Abnormal Psychology Midterm - Frala
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209 Terms
Describe the diagnostic criteria for somatic symptom disorder
o 1+ somatic symptom that distress patient or disrupt daily life
o excessive towards symptoms or health concerns as manifested by one of the following
♣disproportionate and persistent thoughts about the seriousness of ones' symptoms
♣high level of anxiety about health/symptoms
♣excessive time/ energy devoted to symptoms/concerns
o state of being symptomatic is persistent (6+ months)
Identify a case description of a client with somatic symptom disorder
Margaret hated her job she had to get in a hospital cafeteria. One day she slipped and fell, the physician cleared her but she claimed to have chronic pain in her lower back & sometimes the abdomen. There were no signs of pain from tests ran but she filed for disability. Financials got so bad she had to move back in with her children
what is the prevalence rate of somatic symptom disorder (we will still be using the data from somatization disorder)
Rare. <5% or 6.6%(in medical setting)
what is the sex ratio for somatic symptom disorder (we will still be using the data from somatization disorder)
2:1 (women: men)
what is the age of onset for somatic symptom disorder (we will still be using the data from somatization disorder)
adolescence
what is the course for somatic symptom disorder (we will still be using the data from somatization disorder)
Chronic
Describe the treatment approach to somatic symptom disorder including the role of a primary physician
Difficult. Control health care costs by specific primary care physician acts as gate keeper. Can only go to specialist if physician allows
Describe the diagnostic criteria for illness anxiety disorder
(Hypochondriasis previously)
o Preoccupation with having or acquiring a serious illness
o No present somatic symptoms
o High level of anxiety about health
o Performs excessive health-related behaviors or maladaptive avoidance
o Preoccupation has been present for 6 months+ (specific feared illness may change over time)
o preoccupation is not better explained by other mental disorder
REMINDER: reassurance only helps for short periods of time.
Identify a case description of a client with illness anxiety disorder
Gale in a low SES, finds out husband is having an affair and then starts having concerns about anxiety/ stress. Complains of breathlessness= heart attack and headache = brain tumor. Trouble sleeping. Anytime she sees or hears of new illness, she is convinced she has it
List the prevalence rate, sex ratio, age of onset, and course of illness anxiety disorder (we will still be using the data from hypochondriasis
o prevalence rate: 6.7% (primary care setting)
o sex ratio: 1:1
o age of onset: adolescence, middle age, or after age 60
course: chronic
Discuss the cultural variations of illness anxiety disorder including Koro and Dhat
o Koro: China. Belief/ panic that genitals are retracting into the abdomen.
o Dhat: India. Anxious concern of semen loss
Describe the causal and maintenance factors associated with illness anxiety disorder
o Increased focus on illness cues
o Observational/informational learning: child tummy hurts. Mom let's stay home, it's a positive reinforcement. Find importance in what they said.
o Response to stressors that involve illness or death
Positive reinforcement
Describe the treatments used for illness anxiety disorder and the strength of the evidence supporting them.
o Some support for psychological interventions that includes in-depth explanation of symptoms or "exposures" to symptoms.
