psychopathology exam

anxiety

a general negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future; similar to fear, can work in our favor by activating our autonomic NS (fight or flight), involves negative affect, somatic symptoms (tension), future-oriented, feelings of a lack of control

fear is about the present (sympathetic), anxiety is about the future (autonomic)

what is the main difference between fear and anxiety?

panic attack

an abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and possibly dizziness; fear that occurs at an inappropriate time, can be cued or uncued

behavioral inhibition system (BIS)

biological cause of anxiety that is activated by unexpected events, signals from the cortex to the septal-hippocampal system and amygdala

fight/flight system

biological cause of anxiety that is involved in panic; travels through the amygdala, ventromedial nucleus of the hypothalamus, and central gray matter

bio- genes, brain circuits (noradrenergic, CRF), low GABA, limbic system

psych - lack of control, anxiety, sensitivity, fear responses

what are some of the biological (4), psychological (3), and social (1) causes of anxiety disorders?

psych- lack of control, anxiety sensitivity, fear responses

social- stressful life events

what are some of the biological (4), psychological (3), and social (1) causes of anxiety disorders?

generalized biological vulnerability, generalized psychological vulnerability, and specific psychological vulnerability

what are the 3 main components of the integrative model/Barlow's model/triple vulnerability model of psychological disorders?

depression (50%), physical disorders (thyroid, respiratory, etc), and suicide (20%)

what are some disorders that are comorbid with anxiety and panic disorders? (3)

GAD, panic disorder (& agoraphobia), specific phobias, SAD, separation anxiety disorder, selective mutism

what are the 6 main anxiety disorders covered in the chapter?

social anxiety disorder (SAD)

anxiety disorder that involves extreme and irrational fear with social/performance situations, significant impairment, and avoidance or distressed endurance; equal risk for males and females, common in young adults, undereducated, single, and low SES, 12.1% of pop (2nd most common)

bio- tendency for social inhibition or anxiety

gen psych- belief that stressful events are uncontrollable

specific psych- learned that social evaluation is dangerous

what are the general biological, general psychological, and specific psychological factors for social anxiety disorder?

no alarm (ex. thinking you are awkward), false alarm (ex. thinking everyone is watching you), true alarm (ex. bullying)

what are the 3 kinds of alarms often present in anxiety disorders (ex. SAD)?

cognitive therapy for automatic perceptions of danger, interpersonal psychotherapy (IPT), CBT, family-based intervention, SSRIs (Paxil, Zoloft, Effexor)

what are some of the main treatments for social anxiety disorder (SAD)? (5)

SAD- adding medication to therapy is no better than using one or the other

panic- therapy plus medication is ideal (except for benzodiazepines)

how does the relationship between using psychotherapy and medication for treatment of SAD differ from treatment of panic disorder/agoraphobia and mood disorders?

generalized anxiety disorder (GAD)

anxiety disorder that involves worry about minor, everyday concerns, shifts in concerns, problems with sleeping, concentration, and irritability, excessive worry, inability to control worry, tension, fatigue, less physiological than other disorders; common in females, early adulthood for onset, gradually onsets, older adults

anxiety sensitivity

an inherited tendency to become distressed in response to arousal related sensations; biggest risk factor for GAD

benzodiazepines (best for short term), CBT, meditation and mindfulness

what are the main treatments for GAD? (3)

panic disorder (and agoraphobia)

anxiety disorder that involves unexpected (uncued) panic attacks, anxiety, worry, or fear of another attack and its consequences; common in women, young adults, and Americans, expressed differently in different cultures

agoraphobia

fear or avoidance of situations/events in which a person feels unsafe or unable to escape back to their home or to the hospital; stems from panic disorder, culturally/socially influenced, interoceptive avoidance

interoceptive avoidance

avoidance of internal physical sensations; characteristic of agoraphobia

nocturnal panic

form of panic disorder that involves panic attacks that occur while one is asleep, that aren't the result of nightmares; involves sleep terrors, isolated sleep paralysis, sleep apnea, etc.

