Psychopathology exam 2

OCD

• massive list before landing on OCD

• 1.2% - 12 m/o

• 15% start symp. by 14

• more woman than men (slightly)

  • men have more likely childhood onset

• mean onset = 19.5 yr old

• rare to onset after 35

• higher in 1st relative (siblings, parent, children) - if relative has childhood onset you have 10x more likelihood to get it - sibling = 2x more

• consistent across countries b/c it’s biological

• avg symp. age = 11 y/o

• woman get it later

• ¼ people with ocd attempt suicide - must assess suicidal tendencies

• often comorbid

• obsessions - unwatned/intrusive anxiety about something - try to make it stop by doing something else

• compulsion - repetitive behavior people feel driven to, used to ease anxiety, makes things worse (compulsions becomes the problem)

• time consuming, impairment, distress, people w/ ocd embarassed by symp.

• striatum circuit - frontal cortex, basal ganglia is the caudate nucleas inhibits impulses - doesn’t work right = ocd, if not working right

• txt: cbt, exposure and response prevention, ssri’s

Body dysmorphia disorder (OCD)

• distorted perception of 1-4 part of the body

• slight or not observable to others

• social media is terrible for this

• repetitive behavior (mirror checking, skin picking, etc)

• clinically sig. distress or impairment in social settings

• cant be explained by ED

• can diagnose with muscle dysfunction (too big or small)

• good, poor, delusional

• 2.4% life time

• 2.5 W: 2.2 M

• 30% attempt suicide - 1/3

• onset at 16 y/o

• 12/13 y/o most common

• people w/ dis. who get: dermatology - 9-15%, plas. surg - 7-8%, orthodontic - 8%, 10% matiofacial surg.

• txt - ssri’s, cbt

• 3-8 hrs grooming/preocupation

hoarding disorder (OCD)

• difficulty getting rid of possessions, regardless of value, must save items, distressing if not

• 2.5% lifetime, increases with age, 3x higher in older adults

• causes distress with people around person

• can’t be explained by ocd, depression, schizo, alzheimers, autism

• specify with exessive aquisition

• good, poor, delusional

• assessing hoarding: Philidalphia hoarding scale, rate pictures with client present, is the __ unusable

• onset - 11-15 y/o

• higher on indesisiveness

• comorbid with depression and anxiety

• txt - cbt, depends on clients motivation, ssri’s

trichotillomania (OCD)

• 1-2% - 12m/o

• onset - 13 y/o

• 10x more W than M

• compulsion to pull out hair, sometimes people also eat the hair

• txt - habitual reversal training, don’t supress the compulsion, just run hands through hair instead - alternate behavior

excortiation (OCD)

• skin picking

• onset - 13 y/o (puberty)

• txt - habitual reversal therapy

• 1.4% - 12 m/o

• 75% woman

• more than one hour picking a day

medication/txt

SSRI/SNRI

50-80% lower symp. on meds

use meds + CBT

in rare cases ocd is attributed with having strep in childhood

cbt gets rid of negative thoughts about obsessions and irrational fears

compulsions start through operant conditioning

exposure and responsive prevention therapy is 60% effective

reactive attachment disorder (trauma and stress related disorder)

• in kids

• don’t know prevalence

• social neglect of babies and young children

• patterns of extreme insufficient care (social, emotional, and physical neglect)

• inhibited emotional withdrawn behavior to adults

• doesn’t seek comfort in adults and doesn’t respond to comfort

• social and emotional disturbance

• less positive emotions, irritable, sad, less emotional response

• not autism disorder

• before age of 5

• onset of 9 m/o

trauma is

an experience

disinhibited social engagement disorder (trauma + stress related disorder)

• in kids (can happen in adults - rare)

• approach and interact unfamiliar adults

• overally familiar behavior

• dont check back with caregiver

• willing to go with strangers

• cannot be ADHD - only socially disordered behavior

• because of social neglect/deprevation/interaction

• must be at least 9 m/o to get diagnosed

• can classify as severe or persistant

• dont know who to go to since neglected so they go to anyone

• dont know prevelance

• lower threat preception

• CBT

PTSD (post traumatic stress disorder) (trauma + stress related disorder)

• 3.5% - 12 m/o

• more woman than men b/c of sexual violence and womans likelihood to experience trauma

• depends on

  • proximity (happen to you or did you witness it)

  • severity (how intense was the event, SA, captivity, military combat (depends), ethnic/politcal motivated genocide/internment

  • frequency (how often)

  • W 7% more likely to be exposed to trauma

  • 1st respondents 10% get PTSD - witnessing scenes

  • 46% people experience SA, are diagnosed w/ PTSD

  • exper. repeated exposure to aversive details of trauma event (not included in social, media, movies, etc, unless related to work)

  • 1 or more intrusive symptoms

  • involve memory of event

  • dissociative reactions (5 senses)

  • physiological reaction to cues of event

  • dreams with event

  • intense prolonged psych. distress to internal and external cues

  • dont touch person

  • avoid situations associated with trauma (5 senses)

  • dissociative amnesia with events

  • negative beliefs about self/others (survival skill to gain control (if i do this, this will be fixed, short term help not long term)

  • blame self/others

  • neg emotional state

  • detachment

  • less interest in activites

  • less positive emotions/cant experience

  • destructive behavior

  • hypervigillence

  • exaggerated startle response

  • problem w/ concentrating

  • sleep disturbance

  • more than 1 month to get PTSD - clin impairment and distress

  • specify - depersinalization (detached from self), dissociation, derealization (unreality of sorroundings)

