Psychological Disorders Final Exam

Maladaptive pattern of substance use leads to significant impairment or distress often manfisted by at least 2 of the following 11 symptoms within a 1 year period

1. Substance often taken in larger amounts or longer time

2. Desire or unsuccessful efforts to reduce or control use

3. Much time spent trying to obtain, use, or recover from the effects of substance use

4. Cravings for substance

5. Failure to fulfill major role obligations

6. Continued use despite persistent interpersonal problems

7. Reduction of important activities

8. Continued use in dangerous situations

9. Continued use despite worsening of physical or psychological problems

10. Tolerance effects

11. Withdrawl reactions

Substance Use Disorder

Gambling Disorder

• Individual displays a maladaptive pattern of gambling, featuring at least 4 of the following symptoms over the course of a full year

1. Can achieve excitement only by increasing gambling

2. Feels restless or irritable during gambling reduction

3. Repeated failures at controlling gambling

4. Consumed with gambling thoughts

5. Gambling often triggered by upset feelings

6. Frequently returns to gambling to recoup previous losses

7. Lies to cover up amount of gambling

8. Gambling puts important relationships, job, or education at risk

9. Seeks money from others to address gambling debts

• Individual experiences significant distress or impairment

Fetishistic Disorder

Recurrent intense sexual urges or fantasies involving use of a nonliving object or nongenital body part, often to the exclusion of all other stimuli, accompanied by clinically significant distress or impairment

Fantasies, urges, or behaviors involving dressing in clothes of the opposite sex to achieve sexual arousal, causing significant distress or impairment (does not involve any transgender feelings or behaviors)

Transvestic Disorder

Characterized by arousal from the exposure of genitals in a public setting, sexual contact is rarely initiated or desired

Exhibitionistic Disorder

Voyeuristic Disorder

Characterized by repeated and intense sexual urges to observe people as they undress or to spy on couples having intercourse - risk of discovery adds to excitement

Frotteuristic Disorder

• Characterized by recurrent and intense fantasies, urges, or behaviors involving touching and rubbing against a nonconsenting person

• Almost always male, the person fantasizes during the act that he is having a caring relationship with the victim

Repeated and intense sexual urges or fantasies about watching, touching, or engaging in sexual acts with prepubescent children, either acts on these urges or experiences clinically significant distress or impairment

Pedophilic Disorder

• Characterized by fantasies, urges, or behaviors involving the act or the thought of being humiliated, beaten, bound, or otherwise made to suffer, accompanied by clinically significant distress or impairment

• May include hypoxyphilia and autoerotic asphyxia (lethal)

Sexual Masochism Disorder

Sexual Sadism Disorder

Characterized by repeated, intense sexual arousal from fantasies, urges, or behaviors involving thought or act of psychological or physical suffering of a victim

Many were sexually abused as children, have another psychological disorder, and have sexual difficulties while married

What is a common experience of people with pedophilic disorder?

Age 16 and older and at least 5 years older than the child in question

What is the minimum age requirement to be diagnosed with pedophilic disorder?

Hypoxyphilia and autoerotic asphyxia

Practices of intentionally restricting oxygen to the brain to alter consciousness during sexual activity (hypoxyphillia is someone else restricting oxygen and autoerotic asphyxia is self-restriction of oxygen)

16.5%

What is the prevalence of Substance Use Disorder (overall)

Alcohol Use Disorder

What is the most common Substance Use Disorder?

Tolerance

The need for more of a substance to achieve the desired affect- increases consumption levels

Negative side affects associated with stopping using a substance

Withdrawl

33%

What percentage of college students binge drink?

Cannabis

What drug is connected with the onset of Schizophrenia in those with genetic predisposition

Detox is the systematic and medically supervised withdrawl from a substance- it is not considered treatment by itself but is often the first step in treatment

What is detox and is it considered treatment?

Gambling Disorder

What behavioral “other addictive disorder” was added to the DSM-5?

Internet Use Disorder and Internet Gaming Disorder

What other behavioral disorders are being considered for future versions of the DSM-5

Not all paraphilic disorders have to cause distress in order to be diagnosed, in pedophilic, exhibitionistic, voyeuristic, frotteurism, and sadism, the performance of the paraphilic behavior indicates a disorder regardless of whether the individual experiences impairment

Do all paraphillic disorders have to cause distress in the individual to be diagnosed? What else may be required for a diagnosis?

Experienced by 35% of people

How common are sexual dysfunctions?

Desire, arousal/excitement, orgasm

What phases of the sexual response cycle do sexual dysfunctions affect?

