Psychopathology Exam 3

Malingering

Intentionally feigning illness to achieve some external gain ($ or time off work)

What is the difference between malingering and factitious disorder?

Malingering - goal is external gain 

Factitious disorder - goal is fulfillment of psychological need

Another name for factitious disorder imposed on self?

Munchhausen syndrome

(Baron Von Munchhausen)- told fake stories of military adventure

Likely traits of someone with factitious disorder imposed on self?

• Knowledgeable about medicine 

• Eagerly undergo treatment 

• Deny faking, leave hospital 

• Go to different hospital

Factitious disorder imposed on self fraction? Women vs men 

⅔ women but men more severe

When does factitious disorder imposed on self begin? Likely among who?

Early adulthood

1. Received extensive treatment for a medical problem as a child 

2. Grudge against medical professional 

3. Worked as a nurse, lab tech, medical aid

4. Poor social support

5. Few enduring social relationships 

6. Little family life

Factitious disorder imposed on self

Persons feign or induce physical symptoms on themselves, typically for the purpose of assuming the role of a sick person

How do medical practitioners feel about people with Factitious disorder imposed on self?

• Annoyed 

• Ager 

• Waste of time 

How do medical practitioners feel about people with Factitious disorder imposed on self?

• Annoyed 

• Ager 

• Waste of time

What is the name of factitious disorder imposed on another

Munchausen syndrome by proxy

Conversion Disorder

Psychological distress manifests as physical symptoms that cannot be explained by a medical condition. 

Bolidly symptoms affect voluntary motor and sensory functions, but symptoms are inconsistent with medical diseases

• Symptoms not on purpose

Another name for conversion disorder?

Functional neurological symptom disorder

What are neurological-like symptoms

• Paralysis 

• Blindness 

• Loss of feeling

Glove anesthesia

Numbness begins sharply at the wrist and extends evenly right to the finger tips 

• Neurology follows the nerves but person reports whole hand

Facts of conversion disorder

• Every 1/10,000 

• Late childhood- young adulthood 

• 2:1 women: men

What is the checklist for conversion disorder

1. Symptom that affects voluntary or sensory function 

2. Inconsistent with known neurological/ medical disease 

3. distress/ impairment

Somatic Symptom disorder

People become excessively distressed/ concerned/ anxious about bodily symptoms - lives are disproportionately disrupted by the symptoms 

• Somatic symptoms have no known cause (sometimes) 

• No medical explanation available

What are the patterns of somatic symptom disorder?

1. Somatization pattern

   1. Large and varied amounts of symptoms 

2. Predominant pain pattern 

   1. Primary problem is pain 

   2. Usually develops after an accident that causes pain and then pain continues

What is Briquet’s syndrome

Somatization pattern of SSD 

• Pain symptoms 

• Gastrointestinal 

• S*xual 

• Neurological type 

Can last for years- therapy helps 

Adolescence - young adulthood

What is the electra complex?

Freud: phallic stage age 3-5 

Each girl experiences sexual feelings for her father and at the same time recognizes that she must compete with her mother for his affection → repression 

Opposite to oedipus complex?

What is the psychodynamic view of hysterical disorders

Unconscious conflicts from childhood that cause anxiety are converted into more tolerable physical symptoms 

• Primary gain- bodily symptoms keep internal conflicts out of awareness 

Secondary gain- bodily symptoms enable them to avoid unpleasant activities/ sympathy from others

Somatic vigilance

Cognitive-behavioral

• Some individuals are more attentive than others to their bodies → focus on bodily discomfort → more arousal in response to them→ worry

Anxiety- sensitivity

Cognitive-behavioral

The personal to focus on bodily sensations that is linked to panic disorder 

• More likely to experience pain and pain related anxiety more

Explain the rewards of hysterical disorders

Cognitive-behavioral 

• Symptoms remove person from unpleasant relationship/ bring attention from others 

• More likely if you’ve seen others with symptoms 

Similar to secondary gains (psychodynamic)

Illness anxiety disorder 

1. When does it start

Hypochondriasis 

Chronically anxious/ preoccupied with the notion that they have or are developing a serious medical illness, despite the absence of somatic symptoms 

1. Early adulthood (or any age)

Illness anxiety disorder explained by cognitive behaviorists

1. Illness fears come through classical conditioning or modeling 

2. Sensitive or and threatened by bodily cues → misinterpretation

Treatment for illness anxiety disorder

Similar to OCD therapy 

• Antidepressants 

• Cog-behave therapy

Psychophysiological disorder

(psychological factors affecting other medical conditions)

Biological, psychological, and sociocultural factors interact to cause/ worsen physical illness

• Ex: have medical condition but mental state worsens medical condition

What is the criteria for Psychophysiological disorder

1. Presence of medical disorder 

2. Psychological factors negatively affect the medical condition by 

   1. Affecting course of the medical treatment 

   2. Providing obstacles for the treatment of the medical condition 

   3. Posing new health risk 

   4. Triggering or worsening the medical condition

Most common Psychophysiological disorders?