history of physical disorders, anxiety about health, childhood separation anxiety

what are the main bio/psych vulnerabilities for panic disorders? (3)

medication (benzodiazepines, SSRIs, SNRIs), exposure-based therapy, relaxation-based coping methods, panic control treatment (PCT), CBT, booster sessions after therapy completion

what are the main treatment approaches for panic disorders? (6)

panic control treatment (PCT)

treatment method for panic disorders that involves exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks

specific phobia

anxiety disorder that involves an irrational fear of a specific object or situation that markedly interferes with an individual's ability to function; 12.5% of pop (most common), 4 major subtypes, common in females, younger ages, and Hispanics

direct experience, experiencing a false alarm in a specific situation, observing someone else experiencing severe fear, or being told about danger

what are the 4 main causes of a specific phobia?

blood-injection-injury phobia, situational phobia (ex. claustrophobia), natural environment phobia (ex. heights, storms, water), animal phobia

what are the 4 major subtypes of specific phobias?

structured and consistent exposure treatment

what is the main treatment approach for specific phobias?

separation anxiety disorder

anxiety disorder that involves children's unrealistic and persistent worry that something will happen to their parents or other important people in their life, or that something will happen to the children themselves that will separate them from their parents; 4.1% of children have this

parents help structure exercises, and the therapist may talk the parents through what to do/say when the child resists separation

what are the main treatment approaches for separation anxiety disorder? (2)

selective mutism (SM)

anxiety disorder that is a rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected

CBT similar to social anxiety but with a greater emphasis on speech

what is the main treatment approach for selective mutism?

OCD, hoarding disorder, body dysmorphia, trichotillomania, and excoriation

what are the 5 main obsessive-compulsive and related disorders mentioned in the chapter/

obsessive-compulsive disorder (OCD)

disorder that involves obsessions (intrusive and nonsensical thoughts, images, or urges and attempts to resist or eliminate) and compulsions (thoughts or actions to suppress obsessions and provide relief); around 2% of the population, may create a tic disorder, may involve thought-action fusion

brain regulation of intrusive thoughts (bio) and early learning that intrusive thoughts are unacceptable or dangerous (psych)

what are the general psychological and biological vulnerabilities for OCD?

performing the compulsive behavior strengthens the specific psychological vulnerability

how do compulsive behaviors relate to the psychological vulnerabilities for OCD?

symmetry, forbidden thoughts/actions, cleaning and contamination, hoarding

what are the 4 major types of obsessions with OCD?

thought-action fusion

a tendency for patients with OCD to equate thoughts with the specific actions/activities represented by the thoughts (ex. believing that thinking about murdering someone is just as bad as actually murdering someone); often comes from excessive responsibility in childhood

exposure and response prevention (ERP), medication (clomipramine, SSRIs), psychosurgery (lesion cingulate or deep brain stimulation (DBS))

what are the main treatment approaches for OCD? (3)

exposure and response prevention (ERP)

treatment method for OCD where the patient's rituals are actively prevented and the patient is systematically and gradually exposed to the feared thoughts or situations; during exposure, the patient is not allowed to perform their compulsive behavior

body dysmorphic disorder (BDD)

disorder that involves the preoccupation with some imagined defect in appearance by someone who actually looks reasonably normal; persistent thoughts about appearance (obsession) and constantly looking in mirrors (compulsion)

medication (clomipramine, fluvoxamine (SSRIs), Prozac), exposure and response prevention (ERP)

what are the 2 main treatment approaches for body dysmorphic disorder (BDD)?

hoarding disorder

disorder that involves an excessive acquisition of things, difficulty discarding anything, and living with excessive clutter under conditions best characterized as gross disorganization

CBT

what is the main treatment approach for hoarding disorder?

