Psych Disorders Exam 2

What is the societal impact of mood disorders?

They cost the US $210 billion per year, loss of job productivity, costly in both mental health care and medical care

Affect

observable behavior associated with an emotion (smiling while happy, crying while sad)

Mood

sustained pervasive emotion across time and situations

Sadness

 passing state of normal feeling associated with loss, hurt, disappointment, or difficulty; comes and goes

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Dysphoria

Overwhelming continual feeling of gloom, despair, strong disappointment, emptiness, hopelessness

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Anhedonia

Inability to experience pleasure from activities usually found enjoyable

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Clinical Depression

Depressed mood and anhedonia along with other symptoms: Fatigue, loss of energy, difficulty sleeping, appetite changes, thoughts of guilt and worthlessness, etc.

Euphoria

elated, energetically happy mood

Mania

Euphoria along with other overly-positive states such as:

• inflated (high) self-esteem,

• decreased need for sleep,

• distractibility,

• pressure to keep talking,

• thoughts racing

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Episodes

cycles of mood disorders. Classification is based on the mood states of clients’ episodes.

• Depressive disorders include only clinical depression episodes

• Bipolar disorders include mania episodes, either mania alone (less common) or episodes of both

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Symptoms of Depression

Trouble concentrating, “slow” thinking, unwarranted guilt, ‘feelings’ of worthlessness and suicidal ideation

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Depressive Triad

Focusing on negative features of 1. self, 2. environment/world, and 3. future

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Rumination

Repeatedly thinking about negative past events and failures

psychomotor retardation

Slowed movement and speech

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Cognitive symptoms of mania

• Racing thoughts

• Easily distracted

• Grandiosity (being “over the top”)

and high self-esteem

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Emotional

• Euphoria and confidence

• Irritable; easy to anger (especially when

“coming down”)

Somatic

• Drastic reduction in need for sleep

• 2-4 hours of sleep and still feel full

of energy all day.

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Behavioral

• Highly energetic, sociable

• Extreme pleasure-seeking, disinhibited

• Often shop to excess despite finances or are hyper-

sexual

• Excessively pursue goals

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Major Depressive Disorder Criteria

Either depressed mood or anhedonia (loss of interest or pleasure)

• Most of the day, nearly every day, for AT LEAST TWO WEEKS

• At least four of the various symptoms from previous slides

• E.g., fatigue, low/high appetite, feelings of worthlessness/guilt, thoughts

of death

• Significant distress or impairment

• Not due to drug or medical condition

• Has NEVER EXPERIENCED A MANIC EPISODE

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Persistant depressive disorder criteria

A (usually) milder depression that lasts for years

• Depressed mood or anhedonia

• Most of the day, more days than not, for OVER TWO YEARS

• Cannot have TWO MONTHS+ depression-free within that

time

• Two or more secondary symptoms (from previous slides)

• Distress or impairment

• Not due to a drug or medical condition

• Has never experienced a manic episode

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what is a specifier?

what are all the boxes one must check in order to be diagnosed with a disorder. Add on to a diagnosis you don’t have a specifier without a diagnosis

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Specifiers of Depression: Melancholic Features

Severe depression, lose almost all capacity for pleasure, catatonia-like features, early waking, more intense forms of other symptoms.

Psychotic Features

Hallucinations (false sensory experiences) or delusions (false beliefs)

postpartum onset

starting after childbirth

Bipolar I Disorder Criteria

 Have experienced at least one full manic episode (7

day minimum)

• Lasting at least one week and present most of the day,

nearly every day

• Three or more secondary symptoms:

• Inflated self-esteem

• decreased need for sleep

• talkative

• racing thoughts

• distractibility

• increase in goal directed activity

• Dangerous pleasure seeking (unprotected promiscuity, heavy drugs etc.

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Bipolar II Disorder Criteria

Has experienced at least one hypomanic episode, one full major

depressive episode, and no full-blown manic episodes.