o There is less support for medication: placebo
Define depersonalization
o Temporary loss of the sense of one's own reality
o Ex: in a dream and watching self
Define derealization
o Temporary loss of the sense of reality of the external world
Ex: things change shape/ size. People seem dead or mechanical
Describe the diagnosis criteria for dissociative amnesia (including the subtypes
o 1+ episodes of inability to recall personal info (too extensive for normal forgetfulness)
o not related to a GMC, effects of substance, or other psyc disorder
o unable to recall causes significant distress or impairment
♣localized/selective: memory loss is limited to specific time frame/event. Usually traumatic
♣generalized: loss of all personal info incluing identity. Life-long or more recent time period
Discuss the causal and maintenance factors associated with dissociative amnesia
o Stress/trauma
o Secondary gain
Discuss the treatment strategies used with dissociative amnesia
o Fix stressful situation
o Fill details (pictures, stories)
o Coping skills training in stressful situations
Discuss the dangers of hypnosis as a treatment for dissociative amnesia
Can cause recall of false memories (not intentionally making up- filling in story)
Describe the diagnostic criteria of the type of dissociative amnesia known as dissociative fugue
o Sudden, unexpected travel from home or customary place of work, with inability to recall past
o Confusion about personal identity or assumption of new identity
o Not occur exclusively during the course of DID; not caused by a GMC or effects of a substance
o Significant distress/impairment
Describe the prevalence, age of onset, and course of dissociate fugue
o Prevalence: unknown
o Age of onset: puberty-age 50
o Course: may be chronic, recurrent episodes precipitated by stress
Describe the diagnosis criteria for dissociative identity disorder
o Prevalence of 2+ distinct identities, each with own relatively enduring pattern
o At least 2 identities recurrently take control of behavior
o Unable to recall personal info
o Not caused by GMC or effects of a substance
Define alter and discuss the different characteristics that each might possess (know the average number of alters for someone with DID)
o Average #: 15
o Alter: a distinct personality or identity
o Could be male or female at any age, contrast with primary, own history/self-image/identity
Discuss ways in which different alters can be identified through psychological testing and measurements
o Personality tests (MMPI)
o physiological measurements (skin responses, heart rate, response to diff tasks,etc)
o memory function
brain function
Discuss comorbidity associated with DID
High with other disorders
Describe causal and maintenance factors associated with dissociative identity disorder (especially the links to child abuse)
o Long-term psychotherapy
o Attempt to re-integrate personality
o Exposure to memories of and cues associated with the trauma
hypnosis
Explain the debate about the faking of DID and what the evidence suggests
o Hillside strangler; Kenneth Bianchi - famous serial killer in 70's. Faked illness. Steve admitted to doing killings. Told he has to have 3 and immediately produced a 3rd personality
o Iatrogenic: therapy treatment causing a faking
Differentiate between fear and anxiety
o Fear: intense emotion associated with activation of sympathetic nervous system. Heightened arousal. Immediate to danger
o Anxiety: how to avoid and have a reaction
Describe how fear and anxiety are both evolutionary useful and can cross over to disorder
o fear: defensive response that motivates protection from an imminent threat
o anxiety: preparatory response that motivates avoidance of impending threat
Know the statistics about the lifetime and year prevalence of anxiety disorders and the comorbidity with depression
o Lifetime: ¼ (28%) at some point in life
o Year: 18%; 40 mill American adults per year
o Comorbidity: with depression = 50%
Discuss the biological contributions to fear and anxiety including The role of GABA and how this works with the most common anxiety drugs:
lower levels when people are
anxious. Tranquilizes drugs
Discuss the biological contributions to fear and anxiety including The multifinality of serotonin and its relationship to both anxiety and depression:
SSRI's used to treat depression by blocking the re-uptake of serotonin
Discuss the biological contributions to fear and anxiety including The roles of the CRF and the HPA axis:
change ways we react to stress
Discuss the biological contributions to fear and anxiety including The limbic system and amygdala:
fight or flight, fear and aggression
Discuss the biological contributions to fear and anxiety including The theoretical construct of the behavioral inhibition system and its reaction to anxiety:
series of systems
activated in specific way to respond to danger.
Discuss the biological contributions to fear and anxiety including How the flight/fight system contributes to anxiety:
acts as bodily fire alarm
Discuss the role of generalized psychological vulnerabilities and how these vulnerabilities develop from early learning environments.
oLearned helplessness
oAsk for something, get to achieve satisfaction of needs; predict how parents will react to situations
understand uncontrollability
and unpredictability and how these create a predisposition for anxiety disorders (and mood disorders).
Uncontrollability & unpredictability: feel they can't cope with problems, can't guess what's next and if can then they can't do anything about it
Compare generalized psychological vulnerabilities with specific vulnerabilities.
o Early learning: parents who persistently act in positive
way; abuse, neglect
o Conditioning: classical, operant, vicarious
-Mom freaks out at spider= spiders are dangerous
Describe how specific psychological vulnerabilities form.