trichotillomania

disorder that involves the urge to pull out one's own hair from anywhere on the body, including the scalp, eyebrows, and arms

excoriation

disorder that involves repetitive and compulsive picking of the skin, leading to tissue damage

habit reversal training

what is the main treatment approach for trichotillomania and excoriation?

post-traumatic stress disorder (PTSD)

disorder that involves exposure to actual or threatened death, serious injury, or sexual violence (criterion A), and symptoms from other clusters including re-experiencing symptoms, avoidance, mood/cognitive changes, and hyperarousal; dependent on true alarms rather than false alarms

re-experiencing symptoms (ex. vivid dreams), avoidance, mood or cognitive changes, hyperarousal

what are the 4 main symptom clusters for PTSD (other than exposure to threat and 1 month minimum symptom duration)?

PTSD, delayed onset PTSD, acute stress disorder, adjustment disorders, attachment disorders

what are the 5 main trauma and stressor-related disorders mentioned in the chapter?

delayed onset PTSD

disorder where individuals may show few or no symptoms immediately or even for a few months after a trauma, but then suddenly develop full-blown PTSD

move from avoidance of the feared stimuli to a feeling of relative neutrality (both feelings will always be there, but ideally neutrality will be stronger)

what is the main goal of treatment for PTSD and other trauma disorders?

fear learning readily generalizes, safety learning is context dependent (takes time)

in relation to trauma disorders, what is the difference between fear learning and safety learning?

acute stress disorder

disorder that is similar to PTSD, but with a severe reaction that some people have immediately following their trauma; good predictor for who will develop PTSD

exposure hierarchy

the list of rather specific feared stimuli that a patient will confront during therapy for trauma disorders

catharsis, imaginal exposure (systematic), cognitive therapy (for self blame, etc.), medication (SSRIs, DCS)

what are the main treatment approaches for trauma disorders? (4)

adjustment disorders

disorders that involve anxious or depressive reactions to life stress that are generally milder than one would see in acute stress disorder or PTSD, but that are still impairing in terms of interfering with work or school performance, interpersonal relationships, or other areas of living

attachment disorders

disorders that involve disturbed and developmentally inappropriate behaviors in children, emerging before 5 years of age, in which the child is unable or unwilling to form normal attachment relationships with caregiving adults; can be reactive or disinhibited, often the result of early persistent harsh punishment and other similar child-rearing practies

reactive attachment disorder

attachment disorder where a child very seldom seeks out a caregiver for protection, support, and nurturance, and will seldom respond to offers from caregivers to provide this kind of care

disinhibited social engagement disorder

attachment disorder that involves a pattern of behavior in a child where they show no inhibition whatsoever to approaching adults

somatic symptom disorder, illness anxiety disorder, psychological factors affecting medical condition, conversion disorder, factitious disorder

what are the 5 main somatic symptoms and related disorders mentioned in the chapter?

somatic symptom disorder

somatic disorder that involves excessive thoughts, feelings, and behaviors related to somatic symptoms for more than 6 months, that distresses/disrupts daily life; leads to overuse of medical services, caused by enhanced sensitivity to illness cues, stressful life events, growing up with lots of disease in the family, social influences (sick role), common in women and adolescents

CBT, psychoeducation/explanatory therapy, exposure therapy, medication (antidepressants)

what are the main treatment methods for somatic symptom disorders? (4)

illness anxiety disorder

somatic disorder that involves unwarranted fears about a serious illness despite absence of any significant symptoms; very similar to somatic symptom disorder, just without any physically present symptoms

prone to neuroticism and negative emotions, catastrophizing, and health concerns

what is the main bio/psych vulnerability for somatic disorders?

psychological factors affecting medical condition

somatic disorder that involves psychological distress caused by a severe medical condition that actually worsens that medical condition (ex. a patient with diabetes refusing to check their insulin levels regularly, putting themselves at greater risk)

conversion disorder

somatic disorder that involves neurological symptoms that cannot be explained by medical disease (ex. paralysis, blindness, difficulty speaking, etc.); may be caused by severe stress/trauma, repression making the conflict unconscious, anxiety trying to move into consciousness (converting to physical symptoms), and social and cultural factors

how much the patient is willing to buy into the techniques

for conversion disorder, what determines how effective identifying traumatic life events and creating stress management will be as a form of treatment?