Potential causes of sexual dysfunctions

• Biological factors- hormones, neurotransmitters, drugs, medications

• Psychological factors- stress, anxiety, depression, OCD, fear, body dissatisfaction, trauma, performance anxiety

• Sociocultural factors- societal messages, relationship issues, double standards

1. Prodromal- beginning of deterioration, mild symptoms

2. Active- symptoms are apparant

3. Residual- return to prodromal-like state/level

What are the three phases of Schizophrenia?

• Medications mainly affect positive symptoms and do not do much when it comes to negative symptoms

• High rates of symptom relapse if medications are stopped prematurely

• Patients often dislike side effects

What are the problems with medications for Schizophrenia?

What is “expressed emotion” and how does it relate to symptom relapse?

“Expressed emotion” is a measure of family enviroment and inlcudes criticism, hostility, disapproval, and overinvolvement, more expressed emotion leads to a higher likelihood of symptom relapse

Uniquely expressed characteristics that influence thoughts, emotions, behaviors, and interactions

Personality

The Big Five Theory of Personality

The basic structure of personality may consist of five super traits or factors: openness to experience, conscientiousness, extroversion, agreeableness, and neuroticism (OCEAN)

• Individual displays a long term, rigid, and wide-ranging pattern of inner experience and behavior that leads to dysfunction in at least 2 of the following realms

1. cognition

2. emotion

3. social interactions

4. impulsivity

• Pattern is inflexible, maladaptive, and is significantly different from ones usually found in his or her culture

• Individual (or others) experience significant distress or impairment

Personality Disorder

Do people with personality disorders generally seek treatment?

No- people with personality disorders are typically treated when they are being treated for a comorbid disorder or when someone close to them experiences distress and pushes them to get treatment

Complaints about the current system of classifying personality disorders

Assumes that problematic personality traits are either present or absent, personality disorder is either displayed or not displayed, and a person who suffers from a personality disorder is not markedly troubled by personality traits outside of that disorder

Differences in the current classification system and the proposed classification system of personality disorders

The current classification system is categorical and the proposed classification system is dimensional, the current classification system also recognizes 11 personality disorders while the proposed classification system recognizes only one personality disorder

Negative affectivity, detachment, antagonism, disinhibition, and psychoticism

What are the five traits (on a spectrum) that could be problematic and lead to a diagnosis of Personality Disorder-Trait Specified

Which personality disorder cannot be diagnosed in someone under the age of 18

Antisocial Personality Disorder

11% of the U.S population

Prevalence of personality disorders in general

Which personality disorders are the most common?

Obsessive-Compulsive Personality Disorder, Borderline Personality Disorder, and Narcissistic Personality Disorder

Borderline Personality Disorder

Which personality disorder responds most to psychological treatment?

Dialectic Behavioral Therapy (DBT)

• Treatment designed specifically for Borderline Personality Disorder

• Increases emotional regulation and distress tolerance

• Teaches problem-solving skills and coping skills

• Learning social skills, trying to change “all or nothing” mindset to better interact with others

• Mostly cognitive-behavioral therapy with some psychodynamic therapy mixed in

• Time intensive and work intensive

• If followed through with, significantly reduces suicidal behavior, reckless behavior, and reduces hospitalizations

Borderline Personality Disorder can be treated with antidepressants, mood stabilizers, antianxiety, or antipsychotic drugs, but should be used in addition to therapy and used with caution due to high suicide risk

Do any personality disorders benefit from medication treatment?

Around 2 in 3 (67%)

What is the comorbidity rate with personality disorders

Odd or Eccentric (Cluster A) Personality Disorders

Paranoid, Schizoid, and Schizotypal Personality Disorders

Dramatic or Erratic (Cluster B) Personality Disorders

Antisocial, Borderline, Narcissistic, and Histrionic Personality Disorder

Anxious or Fearful (Cluster C) Personality Disorders)

Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders

• Characterized by deep distrust and suspicion of motives of others

• Limited close relationships, are cold and distant

• See threats everywhere

• Can interpret simple things (like compliments) as being criticized or or think that the person is out to get them

• Excessive trust in their own ideas and abilities, crucial of weakness and fault in others

• Holds grudges

Paranoid Personality Disorder

Schizoid Personality Disorder

• Persistently avoid personal relationships and show little emotion

• Prefer to be alone, little to no interest in others

• No need for attention or acceptance

Schizotypal Personality Disorder

• Characterized by a range of interpersonal problems, marked by extreme discomfort in close relationships, odd or even bizarre ways of thinking, and behavioral eccentricates