• Plus three secondary symptoms (as previously shown)

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Hypomania

Period of increased energy that is less intense than mania, only lasts FOUR days

• Associated with change in functioning uncharacteristic of the person.

• Disturbance in mood and change in functioning observable by others.

• Mood change must not impair social or occupational functioning

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Cyclothymia Criteria

Chronic but less severe form of bipolar

• Person must have experienced several periods

of hypomanic symptoms and periods of

depressive symptoms.

• During a period of TWO YEARS.

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Specifiers of Bipolar: Rapid Cycling

• Person experiences AT LEAST FOUR episodes of major

depression, mania, or hypomania WITHIN A 12- MONTH PERIOD

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Specifiers of Bipolar: Seasonal Pattern

Regular episode onset during particular times of the year

Seasonal Effectiveness Disorder

Mood disorder associated with changes in seasons

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Social Causes of MDD

Greater # & intensity of stressful life events, learned helplessness

• Higher probability of depression later

• MAJOR LOSS of important people or roles.

• Defeat, humiliation, or entrapment  higher MDD likelihood

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Psychological causes of MDD

Persistent negative thoughts  MDD

• Common errors and biases in thinking, including filtering, overgeneralization, maladaptive schemas, and hopelessness

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Filtering

Focus only on negatives, seldom on positives.

• Strong memory bias for negative information in MDD

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Overgeneralization

making broad, generalized conclusions based

on a single incident or piece of evidence.

• Self, environment, and future  I’m a total failure, life sucks, it always

will.

• Failure is given strong personal meaning and global impact.

Maladaptive Schema

 lead to depression:

• Enduring, general patterns of thought that

guide perception & interpretation of

events

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• “I’m a failure” / “I’m unlovable” / “My life is awful”

Hopelessness

 “Life will be bad no matter what I do.”

Biological Causes

Genes influence MDD (about 50% heritability)

• \~ Equal genetic and environment influence

• Polygenic: Influenced by many different genes

• Lower activation related to serotonin (a NT)

• Chronic activation of stress-reactive

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HPA Axis (Not its anatomy \[its “parts”\], but its physiology—\[how it “works” generally\])

Increased cortisol (stress hormone) long-term • Problems in brain regions that regulate emotion

Cortisol

stress hormone

social causes of bipolar

1\. SCHEDULE DISRUPTING EVENTS (sleep loss) & 2. ATTAINING GOALS

• Surge in positive emotions & activity

 mania

• Low social support, hostile families 

higher relapse, slower recovery

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Biological Causes of Bipolar

Highly genetically influenced: 80 – 85%

heritability

• Heightened reward sensitivity in brain

• Mania is associated with brain regions that

have a high density of dopamine

receptors

• Dopamine

Reward Sensitivity

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Dopamine

Neurotransmitter for controlling pleasure and reward

Behavioral Activation

Clients engage in as many reinforcing activities as

possible.

• Activity scheduling monitors activity and plans new

activities.

• Increases positive reinforcement for being active;

reduces neg. reinforcement for being inactive.

Interpersonal Therapy- • Develop better understanding of

interpersonal problems.

• Change ways of relating with

others to counter

depression.

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Cognitive therapy for Depression

Change maladaptive schemas to more rational, adaptive ones.

• Increase flexible thinking and attention to positive factors.

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Anti-Depressant Medication / SSRIs

• Stops reuptake of serotonin at pre-synapic terminal,

leaving more serotonin in the synaptic gap for receptors

• >80% of prescriptions for depression, common

• Fewest side effects and risks

• Examples

• Fluoxetine (Prozac)

• Sertraline (Zoloft)

• Escitalopram (Lexapro)

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Treatment for Bipolar Disorders

Best to combine medication and psychotherapy

Medication Management

Therapy to help client adhere to medications

• Medication is crucial: Mood Stabilizers

• LITHIUM: 1st choice, helps both depr. and mania,

prevents episodes

• Risk of kidney disease or hypothyroidism

• Use of SSRIs may trigger mania in some people

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Lithium Interpersonal-Psychological Theory of Suicidal Behavior

The interpersonal theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and that near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide.

