Factors) (TD) (Week 6)

If person predisposed to have over-active amygdala and under-active prefrontal cortex

• Greater risk for trauma-related disorders

Coping Styles (Internal Factors) (TD) (Week 6)

Avoidance-related coping

• Trying to get away from stressor

  • Ex: watching “comfort TV”

Emotion-based coping

• Working to manage stress directly

  • Ex: going for a run to lower blood pressure

Problem-focused coping

• Trying to eliminate the stressor or its threat

  • Ex: studying for a test

Coping Style (Flexible coping) (TD) (Week 6)

Most adaptive coping style

• If you’re stressed about a relationship… problem coping might help you talk to person directly

• If you’re stressed about a medical diagnosis… emotion coping can help you accept it

• If you’re stressed about waiting for a test grade… avoidance coping will help you be patient

Traumatic Disorder Symptoms (Week 6)

Excessive arousal

Avoiding trauma-related stimuli

Intrusive thoughts about a trauma

Emotion dysregulation

Excessive arousal (TDS) (Week 6)

• Easy startle

• Lack of sleep

• Constant alertness

• Hypervigilance

Avoiding trauma-related stimuli (TDS) (Week 6)

• Severe negative emotions on encountering these stimuli

Emotion dysregulation (TDS) (Week 6)

• Nightmares

• Flashbacks

• Panic attacks

• Difficulty concentrating

Emotion dysregulation (TDS) (Week 6)

• Guilt, sadness, shame

• Fear and worry

• Lack of positive emotions

Acute Stress Disorder (TD) (Week 6)

Symptoms begin and resolve within 4 weeks of trauma

Post-Traumatic Stress Disorder (TD) (Week 6)

Symptoms being more than a month after trauma, and/or persist for more than a month

Traumatic Disorder Treatments (Week 6)

Exposure Therapy

Cognitive-Behavioral Therapy

Group Therapy

Exposure Therapy (TDT) (Week 6)

Presenting a person w/ stimulus that causes a negative response to help them unlearn the response

Cognitive-Behavioral Therapy (TDT) (Week 6)

Challenging clients’ illogical beliefs

Learning more adaptive responses to stress

Group Therapy (TDT) (Week 6)

One therapist and many clients all meet at once

All clients have same or similar presenting problem

All share support

Suicide (Week 7)

Causing one’s own death thought actions intended primarily to cause that death

Parasuicide (Week 7)

An action taken with the intent of ending one’s life that does not result in fatality

Non-Suicidal Self Injury (Week 7)

Old new: all self-injury related to suicidality

New View:

• Self-injury as a compulsion

• Self-injury to interrupt intrusive thoughts

• Self-injury as self-punishment

• Self-injury for release of endorphins

• Other causes of self-injury

Suicide Patterns (Week 7)

Categories of actions that result in death

• Death seeker

• Death initiator

• Death ignorer

• Death darer

• Sub-intentional death

Death Seeker (SP) (Week 7)

Person intends to end their existence through action of suicide

• Impulse often lasts relatively little time

Death Initiator (SP) (Week 7)

Person believes (often correctly) that death will occur soon regardless, and that they choose to bring it about early

Death Ignorer (SP) (Week 7)

Person takes suicidal actions in order to achieve an afterlife

Death Darer (SP) (Week 7)

Person feels ambivalent (positive and negative) or changeable views of death

• Results in actions that could result in death but are not guaranteed to do so

Sub-intentional Death (SP) (Week 7)

Person shows disregard for own well-being to the point where it results in death

• Closely tied to poor mental health

• Hard to classify as suicide or not

• Ex:

  • Entering combat in a careless fashion

  • Failure to take needed medicines

  • Heavy drug use, e.g. excessive drinking

  • Causing severe self-injuries

  • Reckless driving

Demographics Pt.1 (Suicide) (Week 7)

Men die by suicide more often than women do

• Related to gun ownership — most lethal and easy-to-use means of suicide

The older a person is, the greater their risk of suicide

• Teen suicides, despite media attention, are rare

• Suicides of lonely impoverished older adults recently bereaved (left alone by relative or friend through death) have always been high

Demographics Pt. 2 (Suicide) (Week 7)

Native Americans and white Americans have greater suicide risk than other races

• May reflect lack of community, gun ownership, rates of drug addiction

Non-religious people have greater risk than religious ones

• Judaism/Christianity/Islam forbid suicide

Stressors Pt.1 (Suicide) (Week 7)

Loss

• Suicide risk increases after life changing loss

  • Loss of loved one, loss of job, loos of home

Abuse

• Suicide risk higher for those being abused

  • Can include guardians, other family, authorities

Stressors Pt.2 (Suicide) (Week 7)

Occupational Stress

• Job is source of physical or emotional injury

  • Physical injury: construction work, nursing, combat, farming

  • Emotional injury: therapy, emergency medicine, corporate law

Drug Use

• Chronic or immediate use of drugs often precipitates suicide

Isolation (Week 7)