• On the Schizophrenia spectrum

• Ideas of reference (interpret things different than the average person) and bodily illusions (feeling a force or presence)

• Perceptions of extrasensory abilities or magical control over others (superstitions)

• Difficulty with focus

• Vague speech, loose associations

• Experience loneliness and want to have connections with other people but feel like they can’t

Antisocial Personality Disorder

• Persistently disregard and violate others’ rights, no empathy or remorse

• Do not have reactions to images of people being hurt, do not have a positive response to seeing friends and family, have very little fear response

• The brain and nervous system do not work the same way as someone without this disorder

• 18 years of age minimum for a diagnosis

• Lie repeatedly, reckless, impulsive

• Little regard for other individuals and can be cruel, sadistic, aggressive, and violent

• Not all people with this disorder are serial killers or violent criminals

• Have higher rates of Substance Use Disorders, Gambling Disorder, and Conduct Disorder in childhood

• Have a smaller frontal lobe

• Do not learn to associate negative consequences with actions to not do them again

• Often can be very charismatic and charming

Borderline Personality Disorder

• Characterized by instability and emotion dysregulation, including major shifts in mood, unstable self-image (get self-worth from who they are with), and impulsivity

• Unstable, intense, conflict-ridden relationships

• “All or nothing” mindset, perceive people as all good or all bad, have trouble with nuance

• Have a fear of abandonment

• 85% of people with this disorder have another disorder - depression, eating disorders, substance use disorders, and anxiety disorders are common)

• May end up in therapy because of another disorder or distress due to the symptoms of their disorder on themselves or others

• Prone to bouts of anger, which can result in physical aggression and violence, also may direct impulsive anger inward and harm themselves

• Have an increased risk of suicide, 70% of people with this disorder attempt suicide and 10% of people with this disorder die by suicide

• Individuals are extremely emotional and continually seek to be the center of attention

• Attention-getting behaviors, always “on stage”

• Approval and praise are essential

• Vain, self-centered, and demanding

• Some make suicide attempts, often to manipulate others, usually nonlethal gestures and are used to make someone not leave them or to make other people feel bad

Histrionic Personality Disorder

Narcissistic Personality Disorder

• Generally grandiose, need a lot of admiration, feel no empathy for others

• React if they do not get enough admiration

• Willing to use people to get what they want without empathy

• Exaggeration of achievements and talents, often arrogance, but fragile self-esteem

• Selective about friends because they believe they’re special

• Take advantage of others to achieve their own goals

• May make suicide attempts to manipulate others

• Characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation/judgement

• Similar to social anxiety but much worse, people with social anxiety at least have a few people or situations they feel comfortable with, but people with avoidant personality disorder do not have any people or situations they feel comfortable with

Avoidant Personality Disorder

Dependent Personality Disorder

• Individuals have a pervasive, excessive need to be cared for

• Clinging and obedient, fear of separation from loved ones, distressed, lonely, sad, and prone to self-dislike

• Increased risk of depression, anxiety, and eating disorders

• Feelings of inadequacy and helplessness

• Reliance on others so the smallest decisions cannot be made by themselves

• Difficulty with separation is a central feature

• Can be overly submissive and obedient, would likely stay with someone even if they are being mistreated because they do not want to be alone

• Characterized by intense focus on orderliness, perfectionism, and control, resulting in loss of flexibility, openness to change or spontaneity, and efficiency

• Unreasonably high standards for self and others, fearing a mistake, may be afraid to make decisions

• Can procrastinate due to fear of making a mistake or decision, can severely impact schoolwork

• Difficulty expressing affection, relationships often feel stiff and superficial

Obsessive-Compulsive Personality Disorder

Antisocial Personality Disorder, Borderline Personality Disorder, Paranoid Personality Disorder, and Schizotypal Personality Disorder

What personality disorders have genetic links/more biological factors associated with them?

Children often report more physical symptoms than adults (stomach aches, headaches, tiredness), and may become more irritable

Difference in presentation of childhood mood and anxiety disorders compared to adults

Why was DMDD (Disruptive Mood Dysregulation Disorder) added to the DSM-5?

DMDD was added to the DSM-5 because children were getting overdiagnosed with bipolar disorder and were put on mood stabilizers that were not proven safe for children

Roughly 1 in 5 (20%)

What percent of children have a psychological disorder

20%

What percentage of children report being bullied frequently?