Describe Mower's 2 factor model of anxiety
Describe how Mower's 2 factor model moved the science forward by combining classical and
operant conditioning principles in a single model.
help explain escape and avoidance
central to anxiety.
Discuss the importance of avoidance as a negative
reinforce which perpetuates the maintenance of
anxiety and how the removal of avoidance forms the bedrock of behavioral therapy.
o No sympathetic activation when you avoid situations
o negative reinforcement with avoidance- by avoiding, they are playing into negative reinforcement because they don't have to go through the anxiety, thus making it more likely for them to avoid problematic situations
Identify the diagnostic criteria for specific phobia
o Persistent, excessive, unreasonable fear of a specific object or situation lasting 6+ months
o Immediate fearful or anxious response upon exposure to phobic object/situation
o Phobic situation or object is avoided or endured w intense anxiety/distress
o Fear is out of proportion w actual danger
o Significant stress/ impairment
what are the subtypes of specific phobias
o Animal/ insect:
o Natural environment:
o Blood injection injury: vasovagal response- drop in blood pressure (causes fainting)
o Situational:
o Other
List the prevalence rates, sex ratio, age of onset, and course for specific phobia.
o Prevalence: lifetime 12.5%; 1-yr 8.7%
o Sex ratio: 4:1
o Age of onset: Bimodal (typically in childhood or in
early 20's)
o Course: Chronic
Discuss the causes for specific phobias
o Direct experience
o False alarm
o Vicarious observation
o Information
o Biological vulnerability
Describe the treatment for specific phobia
o Systematic desensitization: gradually introduce fear
o Exposure/flooding: making them address fear and introduced to fear
Define Cognitive Behavioral Therapy (CBT)
Group of psychological treatments based on scientific evidence
Explain the 3 primary domains that make up CBT
o Your behaviors
o Your emotions
o Your thoughts
Discuss both the cognitive and behavioral
components to therapy
o Cognitive: thoughts and emotions
o Behavioral: how they act and what they do
Describe the information provided in the
supplemental CBT hand out about what CBT is.
Not a distinct therapeutic technique;
classification of therapies with similarities
what are the characteristics of CBT according to the CBT hand out
o based on cognitive model of emotional
response
o briefer and time-limited
o a sound therapeutic relationship is
necessary for effective therapy (not the
focus)
o collaborative effort between the therapist and the client
o based on aspect of stoic philosophy
o uses Socratic method
o structured and directive
o based on educational model
o rely on inductive method
o homework is a central feature
Identify the criteria for Generalized Anxiety Disorder
o Excessive anxiety/ worry occurring more days than
not for 6+ months
o Worry is difficult to control
o Associated with at least 3/6:
Restlessness/keyed up/on edge
Easily fatigued
Difficulty concentrating
Irritable
Muscle tension
Sleep disturbance
what are the common areas of worry associated with GAD
o Minor matters
o Work/school
o Finances
o Family
o Health
o Interpersonal relationships
o Community or world affairs
List the prevalence, age of onset, course, and associated information for GAD
o Prevalence: 1-yr: 3.1%; life-time 5.7%
o Age of onset: adulthood
o Course: chronic
o Common among middle-aged to older people
o Cross-cultural phenomenon
Discuss the causes of GAD
o Biological vulnerability
o Heightened sensitivity to threat
o Modeling of anxious/worry behaviors
Discuss the maintenance factors of GAD including The "function" of worry and its role as a negative
reinforce
o Serves as a negative reinforcement
o Vicious cycle
o Contrast effect
Discuss the maintenance factors of GAD including The contrast effect theory of GAD
o By worrying bring mood down a little bit and will
protect us from bad things.
o Trying to not be surprised when anxiety anf fear
come up
Compare and contrast the treatment options of GAD including the pros and cons for each and their relative efficacy.
o Medications
- Benzodiazepines- can become dependent on
them but eliminate anxiety in short term
- Anti-depressants
o Psychological - better long term but not as well as
medicine.