  • txt: SSRI, CBT, prolonged exposure therapy

Acute stress disorder (trauma + stress related disorder)

• diagnosed with if less than 1 m/o of PTSD symptoms

• interpersonal trauma - higher w/ woman

• can diagnose 3 days after event

prolonged grief disorder (trauma + stress related disorder)

• 1 year (12m/o) after death (1/2 year (6 months) for children)

• person close to person who died

• clinically significant or intense yearning for loved one

• preoccupied thoughts with person (kids obsess over how person died sometimes

• emotional numbness

• life = meaningless

• intense lonliness

• disbelief about death

• emotional pain

• difficulty reintegrating into life and difficulty in relationships

• not explained by PTSD, depression, other substance

• at least 3 of these symptoms 1 month everyday

• txt: CBT - must work out specifically what they are stuck on with the person - some people

Adjustment disorder (trauma + stress related disorder)

example: if parents go through a divorce and kid struggles with adjusting to it, resolves on its own usually

within 3 months of the event

txt: stress inoculation therapy, figuring out how to manage stress

Dissociative identity disorder (dissociative)

• 1.5 % - 12 m/o

• different memories, different behavior

• used to be called multi personality disorder

• 2+ personalities/conscious states

• 1.6 W: 1.4M

• over 70% attempt suicide

• individuals see lapses in time - not like normal forgetting, don’t even know where they are

• significant distress/impairment

• not normal or accepted in culture/religion

• hard to diagnose in kids b/c they make up people

• not due to substance

• survival technique

• childhood trauma by a family member

• comorbid with PTSD

• ability to dissociate is genetic - found in twin studies

• 1-6% inpatients get this

• more W than M

• txt: reintigration - make the world safe and put parts together, how they define being safe, become 1 person

dissociative identity disorders

uncommon

caused by extreme trauma/harm

dissociative amnesia (dissociative)

• dont know who they are or any autobiographal info about self

• distortion / impairment

• forget specific events

• not substance, medication disorder

• specify w/ dissociate fungue - purposful travel, wandering association with amnesia for identity for other important autobio. info.

• 1.8% , 12m/o per type of amnesia

• 2.6 W: 1 M

types of amnesia

psychogenic: caused by psychological factors, retrograte (forgets past memories, only often for personal information not general), doesn’t include anterograde amnesia

organic: bio factors (disease, head trauma, drugs), anterograde, can involve retrograde (usually for both personal and general information)

depersonalization/derealization disorder (dissociative)

• 2% lifetime prevalence

• ½ adults experienced in life - but not disordered

• persistent/reoccurring experience of dep.(detached from body)/der.(everything else feels unreal)

• during episode reality testing remains in tact (knows who and where they are)

• caused from childhood emotional, physical, or sexual abuse (usually emotional) - less severe than other dissociative disorders (physical/sexual)

• distress/impairment

• not from substance - usually hallucinogenic

• not another mental disorder (schizo, panic, depression, ptsd)

• txt - grounding technique, holding ice, breathing, knowing where feet are, knowing what makes episodes happen

• 5% get onset after 25 - 95% before 25

• very rare to get past 40

• if co-morbid w/ depression then SSRI’s

Disruptive mood dysregulation disorder (depression disorders)

• in kids

• must be less than 12 to diagnose (over 6 under 18)

• irritability behavioral discontrol

• usually ends up with depressive or bipolar diagnosis later on

• don’t know prevelence for sure - 2-5% in one year?

• higher in boys

• must be in 3+ settings (school, home, sports)

• usually comorbid with other diagnoses

• reocurrent temper outbursts at least 3 times a week

• inconsistent with developmental level

• mood is irrational and angry

• 12+ months without a 3 months break

• onset - 10 years

• mood not during MDE

• must rule out trauma disorder - adjustment/reactive dis

depression + bipolar chart

page 10

persistant/dysthymia disorder

2 years of persistent low mood

can function but barely

(some have MDD and dysthymia)

moods aren’t caused by a specific event

major depressive presentation

adults:

• 21 million adults have 1 MDE

  • 8.3 million US adults

• highest in agest 18-25

• females - 10.3% - males 6.2%

teens:

• 5 mill 1 MDE

• 20.1 - 12-17 year olds have 1 MDE

• more female than male

• higher in people who identify with 2+ races

risk factors:

• genetics

• personality

• traumatic events

• history of other disorders

• substance abuse

• chronic illness

• medications

Noah kahan

• diagnosed as a child

• started busyhead project for MDD advocacy

• depressed mood, low interest, insomnia, worthlessness

• SSRI’s, therapy

• went off medication b/c he thought it blocked his creativity (went back on)

• as his fame went up his health went down

lady gaga

• since 7th grade

• fatigue, worthlessness, suicidal thoughts

• medication, art, therapy, CBT, DBT, radical acceptance

• LGBTQ awareness

• suicidal thoughts

bipolar presentation

• mood disorder

• 1 manic episode lasting 1 week/hospitalization

• higher self esteem, less sleep, more talking - manic

• depressive episode, same as MDD

kanye west

• diagnosed 2016 - @39

• BPD 1

• inconsistent treatment

• hospitalized by risky behavior

• positives: his “superpower”

• negative: bad relationships

carrie fisher

• BPD 1 @ 24

• accepted @ 28

• substance abuse - b/c of bipolar

• released many books about BPD and substance abuse

• advocacy

• struggled to accept self