What are some of the purposes of anxiety? (its “functions”)

Fear and anxiety serve important functions

• Fight, flight, or freeze response

• Yet they can be too strong or not fit for the context /

situation

• Maladaptive

Fight/Flight/Freeze Response

Fear- Negative arousal during immediate

danger.

• Intensifies quickly and leads to

escaping, fighting, or holding still.

Anxiety- Negative arousal in anticipation of

future

problems.

• Signal to prepare for upcoming event

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Symptoms of Anxiety Disorders: Worry

• Repetitive anxious thought that

a future event will turn out badly

• “Apprehensive expectation"

clinical worry- • Excessive

• Uncontrollable

• Unrealistic

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Panic Attacks

• Sudden, overwhelming experience of terror

• More intense and sudden than anxiety

• Must reach peak level in 10 minutes

• Many strong physical symptoms

• Rapid heartbeat, sweating, trembling, nausea, gagging, dizziness,

heat or chills, chest discomfort, shortness of breath, unreality

• Fear of dying, losing control, or “going crazy”

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Phobias

• Persistent, irrational fears associated with a specific

object/situation

• Always immediately experience fear around the object or

situation.

• Almost always avoid contact with the object or situation

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What are some common types of phobias?

• Heights

• Enclosed spaces

• Animals (spiders, snakes, insects)

• Injections, blood, or injury

• Airplanes

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Avoidance

• Avoidance Behaviors

• Preventing or removing

oneself from feared

situation,

rather than facing it.

• Attempting to

reduce/eliminate anxiety.

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Anxiety Disorder Diagnosises

1\. Specific Phobia

2\. Social Anxiety Disorder

3\. Panic Disorder

4\. Agoraphobia

5\. Generalized Anxiety Disorder

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Specific Phobia

• Intense fear or anxiety about specific object or situation

• Object almost always provokes immediate fear

• Object is actively avoided or endured with very intense

fear

• Fear is out of proportion to actual danger

• Must last 6 months or more

• Distress/impairment (as always)

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Social anxiety disorder (S.A.D.)

\--What is the primary concern of S.A.D.?

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• Fear and avoid social situations

• Primarily concerned with possible NEGATIVE

EVALUATION

• Fear of humiliation or embarrassment

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What are the subtypes of S.A.D.?

1\. Interpersonal interactions

• Dating, parties, conversation

• 2. Performance-based

• Speaking in front of others

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Panic Disorder

• Recurrent, frequent, unexpected panic attacks

• Must be follow by 1+ months of

• Persistent concern about future attacks OR

• Maladaptive change in behavior related to the attacks

(avoidance)

• Panic attacks cannot be due to another disorder

• Not only due to phobias, public speaking, socializing,

crowds, etc.

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Agoraphobia

• Fear of being in public

• Persistent avoidance of many kinds of situations

• Crowded streets, shops, enclosed places, public transportation

• May require another person to always accompany them

• SAFETY OBJECT: Anxiety-reducing object or person that enables

emotional avoidance. It prevents exposure & promotes disorder

• Primarily afraid that there will be no way to escape or get

help

• Often unable to leave home

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Generalized anxiety disorder (G.A.D.)

• Excessive and uncontrollable worry

• More days than not for six months or more

• Must worry about multiple events or activities

• At least three other anxiety symptoms:

• 1. Restlessness or feeling “keyed-up” or on edge

• 2. Being easily fatigued

• 3. Difficulty concentrating

• 4. Irritability

• 5. Muscle tension

• 6. Sleep disturbance

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Safety Object

Anxiety-reducing object or person that enables

emotional avoidance. It prevents exposure & promotes disorder

Classical conditioning (regarding anxiety)

 • Intense fear can become associated with

specific situations/stimuli

• Classical conditioning during traumas

• Humans develop phobias more readily to some things rather than others (e.g. snakes, spiders, heights)

Preparedness Model

Humans have evolved to be more sensitive

(prepared) to developing extreme fear of stimuli

that posed common survival risks in our

evolutionary past (snakes, spiders, heights)

Dog bite + fear  Dog Phobia

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Social Learning as Anxiety Cause

• People may begin to fear something solely

from observing others fearing it or suffering from

it (modeling).