• Ulcers

• Asthma

• Insomnia 

• Chronic headaches 

• High blood pressure 

• Coronary heart disease 

• bacterial/ viral infections

Ulcer?

Lesions (holes) that form in the wall of the stomach or duodenum → burning sensation/ pain in stomach 

• Vomit 

• Stomach bleeding 

Due to environmental pressure/ intense feelings and physiological factors (bacteria, helicobacter pylori)

Asthma?

Trachea and bronchi narrow→ hard to breathe

Insomnia?

How much of the population

Difficulty falling or maintaining sleep 

⅓ population yearly 

10% population has it for months-years

What are the different types of headaches

1. Muscle contraction/ tension headaches 

   1. Pain at front/ back of head or back of neck

   2. 5% have chronic 

2. Migraine headaches 

   1. Extremely severe/ nearly paralyzing 

   2. At the side of the head 

   3. With dizziness, nausea, vomiting 

   4. 10% each year

What are the phases of the second headache?

Migraine headaches:

1. Blood vessels in the brain narrow (blood flow reduced) 

2. Same blood vessels later expand so that blood flows through them rapidly→ pain (bc of many neurons firing at once)

Hypertension?

Chronic high blood pressure against artery walls 

• 28% total pop 

• 50% adults 

• 10% all cases caused by physiological irregularities alone

Coronary heart disease

Blockage of coronary arteries, vessels responsible for O2 to the heart 

• 9% total pop

• 50% middle aged men 

• ⅓ middle aged women

What is myocardial infarction

(heart attack)

Biological factors for Psychophysiological disorder

• Autonomic nervous system stimulated too easily 

• Some people are prone to develop a certain Psychophysiological disorder

What psychological factors contribute to psychophysiological disorder? / coronary heart disease 

What are some of the individual characteristics?

• Type A personality: consistently angry, cynical, driven, impatient, competitive, and ambitious → continual stress (x2 type b people get coronary heart disease) 

• Type D personality: D= distress 

  • Experiences strong negative emotions/ reactions 

  • Helplessness feelings 

• Anger, hostility, worry, anxiety, depression (individual characteristics)

• Repressive coping style

Percentage of black and non hispanic white for hypertension?

Black- 57%

Non- hispanic white- 44%

What is psychoneuroimmunology?

Study of connections between stress, immune system, and health

Who are Thomas Holmes and Richard Rahe?

The ones who developed Social Readjustment Rating Scale SRRS

• Assigns numerical values to the stresses that most people experience at some time in their lives 

• Scale not diverse enough (mainly based on non-hispanic white) 

What are some examples of LCUs?

Think DDMRL (death of spouse 100, divorce 73, Marital split 65, Retirement 45, Law violation 11) 300 → health prob

• Death of a long term partner (100)

• Retirement (45) 

• Minor violation of the law (11) 

  • LCUs are added up over the year

• 300 LCU more likely to develop a serious health problem

Immune system

Body’s network of activities and cells that identify and destroy antigens

Antigens

Foreign invaders (bacteria/ virus/ fungi/ parasites/ cancer cells) in the body

Lymphocytes

White blood cells that circulate through the lymph system/ blood stream- helps destroy antigens

Helper T-cells

Lymphocyte: Identifies antigens, multiplies and triggers production of immune cells

Natural Killer cells

Lymphocyte: Seeks/ destroys body cells that have already been infected by viruses- stopping spread

B-cells

Lymphocyte: produces antibodies- protein molecules that recognize and bind to antigens (mark→ destroy)

What slows down the immune system?

• Sleep 

• Diet 

• Old age (less lymphocytes)

Roger Bartrop

Created a study 

Compared the immune system of 26 people 

• Long term partners died (8 weeks earlier) 

• Matched with 26 who’s partners did not die 

• Lymphocytes slower in the bereaved participants

What factors may influence if stress will result in a slowdown of the immune system?