- Self-monitoring
- Exposure to worry images and uncertainty
- Relaxation training
- Acceptance-based interventions
Define the criteria for panic attack and be able to list all the possible symptoms
o Heart palpitations
o Sweating
o Trembling
o Chest pain/tightness
o Tingling sensations
o Fear of losing control
o Stomach distress
o Choking sensation
o Dizzy/light head
o Derealization
o Hot flash/chills
o Fear of dying
o Fear of going crazy
Distinguish panic disorder from panic attack and identify the criteria for panic disorder.
o Panic disorder: recurrent unexpected panic attacks,
1+ month of concerns about panic attacks
o Panic attack: not due to presence of another anxiety
disorder
List the prevalence, sex ratio, and age of onset for panic disorder.
o Prevalence: lifetime 4.7; 1-yr 2.7
o Sex ratio: 2/3 female
o Age of onset: bimodal (late adolescence or mid 30s)
Define introceptive cues and introceptive conditioning
Anything going on inside body; bodily sensations predict aversive event
Define anxiety sensitivity
Scared of own bodily sensations (ex: heart rate increase, sweating)
Discuss the role of classical conditioning in the
development and maintenance of panic disorder
Paired stimulus' with a biological response and thus cause avoidance of certain situations
Compare and contrast the treatment options for panic disorder including the pros and cons of each.
o Medication: highly addictive; many times, they will
stop taking medicine and relapse is very high
SSRI
Benzodiazepines
o Cognitive-behavioral therapy: better long-term
Panic control therapy
o Combined: no additional benefit of just cognitive
therapy; hurts therapy
Identify the diagnostic criteria for agoraphobia.
o Anxiety about having panic attack or symptoms in
situations from which escape is difficult or
embarrassing
o Avoidance of situations
o Out of proportion to actual danger
Identify the diagnostic criteria for social phobia.
o Fear of 1+ social/ performance situations where the
person is exposed to unfamiliar people or to scrutiny
by others, fear of being embarrassed
o exposure to feared situations will provoke anxiety or
panic attack
o avoidance of situations
o significant distress/ impairment
List the prevalence, sex ratio, course, cultural variations (more in your book) and age of onset for social phobia
o Prevalence: lifetime 12.1; 1-yr 6.8
o Sex ratio: 1.4: 1
o Course: chronic
o Cultural variations:
Japan: fear of looking into eye (male's higher
prevalence)
o Age of onset: adolescence (about 15 yrs old)
Discuss both the biological vulnerabilities and specific psychological vulnerabilities in social phobia.
o Biological vulnerability:
More likely to recognize angry face
Infant temperament
o Specific psychological vulnerability:
False alarm or true alarm (neg social event)
Modeling
Discuss cognitive-behavioral therapy for social phobia
o Systematic desensitization
Fear hierarchy
o Cognitive restructuring (all or nothing thinking)
o Include the use of a fear hierarchy and cognitive
restructuring (note that these tools are used in CBT
for many disorders)
Place fears in order for specific phobia, OCD, etc
Distress & avoidance rating
List the criteria for obsessive compulsive disorder
o Presence of either obsession or compulsions
o O or C cause marked distress, are time consuming, or
impairing
o Can be "with poor insight"
Define an obsession
Recurring thoughts, images, or impulses that are intrusive and inappropriate and cause marked anxiety/distress
Define a compulsion
Repetitive behavior or mental acts that the person feel driven to perform in response to an obsession, or according to a rigid rule
Outline the cycle of OCD and explain how the compulsions provide relief from the anxiety but also is then the avoidance that maintains the anxiety.
o Obsession- anxiety-compulsions- relief-repeat
o Relief because they aren't as worried about stressor but acting on it makes it become instinctual and feeds into obsessions
List the prevalence, sex ratio, course, and age of onset (including median age) of OCD
o Prevalence: lifetime 1.6; 1-yr 1%
o Sex ratio: 1:1
o Course chronic
o age of onset: childhood - 30s; median: 19 yrs
Discuss the causes for OCD
o Biological vulnerability
o Psychological vulnerability
o Early life experiences
Define the white bear effect
Idea of telling a person not to think about something, they automatically think about it, more we try not to think about it the more we think about it
Describe the gold standard exposure and response prevention as a treatment for OCD and compare its effectiveness to medication.
