Exam 2 - Adult Psychopathology

Suicide attempts and suicidal thoughts are relatively common among individuals living with

Anxiety disorders, depression, PTSD

Who is more likely to die by suicide: men or women?

Men

Which of the following social factors are key components of Joiner’s interpersonal theory of suicide?

Perceived burdensomeness

What is one key treatment goal that is focused on heavily during DBT for suicidal individuals?

Developing skills to regulate and tolerate emotions

Suicide definition

intentional, direct, conscious taking of one’s own life

Up to what percentage of people who contemplate suicide have a psychological diagnosis?

90%

Suicidal ideation is an official symptom of what disorder classified in the DSM?

Major Depressive Disorder (MDD)

Components of suicidality (3)

Suicidal thoughts/ideation, suicidal intent (desire), suicidal behavior (plan/attempt)

Spectrum of Suicidal Ideation (lower risk → higher risk)

1) Occasional thoughts about mortality/death w/ no ideation

2) Passive Suicidal Ideation (thoughts)

3) Active (Starting to think about a method/form plan)

4) Clear plan articulated to act

NSSI

Non-suicidal self-injury; direct/deliberate destruction of body tissues in the absence of any intent to die (e.g. cutting/burning)

Prevalence of NSSI? What group is prevalence highest in?

17-23% / Adolescents, especially female

Epidemiology of Suicide (U.S.)

Over 1.4 million adults make an attempt each year; rates have been increasing among all ages/gender/ethnic groups

What part of model explains why not every person attempts?

Gap between desire and behavior; capacity that builds pain tolerance is where we see difference

Globally, more than ___ people die to suicide every year

720,000

What percentage of suicides occur in low or middle income countries?

77%

Suicide Risk Factors (6)

Previous intent or attempt, substance use, depression, hopelessness, social isolation, easy access to lethal methods

Suicide Protective Factors (5)

Clear reasons for living, social support, strong emotion regulation and problem-solving skills, openness and access to treatment for mental health, restricted access to lethal means of suicide

Suicide rates for young people are at their highest since the 2000s. Why? (5)

Social media, substance use, bullying, difficulty accessing treatment, historical controversies around antidepressants for teens (concern of increase in thinking)

Suicide rates for older adult men are very high. Why? (Factors of increased risk)

Bereavement, declining physical health, social isolation, financial difficulties

Suicide Multipath Model: Psychological Domain

Joiner’s interpersonal model, focused on social connections

Joiner’s interpersonal model (3 components)

Perceived Burdensomeness: Feeling that others would be better without you, contributes to suicidal ideation & intent

Thwarted Belonginess: lack of connection with others, feeling the need to belong is not met

Acquired Capacity: Habituation to pain, fearlessness about death, prior suicidal behavior, contributes to attempt/death

Phrase someone experiencing perceived burdensomeness might say:

“People in my life would be better off if I was gone”

Phrase someone experiencing thwarted belongingness might say

“These days I feel disconnected from other people”

What component(s) of Joiner’s interpersonal model contribute to suicidal ideation & intent?

Perceived burdensomeness and thwarted belongingness

What component(s) of Joiner’s interpersonal model contribute to suicidal attempt or death?

Acquire capacity

Suicide Multipath Model: Social (Protective & Risk)

Protective: stable marriage/relationship makes suicide less likely; for women - having children

Risk: Divorced/separated/widowed; death of spouse associated with 50% higher suicide rate in men

Suicide: Leading cause

Firearms

Men make up 79% of all U.S. suicides. Why?

Means men choose to use makes them more likely to die (lethal)

Who experiences more suicidal ideation: men or women?

Women

Safety Planning / What is it? What level of risk is this effective for?

A brief, collaborative intervention to reduce suicide risk, builds a personalized step-by-step plan; moderate level of risk

Components of suicide risk safety planning (5)

(1) Recognize warning signs (2) Identify coping strategies (3) Identify supportive social contacts (4) Professional resources (5) Means safety/reducing access to lethal means

An individual with high risk of suicide will be addressed with…?

Hospitalization

High Risk of Suicide: Hospitalization / What does it involve?

Typically involves referral to a higher level of care (voluntary or involuntary); stabilize/ensure immediate safety, initiate treatment

Post-hospital discharge of a patient is a high-risk time in terms of suicide. Why?