Biochemical activity:

• Sympathetic nervous system 

  • releases norepinephrine → effects immune system adversely 

• Hypothalamic-pituitary-adrenal axis (HPA-axis)

  • Releases cortisol/ stress hormones 

• Norepinephrine/ cortisol can go to lymphocytes → inhibitory message 

• Trigger production of cytokines → pro-inflammatory cytokines → chronic inflammation 

Behavioral changes:

• Sleep badly 

• Eat poorly 

• Exercise less 

• smoke/ drink

Personality factors:

• General sense of hopeless → die at above average rates from heart disease/ illness 

• Spirituality linked to better immune functioning 
  Degree of social support: 

• Lonelier → worse immune functioning 

• Loneliness scale → high loneliness has lower lymphocytes 

Behavioral medicine

Field that combines psychological and physical interventions to treat or prevent medical problems

Relaxation training

Treatment procedure that teaches clients to relax at will→self soothe 

• Physical relaxation → psychological relaxation 

  • Example muscle relaxation by group

Relaxation training + medication treats?

• Hypertension

• Somatic symptom disorder 

• Headaches

• Insomnia 

• Asthma 

• Diabetes 

• Pain 

• Certain vascular diseases

Biofeedback

Technique in which a client is given information about physiological reactions as they occur and learns to control the reactions voluntarily

What is an example of biofeedback?

Electromyograph (EMG)- biofeedback on muscle tension in the body 

• Converts electrical energy (potentials) coming from the muscles → image/ pitch

• Example EMG used on 16 with facial pain → jaw relaxed 

• Treats: headaches, muscular disabilities…

Meditation

Turning one’s concentration inward → changed state of consciousness → temporarily ignoring all stressors 

• Typically have mantra (help focus)

Example of meditation

Mindfulness meditation - 

• Pay attention to feelings/ thoughts/ sensations 

• detachment/ objectivity/ no judgement

hypnosis

Sleeplike suggestible state → now used to treat many physical symptoms 

• Helps pain

What are some cognitive behavioral interventions for sickness/ pain 

• Self instruction training 

• Stress inoculation training 

  • Getting rid of “negative self-statements” replaced with coping self statements

Anorexia nervosa 

Disorder marked by the pursuit of extreme thinness and by extreme weight loss 

Key goal: becoming thin 

Motivated by fear of “fat”

• Preoccupied by thoughts of food

What are the types of anorexia?

Restricting type- restricting food intake 
Binge eating/ purging type- forced vomit, abusing laxatives, or diuretics, possible eating binges

How many people in western countries develop anorexia nervosa?

0.6 %

Anorexia and bulimia % in women?

Anorexia 75% in women and girls 

Bulimia 83%

Anorexia peak age of onset?

14-20 (can occur at any age)

Typically after 

• a person of average/ above average height goes on a diet 

• Stressful event

How many become seriously i’ll from anorexia?

6% die from starvation or suicide 

• Suicide rate is 5x gen pop

Explain the starvation study

1940s 

• 36 average weight men volunteer 

• Semistarvation diet for 6 months 

• Became preoccupied with food 

• Started dreaming about food

How do people with Anorexia think?

Distorted ways:

• Low opinions of body shape 

• Think of selves as unattractive 

• Overestimate proportions 

• 20% over under for normal but most anorexic were over

What are the medical problems associated with Anorexia?

• Amenorrhea- absence or failure to begin menstrual cycles 

• Lowered body temp 

• Low blood pressure

• Body swelling 

• Reduced bone mineral density 

• Slow heart rate 

• Metabolic electrolyte imbalance 

Amenorrhea

absence or failure to begin period

Lanugo

The fine silky newborn hair, sometimes developed by those with anorexia

Bulimia Nervosa

“Binge-purge syndrome” 

Marked by frequent binge eating followed by forced vomit or another extreme compensatory behavior to avoid gaining weight

Binge

An episode of uncontrollable eating during which the person ingests a very large quantity of food (2 hours)

What are some examples of compensatory behaviors?

• Inducing vomit 

• Misuse of laxatives, diuretics, enemas

• Fasting

• Excessive exercise

What percentage of people develop bulimia?