malingering

intentionally faking psychological or somatic symptoms to gain from those symptoms (ex. for insurance/disability or other medical accommodations, not so much for attention seeking)

factitious disorder

somatic disorder that is the voluntary falsification of psychological or physical symptoms, without evidence of gain from those symptoms (ex. no obvious reason for producing symptoms other than maybe for attention); best identified by whether symptoms improve when separated from other people, can be imposed on another person (Munchausen by proxy)

depersonalization-derealization disorder, dissociative amnesia, dissociative identity disorder (DID)

what are the 3 main dissociative disorders mentioned in the chapter?

depersonalization-derealization disorder

dissociative disorder that involves feelings of unreality that are so severe and frightening that they dominate an individual's life and prevent normal functioning; common in adolescents, and people with anxiety, mood, and personality disorders

derealization

when a person's sense of reality of the external world is lost; people may seem mechanical, things may appear to change in shape/size, etc.

dissociative amnesia

dissociative disorder that involves a lack of conscious access to memory, typically of a stressful experience; most common dissociative disorder, memory deficits are in explicit memory rather than implicit memory, onset in adulthood

dissociative fugue

specific form of dissociative amnesia that involves memory loss revolving around an unexpected trip (not knowing how you ended up in a certain place)

dissociative identity disorder (DID)

dissociative disorder that involves at least 2 distinct personalities (alters) that act independently of each other; on average 15 identities coexisting, each has unique modes of being, thinking, feeling, acting, memories, and relationships, onset in childhood but diagnosed in adulthood, more common in women, not related to schizophrenia

posttraumatic model and sociocognitive model

what are the 2 main models of the causes of dissociative disorders (specifically DID)?

posttraumatic model

model of DID that claims that it is caused as a result of severe psychological and/or sexual abuse in childhood (most common explanation)

sociocognitive model

model of DID that views it as a form of role-play in suggestible individuals, occurs in response to prompting by therapists or media, no conscious deception

long term therapy for reintegrating identities, identifying triggers, talking about trauma, hypnosis

what are the main treatment approaches for dissociative identity disorder (DID)?

major depressive episode

an extremely depressed mood state that lasts at lease 2 weeks and includes cognitive symptoms (ex. worthlessness) and disturbed physical functions (ex. sleep patterns)

hypomania

a less severe form of mania that does not cause marked impairment in social or occupational functioning

mixed symptoms

the concept of experiencing manic symptoms with some feelings of depression, or vice versa

major depressive disorder (MDD), persistent depressive disorder (PDD), premenstrual dysphoric disorder (PMDD), disruptive mood dysregulation disorder

what are the 4 main depressive disorders mentioned in the chapter?

major depressive disorder

depressive disorder that involves 5 or more depressive symptoms, including sad mood or loss of pleasure/interest in normal activities, for at least 2 weeks; onset in adolescence and early adulthood, affects 18-20% of the population

persistent depressive disorder (PDD, dysthymia)

depressive disorder that involves sad mood and at least 2 other symptoms of depression at least half of the time for 2 years; symptoms usually start to decrease on their own

recurrent major depression

persistent depressive disorder

double depression

chronic major depression episode

major depression episode with partial remission

recurrent major depression without full interepisode recovery

what are the 6 main cycles/courses of depression?

peripartum onset, seasonal pattern, psychotic features, anxious distress, mixed features, melancholic features, atypical features, catatonic features

what are the 8 notable specifiers of the course of depressive disorders (and bipolar disorders)?

normal grief, integrated grief, and complicated grief

what are the 3 main forms of grief?

premenstrual dysphoric disorder (PMDD)

depressive disorder that involves increased depressive and related symptoms in females during the week before their menstrual cycle begins