• People also learn to avoid stimuli others fear, preventing

them from ever learning if the fear is warranted.

• Anxious, worrying parents model anxiety and teach their

children to be anxious

• “Helicopter” parenting can prevent natural exposure (“facing

fears”) and healthy approach behavior.

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Hypervigalance

State of increased awareness;

extreme sensitivity to one’s surroundings

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Catastrophic Misinterpretation

• Those with panic disorder misinterpret bodily

sensations as signaling serious problems

• This CATASTROPHIC MISINTERPRETATION

then leads to more fear.

• Anxious interpretations increase anxious

bodily responses and hypervigilance.

• Certain drugs and lab procedures induce panic

attacks in those with panic disorder, but not

controls.

• This is due to misinterpretation (Clark 1993)

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Genetics in Anxiety

 Anxiety disorders are moderately heritable (20-

30% for GAD).

• Polygenic

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Amygdala

• Brain region for fear conditioning & responding

• Links US and CS in memory

• Activates fight/flight/freeze response

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What are the emotional effects of worry?-

Excessive &

uncontrollable Worry

• Functions to avoid future

negative outcomes,

uncertainty, and negative

emotional shifts.

• Tends to be unrealistic.

1\. INCREASES distress.

2\. STOPS positive

emotion.

3\. PREVENTS shifts in

negative emotion.

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Functional Models of Worry in GAD

\--Contrast Avoidance Model

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Worry creates distress to prevent

sudden shifts in negative

emotion

• Those with GAD strongly dislike unexpected

drops in mood, so they keep themselves

distressed across time by worrying.

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Functional Models of Worry GAD

\-- Intolerance of uncertainty

• Those with GAD find uncertainty and ambiguity upsetting

• Believe that worry will serve to either help them cope with

feared events more effectively or to prevent those events

from occurring

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Functional Models of Worry GAD

\-- Metacognitive model (positive beliefs about worry)

• People with GAD ”worry about worry”

• Also have positive beliefs about worry

• That it motivates them, gives a sense of control, prevents

bad outcomes, makes them caring/conscientious, etc.

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Treatments for anxiety: Exposure Therapy

• Exposure therapy

• Directly facing feared stimulus until

habituation (i.e., anxiety lessens) without relaxation

• Goal is to “maximize” anxiety and sustain it.

• Exposure-based treatments are used for all anxiety

disorders (though they are not recommended for

GAD).

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Interoceptive Exposure

Inducing internal bodily sensations as exposure for panic disorder

• Goals:

1\. Help clients habituate to the physical cues that start panic

attacks

2\. Help clients fully realize their panic attacks are not dangerous

• Ex: Spinning in office chair  dizziness  panic attack

• Ex: Breathing through a coffee straw  shortness of breath 

panic

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Diaphragmatic Breathing

Teaching clients to breath steady from the

stomach, not the chest

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Applied Relaxation

• Clients learn to recognize their anxiety cues

• Then engage in relaxation whenever they

encounter cues.

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Progressive Muscle Relaxation

 • Tensing muscles groups prior to relaxing them

in a systematic way

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Decatastrophizing

 Imagine worse case scenario, challenge its likelihood,

imagine coping

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Worry Outcome Monitoring

Track worry predictions and mark whether they come

Anti-anxiety medication:

Benzodiazepines-

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Tranquilizers that reduce bodily symptoms

and possibly some worry/rumination

• Often taken “as needed” when a person starts

feeling anxious

• Effective at beginning, but problematic long-term

• Maintain anxiety symptoms through avoidance/being

safety object.