Depression, suicidal thinking and attempts, low self-esteem, anxiety, substance use, somatic symptoms, sleep problems, school problems, and antisocial behavior

What are the psychological consequences of being bullied frequently

5-16%

What is the prevalence of child abuse

Psychological affects of child abuse

Short-term: Anxiety, depression, bed-wetting

Long-term: Lack of social acceptance, alcohol and substance use, impulsivity

• For at least one year, repeatedly has severe outbursts of temper that are out of proportion to triggering siutations and different from ones displayed by most others his or her age (at least 3 times a week and in at least 2 settings)

• Repeatedly displays irritable or angry mood between the outburts

• Initial diagnosis between 6 and 18 years old

Disruptive Mood Dysregulation Disorder

What are the core features of Autism Spectrum Disorder?

• Social difficulties- reduced responsiveness and social reciprocity

• Language and communication difficulties

• Highly rigid and repetitive behaviors, interests, and activities

• Motor movements that may be unusual, repetitive, and rigid (self-stimulating, self-soothing, self-injurious behaviors)

What are the theories for the development of Autism Spectrum Disorder?

• Central perceptual or cognitive disturbance (“theory of mind” deficiency, mind-blindness)

• Genetic factors, prenatal difficulties, or birth complications (abnormal cerebellum structure- potential brain-circuit dysfunction)

Best treatments for Autism Spectrum Disorder?

• Modeling and operant conditioning, create new adaptive behaviors and reduce negative behaviors

• Applied Behavior Analysis (ABA)

• Communication training- teaches other forms of communication

• Neurofeedback

• Parent training- teaches parents to apply behavioral techniques at home

• Community integration

Elimination Disorders

Repeatedly uncontrolled bladder and bowel elimination after age expected to control these bodily functions

Enuresis

Repeated involuntary (but in some cases intentional) bed-wetting or wetting clothes, has to be at least 5 years old

Encopresis

Repeated soiling and defecation into clothing after the age of 4

A group of disabilities in the functioning of the brain that emerge at birth or during very early childhood and affect the individual’s behavior, memory, concentration, and/or ability to learn (includes Tic Disorders, Communication Disorders, Learning Disorders, Intellectual Disability, Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder)

Neurodevelopmental Disorders

What is the prevalence of ADHD?

7-10%

Inattention symptoms of ADHD

1. Unable to properly attend to details, or frequent careless errors

2. Finds it hard to maintain attention

3. Fails to listen when spoken to by others

4. Fails to carry out instructions and finish work

5. Disorganized

6. Dislikes or avoids mentally effortful work

7. Loses items that are needed for successful work

8. Easily distracted by irrelevant stimuli

9. Forgets to do many everyday activities

(6 or more for 6 months)

Hyperactivity symptoms of ADHD

1. Fidgets, taps hands or feet, or squirms

2. Inappropriately wanders from seat

3. Inappropriately runs or climbs

4. Unable to play quietly

5. In constant motion

6. Talks excessively

7. Interrupts questioners during discussions

8. Unable to wait for turn

9. Barges in on others’ activities or conversations

(6 or more for 6 months)

Most effective treatment for ADHD

Combination of…

• Medication treatment (methylphenidate, amphetamines, SNRIs)

• Cognitive-behavioral therapy (operant conditioning (“token economy”) and parent management training)

Common comorbidities with Autism Spectrum Disorder

ADHD, Anxiety, OCD, Depression, and Oppositional Defiant Disorder

Oppositional Defiant Disorder

• Repeatedly argumentative and defiant, angry and irritable, and, in some cases, vindictive

• Characterized by repeated arguments with adults, loss of temper, anger, and resentment

• Children ignore adult requests and rules, try to annoy people, blame others for their mistakes and problems

• More severe behavioral problem in which children repeatedly violate others’ basic rights or ignores rules of society

• Aggression, cruelty to people or animals, many steal from, threaten, or harm others

• Girls present with more of a pattern of relational aggression (spreading rumors, manipulating their friends, etc.)

• Different patterns (open vs secret, destructive vs nondestructive)

• Around 50% go on to have a diagnosis of Antisocial Personality Disorder as adults

• 3 features over the past year, 1 or more in the past 6 months

1. Frequently bullying or threatening others

2. Provoking fights

3. Using weapons

4. Physical cruelty to people or animals

5. Stealing

6. Fire-setting

7. Destroying others’ property

8. Frequently out beyond curfew starting before age 13

9. Running away overnight at least twice

10. Frequent skipping school starting before age 13

Conduct Disorder