Exposure and response prevention: effective 75-80% of time. Attempt to break cycle by exposure and
allow them to create anxiety but prevent response/compulsion
List the criteria for posttraumatic stress disorder
o Witnessed or experience a traumatic or life- threatening event
o Symptoms from each of 4 clusters
o Symptoms for 1+ month
o Distress/ impairment
List the 4 symptom clusters of PTSD
o Re-experiencing
o Avoidance/numbing
o Negative alterations in cognition or mood
o Hyperarousal
Describe criteria A for PTSD
o Exposure to actual or threatened death, serious
injury, or sexual violence in 1+ ways:
Direct experience
Witnessing in person as it occurred
Learning that the event occurred to a close
family member/ friend
Experience repeated/ extreme exposure to
aversive details of event (ex: first responders)
Discuss the types of symptoms that make up each of the symptom clusters B-E.
o Re-experiencing
o Avoidance/numbing
o Negative alterations in mood/cognition
o Hyperarousal
List the prevalence, sex ratio, and risk factors of PTSD and the most common traumas associated by gender.
o Prevalence: lifetime 6.8; 1-yr 3.5
o Sex ratio: 2:1
o Most common in men: combat, witness to
injury/death
o Most common in women: sexual
victimization/assault/rape
Discuss the causes for PTSD including the role of classical conditioning
o Biological vulnerability
o Psychological vulnerability (uncontrollability/
unpredictability)
o True alarm
Discuss the treatment for PTSD
o Medication:
SSRI
o Psychological:
CBT (more specifically the gold standard)
Graduated or massed exposure & imaginal exposure
Allow processing of memory without avoidance
Learn the event will end and individual will be okay
List the criteria for major depressive disorder
o 5 or more of these for at least 2 weeks:
depressed mood most of the day*
anhedonia*
significant changes in weight
ongoing insomnia/hypersomnia
psychomotor agitation/retardation
fatigue/loss of energy
feeling worthless or excessive guilt
diminished ability to think/concentrate
recurrent thoughts of death or suicide; or suicide attempt
List the prevalence, sex ratio, age of onset, and course for major depressive disorder.
o Prevalence: lifetime 13-17; 1-yr 5-7
o Age of onset: adulthood
o Sex ratio: 2:1
o Course: 1 st episode usually 4-9 months, 90% remit within 5 years, 85% have multiple episodes
Define Persistent depressive disorder
o Depressed mood for most of the day, on most days
for a least 2 years
o "double depression"
List the prevalence, age of onset, sex ration and course for PDD
o Prevalence: lifetime 3.6; 1-yr 3.3
o Age of onset: adulthood sex ratio: 2:1
o Course: chronic
Define double depression
Full episode, when comeback they come back to a sad, dark, gloomy mood that's not AS low as they just were
Discuss causal and maintenance factors for MDD & PDD with the relationship to anxiety:
almost all depressed patients are anxious, but not all anxious patients are depressed
Discuss causal and maintenance factors for MDD & PDD with the Permissive hypothesis of serotonin:
when serotonin is
low other neurotransmitters are allowed to range widely causing problems (neurotransmitter party in
the house when serotonin- parent- is gone)
Discuss causal and maintenance factors for MDD & PDD with Cortisol:
over activity in HPA axis. Causing more stress & anxiety
Discuss causal and maintenance factors for MDD & PDD with Sleep patterns:
enter REM sleep more quickly,
sometimes don't his deep sleep if they do its way later than normal
Discuss causal and maintenance factors for MDD & PDD with Brain activity:
less alpha waves
Discuss causal and maintenance factors for MDD & PDD with Stressful life events:
usually death of loved ones is most stressful.
Discuss causal and maintenance factors for MDD & PDD with Learned helplessness:
depressive attributional style- blame self in stable and global; unwilling to try
Discuss causal and maintenance factors for MDD & PDD Cognitive triad:
self, world, future