Single largest risk factor for suicide

• True on several levels

  • Married clients have lower risk than unmarried ones

  • Clients with religious community have lower risk than those without

  • Having friends results in lower risk

  • Cultural isolation and culture shock increase risk

  • Ostracism (exclusion) at work or school increases risk

Interpersonal Theory of Suicide (Week 7)

Cognitive-behavioral theory that suicide results from two irrational beliefs:

• Perceived burdensomeness

• Thwarted belongingness

And one behavior:

• Capability of harm

Perceived Burdensomeness (ITS) (Week 7)

Belief that one’s existence causes misery or stress to one’s loved one, and/or that loved ones would be “better off” if one died

Thwarted Belongingness (ITS) (Week 7)

Sense of being disconnected from others, not truly a part of a family, community, or any other group

Capability of Harm (ITS) (Week 7)

Ability to envision, desire, and achieve lethal self-injury

• Goes against fundamental human biology

• Requires a certain degree of volition

Suicide Treatments (Week 7)

Crisis Intervention

Crisis Intervention (ST) (Week 7)

Training given to police officers, firefighters, EMTs, nurses, etc.

Goal is to keep person alive until can receive help from mental health professional

Bipolar Disorder (Week 7)

Defined by cycling between mood states

• Mania

  • State of euphoria (extreme happiness) and grandiosity (belief in self-importance)

  • Characterized by excessive energy, rapid disorganized thought patterns, and lack of negative emotions

  • Can involve hallucinations, delusions, reckless actions

• Depression

  • State of hopelessness and low self-worth

  • Characterized by lack of energy, excessive sleep, guilt, sadness, and inability to feel emotions

  • Can involve slowed speech, brain fog, loss of volition

Types of Bipolar Disorder (Week 7)

Bipolar I

• Person experiences depressive episodes and manic states

Bipolar II

• Person experiences depression but only hypo-manic states

Manic State (Week 7)

Reduced sleep, increased energy

Racing thoughts and rapid speech

Lasts at least 1 week

Can involve hallucinations and delusions

Severe threat to functioning

Hypomanic State (Week 7)

Reduced sleep, increased energy

Racing thoughts and rapid speech

Lasts at least 4 days

Does not involve hallucinations and delusions

Moderate threat to functioning

Bipolar Disorder Causes (Week 7)

Genes

• 2.5% of general population have bipolar

• 5-10% of those with a bipolar parent have bipolar

Environment

• Major stressors can trigger switch from mania to depression or vice versa

Bipolar Treatment (Week 7)

Lithium

• Chemical element that prevents manic and depressive states from occurring

• Highly effective

• Carries high risk of overdose, drug interaction, increased tolerance

Depression Symptoms (Week 7)

Emotional

• Constant or near-constant negative mood

• Lack of positive emotions

Motivational

• Lack of volition — drive, interest, activity level

Physical

• Interrupted sleep — either sleeping too little or sleeping to excess

• Interrupted appetite — either not eating or eating to point of sickness

Cognitive

• Pessimistic, negative, and self-hating

• Unable to concentrate, forgetful, easily distracted (brain fog)

Depression Patterns (Week 7)

Major Depressive Episode

• Most symptoms present every day for at least 2 weeks

Persistent Depressive Disorder

• Most symptoms present most of the time for at least 2 years

Premenstrual Dysphoric Disorder

• Person experiences depressive episodes in the week before menstruating

Postpartum Depression

• Person experiences depressive episode shortly after giving birth

Depression Causes (Week 7)

Genes

• 20% of general population experience a depressive episode

• 30% of those with a depressed parent have depression

Hypothalamus-Pituitary-Adrenal Axis

• Regulates stress response

• Over-active in those with depression

Learned Helplessness

• If experience has taught you that bad things will happen and there’s nothing you can do about it…

• Hopelessness, negativity, loss of motivation occur

Depression Treatments (Week 7)

Antidepressant Drugs

Ketamine

Brain Stimulation

Antidepressant Drugs (DT) (Week 7)

Medicines that relieve depression

• First generation: Monoamine Oxidase Inhibitors (MAO-Is)

• Second generation: Selective Serotonin Reuptake Inhibitors (SSRIs)

• Third Generation: Tricyclic antidepressants

• Fourth generation: Ketamine

Ketamine (Week 7)

Psychedelic drug — produces hallucinations and delusions

• Makes user more open to suggestion

• Appears to be helpful adjunct (support) to talk therapy

Brain Stimulation Pt.1 (Week 7)

Especially useful for treatment-resistant depression

• ~35% of clients don’t show benefit from antidepressant drugs

• ~25% of clients don’t show benefit from talk therapy

Electro-convulsive therapy (ECT)

• Highly effective at quickly/Thoroughly relieving depression with few physical risks

• Causes memory loss, especially with repeated use

Transcranial magnetic stimulation (TMS)