Hospitalization does not remove risk factors

What type of therapy can be used to manage ongoing suicide risk?

Cognitive Behavioral Therapy (CBT)

CBT for managing ongoing suicide risk

Targeting underlying processes, often used after recent attempt or high-risk event

Components of CBT for managing ongoing suicide risk

Safety planning, coping and problem-solving skills, cognitive restructuring

CBT Key: Suicidal thoughts are ____ through ____ & ____ change

modifiable; cognitive; behavioral

Diagnosable eating disorders are not solely about body weight/size/shape but also…

Persistent symptoms, interfering with daily functioning & causing distress

Anorexia nervosa is characterized by…(3)

• Caloric restriction + low body weight

• Intense fear of weight gain

• Disturbance in body image (continue to insist one is overweight even when clearly underweight)

Anorexia’s two subtypes (+ description of each)

1) Restricting: weight loss through extreme dieting or exercising

2) Binge-eating/purging: self-induced vomiting, laxatives, or diuretics

Course of Anorexia Nervosa

Course is highly variable. Some recovery after one episode, others fluctuate between weight gain and relapse, others have chronic/deteriorating course.

Outcome of Nervosa Anorexia

Onset in adolescence is associated with more positive outcomes; high mortality rate in anorexia

Physical complications of Anorexia Nervosa

Irregular heart rate, low blood pressure, heart damage

Characteristics of Bulimia (3)

Recurrent episodes of binge eating followed by compensatory behaviors, self-evaluation strongly influenced by weight or body shape, typically of average weight

Compensatory behaviors seen following binge episode in Bulimia

Purging, excessive exercising, fasting

Cycle of Bulimia

Comparison of onset of Bulimia and Anorexia Nervosa

Bulimia begins in late adolescence or early adulthood; compared to early adolescence for anorexia

Is prognosis (course over time) more positive or negative in Bulimia compared to anorexia?

More positive

Binge-eating Disorder characteristics

Individual engages in binge-eating episodes (1/week for at least three months), experiences distress, but does not use compensatory behaviors

Characteristics of a binge episode (5)

Eating more rapidly than normal, uncomfortable feelings of fullness, eating large amounts of food even when not hungry, eating alone due to embarrassment, feeling depressed or guilt after bingeing

People with eating disorders often later develop ___

Other eating disorders

Two common diagnostic crossovers in eating disorders

Transition between 2 subtypes of anorexia, shift from anorexia to bulimia

Rare diagnostic crossover in eating disorders

Transition from bulimia to anorexia

Psychological Dimension of Eating Disorders

High perfectionism personality type (inflexibly high standards, negative self-evaluation after mistakes), distorted thinking related to weight/shape, difficulty with regulating emotions (anxiety, guilt, shame, sadness)

What personality type is commonly seen in anorexia and bulimia?

High perfectionism

Social Dimension of Eating Disorders

Families and peers often reinforce social messages about weight/shape (“fat talk”), appearance standards strongly influenced by social media (thin ideal internalized)

Among what group are EDs increasing in?

Men

Non-Western countries show increases in EDs after exposed to…?

Western cultural ideals

Biological Dimension of Eating Disorders

Genetics: 40-60% increased risk in first-degree relatives

Neurotransmitters: dysregulation in serotonin and dopamine

Brain circuitry: atypical activity in reward pathways (striatum) and cognitive control (prefrontal cortex)

Hormones: disruptions in leptin & ghrelin (fullness signal) and HPA axis

Neurotransmitters that are dysregulated in eating disorders + their role

Serotonin - mood and appetite, Dopamine - reward

Psychological Interventions for EDs

CBT and Family based interventions

How does CBT address EDs?

Establishing regular eating patterns, address distorted thinking, identify triggers, interrupt behaviors maintaining disordered eating cycles (especially bingeing / compensatory behaviors)

Family based interventions for EDs is especially effective for what group?

Adolescents

Medical Interventions for EDs

Weight restoration (gradual increase) and SSRIs

Why are SSRIs less effective for anorexia compared to bulimia and binge eating disorder?