1%

When does bulimia begin?

adolescence/ young adulthood 

15-20

• Can last for years

Bulimia typical weight

healthy/ slightly heavier weight 

• If underweight → anorexia

How is anorexia and bulimia similar?

• Begin after period of dieting

• Fear being obese 

• Preoccupied by food, weight, and appearance 

• Mental health issues 

• Hightened risk for suicide 

• Distorted body image 

• Disturbed attitudes toward eating

How is bulimia different from anorexia?

Anorexia	Bulimia
	Pleasing others
	Attractive to others
	Experiencing intimacy
	History of mood swings
	Hard time controlling impulses/ strong emotions
	⅓ show personality disorder  Borderline  Avoidant personality disorder
	Vomit → coats teeth with hydrochloric acid → dental issues
	Long-term cardiovascular disease

Binge- eating disorder

Recurrent binge eating episodes 

Has at least 3 of these features:

• Unusually fast eating

• Absence of hunger 

• Uncomfortable fullness 

• Secret eating due to sense of shame 

• Subsequent feeling of self-disgust/ depression/ severe guilt 

Weekly over 3 months 

No compensatory behaviors

How many in the US binge eat?

2.8%, most prevalent eating disorder

Binge eating disorder % in women?

67%

Who is at risk of binge eating disorder?

Those who grew up with food insecurity

How is binge eating disorder different from other EDs?

• Perceive large portions as moderate 

• Doesn’t begin with dieting 

• Developed in their 20s 

Hilde Bruch

Psychodynamic- ego defenses 

Theory:

• Disturbed parent-child interactions → ego deficiencies (poor sense of independence/ control)

• Leads to severe perceptual disturbances

• Child cannot perceive internal cues

• Parents respond effectively or ineffectively to child's needs 

• Child grows up unaware of own internal needs → turn to external (parents) 

• They feel out of control 

• Adolescence want control but can’t → excessive control of weight 

Parents of children who had anorexia → always anticipated needs (child can’t feel hungry)

What is the core pathology of EDs?

Cognitive behavioral- 

They judge themselves almost exclusively on their shape/ weight and ability to control it 

What is the most used psychotherapy for EDs?

Cognitive behavioral therapy.

What are the 6 kinds of evidence for depression being a precursor to EDs?

1. Those with ED qualify for depression diagnosis (more than gen pop) 

2. When experience depression- inducing circumstances ED intensifies 

3. Close relatives of those with ED more likely to have depression 

4. Those with depressive disorders more likely to have EDs 

5. Brain circuits similar in ED/ depressed brains 

6. Antidepressant treats both ED and depression

Biological explanation for EDs?

Which circuits are involved?

Which structures in the circuits are involved?

• ED relatives 6x more likely to develop an ED

• Identical twin 70% other twin will develop anorexia (23% bulimia) 

• Fraternal twin 20% other twin will develop anorexia (9% bulimia)

Dysfunctional brain circuits:

• Same as GAD, OCD, DD (depressive)

  • Insula (fear circuit- large) 

  • Orbitofrontal cortex (OC circuit- large)

  • Striatum (OC circuit- over active)

  • Prefrontal cortex (all three circuits- small)

hypothalamus - brian structure that helps regulate bodily functions like eating an hunger

Explain the hypothalamus- what are the areas in the hypothalamus that contribute to eating?

Plays role in how the brain process pleasure and reward experiences 

Lateral hypothalamus (LH) produces hunger when activated 

• Lowers metabolic rate

Ventromedial hypothalamus (VMH) reduces hunger when activated  

• Increases metabolic rate

What is GLP-1?

Glucagon-like peptide-1

• Brain chemical 

Natural appetite suppressant

What is the weight set point?

The weight level that a person is predisposed to maintain, controlled in part by the hypothalamus 

• Genetics + early eating practices 

Like an inner thermostat

Metabolic rate

The rate at which the body expends energy

What percentage of people who experience body dissatisfaction

Men and women?

Women- 83% 

Men- 74%

Who came up with an enmeshed family pattern? And what is it?

Salvador Minuchin 

Family system which members are over involved with each others affairs and overly concerned about each others welfare

• Child push for independence → no → sickly → ED → reliant on parents

What is the main reason for EDs in men?

Meeting requirement for job/ sports (37% of men with ED)

What is muscle dysmorphia

Reverse anorexia nervosa-

Men want to bulk up 

• View selves as too scrawny → eat/ abuse steroids…

• ⅓ binge eat