• Less invasive than ECT, with fewer side effects

• Lower effectiveness but similar mechanism for relieving depression

Brain Stimulation Pt.2 (Week 7)

Methods that involve brain surgery to implant device

• Deep brain stimulation

• Vagus nerve stimulation

Both highly effective, both rarely used because infection risk so high

Depression and Gender (Week 7)

Depression diagnosed about 2.5x as often in women as in men, across cultures and ages

Artifact Theory (Week 7)

Depression is almost certainly being under-diagnosed in men

• Women may outwardly express distress more

• Men may die by suicide without treatment

Hormone Theory (Week 7)

Shifts in hormones around menstruation, pregnancy, and menopause seem to increase one’s risk for depression

• Estrogen is chemical messenger in HPA axis

Life Stress Theory (Week 7)

Women at higher risk than men for abuse, poverty, discrimination, and other violence

• Could increase risk of learned helplessness

Body Dissatisfaction Theory (Week 7)

Women are taught self-hatred as part of society’s effort to make them decorative and sell them products to “fix” their bodies

Lack-of-Control Theory (Week 7)

Sense that they cannot change one’s own life creates hopelessness

• Women literally do have less control and fewer options on average than men

Rumination Theory (Week 7)

Dwelling on or mentally “turning over” a source of distress without trying to change it

Women show this pattern more often than men

Bodymind (Week 8)

Emphasizes there is no meaningful distinction between “body” and “mind”

• Concept originates in Buddhism

Counter to Western dualism

• Concept of flesh containing a separate entity

• Underpins division between mental health and physical health

Examples of Disorders:

• Bipolar Disorder

• PTSD

• Social Anxiety Disorder

• Asthma

• Migraine

• Hypertension (high blood pressure)

Bipolar Disorder (Bodymind) (Week 8)

Caused by problems with ion channels in neurons and chaotic life

PTSD (Bodymind) (Week 8)

Caused by severely stressful experience and problems with amygdala and frontal lobe

Social Anxiety Disorder (Bodymind) (Week 8)

Caused by stress sensitivity and negative social experiences

Asthma (Bodymind) (Week 8)

Caused by weaknesses of the airways and immediate distress

Migraine (Bodymind) (Week 8)

Caused by malformation of blood vessels and chronic physical tension due to stress

Hypertension (High Blood Pressure) (Bodymind) (Week 8)

Caused by food additives, nicotine, poor calcium processing, and frequent frustration or anger

Psychophysiological Disorders (Week 8)

Physical illnesses that are caused and/or worsened by psychological and social factors

Psychophysiological Causes Pt.1 (Week 8)

Social Readjustment Rating Scale

• Measure of life stress in the past year

• Involves checking off 43 events

  • Death of a spouse: 100 life adjustment units

  • Planning a vacation: 12 life adjustment units

• Scores of 150-300: ~50% of participants have major health breakdown in next year

• Scores of 300+: >80% of participants have major health breakdown in next year

Psychophysiological Causes Pt.2 (Week 8)

Self-Care

• Behaviors to maintain physical health

  • Sleeping 8 hours a night

  • Eating 3 meals a day

  • 30+ minutes of exercise a day

  • Drinking 32oz of water a day

  • Seeing doctor as needed

  • Minimizing recreational drug use

• All negatively affected by stress

Psychophysiological Causes Pt.3 (Week 8)

Psychoneuroimmunology

• Psychoneuro = mind, brain

• Immunology = related to body’s system of defense against disease

• Stress response — body shuts down non-essential functions to get ready for a threat

  • Includes: immune system, digestive system, certain cognitive functions

Psychophysiological Causes Pt.4 (Week 8)

Social Support

• Helps person relax and receive help with activities of daily living during times of stress

• Speeds recovery from illness and injury

Psychophysiological Causes Pt.5 (Week 8)

Discrimination

• Experience of being treated differently because of one’s identity

• Chronic recurring stressor

• Biological factors do not account for health differences in U.S. races

• Frequency and riskiness of bad treatment do account for differences

Psychophysiological Treatments (Week 8)

Most treatments are used in combination

Major types

• Biofeedback and Relaxation Training

• Meditation and Hypnosis

• Support Groups

Biofeedback (PT) (Week 8)

Client receives live information on their own heart rate, skin tension, and other markers of physical stress

Client works to reduce those stress markers

Relaxation Training (PT) (Week 8)

Client is taught to clench and the loosen muscles to produce physical relaxation

Meditation (PT) (Week 8)

Self-induced dreamlike state of neutral mood and acceptance of body sensations

Hypnosis (PT) (Week 8)

Clinician-induced dreamlike state of neutral mood and acceptance of body sensations

Support Groups (PT) (Week 8)

Especially helpful with chronic illness to know “what’s normal” and “what to expect”

Physical Disorders with Psychological Origin (Somatoform) (Week 8)

Illness Anxiety Disorder

Conversion Disorder

Somatic Symptom Disorder

Factitious Disorder