• High potential for addiction

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Obsessions

• Repetitive, unwanted, intrusive cognitions

• Thoughts, images, or impulses

• Lead to an increase in anxiety

• Usually include socially unacceptable themes:

• Sex, violence, contamination, immoral or religious taboos

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Compulsions

• Repetitive behaviors or mental acts used to

reduce anxiety.

• Typically considered senseless or irrational by

client.

• ...But are done nonetheless

• When resisting the urge to do

compulsions, anxiety spikes.

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Obsessive Compulsive Disorder

• Must have either obsessions or compulsions

• Though most who meet criteria have both

• Compulsions must be aimed at preventing/reducing anxiety

• Must attempt to ignore, suppress, or neutralize

obsessions

• Time-consuming: Must take more than one hour per day

• Or cause significant distress or other impairment

• Specifier: Level of insight - good, poor, or absent

Causes of OCD: Biopsychological

• In OCD, certain brain regions are overly active:

• Basal ganglia

• Orbital prefrontal

cortex

• Anterior cingulate

cortex

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Thought-Action Fusion

• The belief that the consequences of a having a thought are

as influential as committing an actual action in the world.

• E.g., having an image of stabbing one’s spouse pop into one’s

mind is as bad as actually stabbing the spouse.

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Thought-Action Fusion Morality

• The belief that having a thought is as morally “bad” as

intentionally carrying out the action of the thought.

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Thought-Action Fusion Likelihood

• The belief that having a thought about an unwanted event

increases the likelihood that that event will occur.

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Overestimation of personal responsibility for unwanted outcomes

• E.g., “If my son dies of cancer, it might be my fault for

not carrying out my compulsions properly”

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Thought Suppression

• Attempting to stop thinking about something by will.

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Mental Rebound

• Attempts to stop a thought only increase the presence of the

thought.

• Greater anxiety  greater mental rebound  greater anxiety

• When thoughts are more upsetting, they are more strongly resisted.

• Which leads to greater mental rebound (i.e., more obsessions).

• Compulsions then negatively reinforce obsessions.

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Treatments for OCD

• EXPOSURE AND RESPONSE PREVENTION

(ERP)

1\. Clients are exposed to obsessions or cues

2\. Then refrain from their compulsions (ideally

until they habituate).

• Example: Put hand in the garbage,

but don’t wash hands.

• Gold standard treatment for OCD

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Cognitive Techniques for OCD

Thoughts are

just thoughts!

• Helping clients realize thoughts do not need to

suggest something highly meaningful,

important, or consequential.

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Lethality of Anorexia

 Anorexia is the deadliest psychological disorder

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Anorexia Nervosa

• Extreme food restriction & low weight largely due to fear of gaining weigh

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Symptoms of Anorexia Nervosa

• Significantly low weight

• Body Mass Index (BMI) under 18.5

• smartbmicalculator.com

• Most 25-30% below normal body weight

• From purposefully restricting food intake (intentional) 

Significantly low weight (Anorexia)

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Emaciation

Extreme thinness from starving

Fear of Gaining Weight

• Intense fear of becoming “fat”

• Fear that relaxing control over food

will lead to uncontrolled

over-eating

• Losing weight does not meaningfully

decrease their fear.

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Distorted Body Image

• Inaccurate perception of body size and shape

• Experience themselves as larger than

they really are

• Often deny their low weight is a

problem

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Egodystonic

• Most disorders are EGO-DYSTONIC:

• Inconsistent with the person’s ideal self-image

• Feelings, thoughts, or beliefs are viewed as

unwanted & undesirable.

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Egosyntonic

• Yet anorexia is dangerously EGO-SYNTONIC

• Consistent with the person’s ideal self-image

• Symptoms are acceptable and welcomed by the client

• Egosyntonic disorders are very hard to treat, because the

client actually values them

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