Less effective when patients are low body weight

Describe the mesocorticolimbic pathway and its role in addiction

Like other rewards, substance activates this pathway. Dopamine is released with pleasure as the response. Chronic usage causes alterations in pathway

DSM-5 Criteria for Substance-Use Disorder: How many symptoms and for how long must these symptoms be present?

Two or more symptoms must be present for > 12 months

Broad symptom themes in Substance-Use Disorder (DSM-5)

Impaired control, social impairment, risky use, pharmacology

Substance Use / Impaired Control

Substance taken in larger amounts or longer than intended, unsuccessful efforts to cut down, time spent obtaining/using/recovering, craving or strong desire to use

“I’ll just have one drink” → ends up drinking all night. This is an example of what broad symptom in substance-use disorders?

Impaired Control

Substance-Use Disorder / Social Impairment

Failure to fulfill major obligations (school, work, home), continued use despite social or interpersonal problems, activities given up or reduced because of use

Skipping class or losing friends because of continued substance use is an example of what broad symptom category?

Social impairment

Substance-Use Disorders / Risky Use

Use in physically dangerous situations, continued use despite knowledge of physical or psychological harm

Drinking and driving despite worsening depression is an example of what broad symptom category of Substance-Use Disorders?

Risky Use

Substance-Use Disorders / Pharmacology

Tolerance ( need more substance for same effect OR diminished effect ), withdrawal ( characteristics symptoms emerge after period of non-use OR using substance to relieve withdrawal )

Substance-Use / Pharmacology Clarification

These can occur with medical use and don’t by themselves equal a disorder

DSM-5 Substance-Use Disorders Severity

Mild - 2 or 3 symptoms present, Moderate - 4 or 5 symptoms present, Severe - 6 or more symptoms present

Substances with multiple effects

• Nicotine - energy & relaxation felt; high addiction potential

• Cannabis - relaxation & euphoria; moderate addiction potential

• Ecstasy - feelings of connection & sensory distortions; moderate addiction potential; moderate addiction potential

• GHB - relaxation & euphoria; high addiction potential

Alcohol abuse cuts across all…

Age, educational, occupational, and socioeconomic groups

Lifetime prevalence for alcohol abuse in the U.S. is

18%

Alcohol Use Disorder is ___ as likely to be diagnosed in men compared to women

2x

More than 37% of alcohol abusers suffer from

at least one coexisting psychological disorder

Progression of substance use to disorder

Individual decides to experiment with drugs → drug begins to serve important purpose; consumption continues → brain chemistry becomes altered from chronic use and physiological dependence, withdrawal symptoms, cravings arise → lifestyle changes occur due to chronic abuse

Typical progression toward drug abuse/dependence chart

Psychological Dimension of Substance Use Disorders

Coping with psychological stress and emotional symptoms as a major motive for substance use and relapse

Two Pathways in Substance Use Disorder (Psych Dimension) & which is research more focused upon

1) Negative mood (depression, anxiety) → substance use*

2) Substance use → negative mood

Substance Use Disorders / Biological Dimension

Genetic factors account for disorders & vary by substance

____ dependence appears to have stronger genetic risk

Cannabis

Substance Use Disorder / Social Dimension (PPA)

• Parents - parental monitoring low / permissive attitude

• Peers - peer pressure / social norms (social media)

• Attitudes - desire to fit in / desire to rebel

In substance use disorders, relapse is ___

common

What helps recovery from Substance Use Disorders?

Combination treatment (therapy & medication), addressing comorbid conditions, stable life needs (employment)

Treatment for Substance Use / Behavioral Therapies

• CBT - changing behavior and thinking

• Motivational Interviewing - enhancing motivation to change

• Contingency Management - rewards for positive behavior change

Treatment for Substance-Use Disorders / Medications

Negative reinforcement for use, lessen cravings (ex. nicotine gum and patches)

Treatment for Substance-Use Disorders / Social support

12-step programs (AA, NA), family involvement

Gambling Disorder

Compulsive desire to engage in gambling activities, diagnosed when a person exhibits at least 4 defining characteristics in 12 months, ranges in severity, relatively uncommon

Internet Gaming Disorder

Condition involving excessive and prolonged engagement in Internet games; diagnostic criteria (withdrawal, tolerance, impairment, distress) similar to gambling disorder