Abnormal Psychology: Exam 2 (Anxiety, Obsessive-Compulsive, Trauma/Stress, Somatic Symptom, and Mood Disorders)

generalized anxiety disorder (GAD)

anxiety disorder characterized by excessive worry; source(s) may be vague or numerous; criteria include:

• restlessness

• fatigue

• irritability

• sleep disturbance

• symptoms lasting at least 6 months

cognitive perspective of GAD

~GAD is caused by thought distortions

• “people are going to judge me”

• “I can’t do this”

• “If I don’t do this perfectly, it will be horrible, awful and catastrophic”

metacognitive theory

the theory that the biggest problem in GAD = individual’s worry about worrying

• “Not only am I worried about my exam, but I am worried about worrying about my exam”

intolerance of uncertainty theory

the theory that one with GAD finds it unacceptable that negative events may occur, even if the possibility is small; they worry in an effort to find “correct” solutions

avoidance theory

the theory that worrying serves a “positive” function for those with GAD by reducing expsoure to situations with high levels of arousal

biological perspective of GAD

~GAD is caused by biological factors

• heightened reactivity to emotional stimuli in the amygdala; GABA (inhibitory NT) deficiency

• modest heritability; biological relatives are around 15% more likely to have GAD vs. the general population

overview of GAD treatment

• behavioral treatments

  • relaxation training and biofeedback; meditation, breath counting, etc.

• biological treatments (medication)

  • anxiolytics, benzodiazepines (valium, xanax)

  • antidepressants (prozac); blunting effect

• both are more effective when combined with cognitive therapy

• studies have failed to offer strong support for psychodynamic or client-centered (humanistic) treatment approaches

phobias

anxiety disorder characterized by disproportionate fear reactions to threats; fear of specific objects/situations → triggers immediate fear upon exposure

• affects 10% of adults

overview of causes of specific phobias

• learned through classical conditioning; remember the Little Albert experiment

• selectivity: most common phobias involve highly restrictred sets of objects

  • knives, firearms, electrical outlets

overview of specific phobia treatment

• medication is not helpful; behavioral techniques are more effective

• systematic desensitization: process of gradual exposure with the aid of relaxation techniques (such as breathing exercises)

  • creation of an “anxiety hierarchy;” a client starts with a low anxiety situation and progresses to a very high one while practicing the relaxation technique

• flooding: non-gradual exposure, the opposite of systematic desensitization

social phobias

anxiety disorder characterized by a fear of social or performance situations where embarrassment may occur

• specific or general

• more common in women

• develops in early preschool or adolescence

• biological factors include

  • heritability is around 45%

  • linked to excessive production of norepinephrine in the locus coeruleus

social phobias

anxiety disorder characterized by a fear of social or performance situations where embarrassment may occur

• specific or general

• more common in women

• develops in early preschool or adolescence

• biological factors include

  • heritability is around 45%

  • linked to excessive production of norepinephrine in the locus coeruleus

panic disorder

anxiety disorder characterized by a history of at least one panic attack and the fear of subsequent attacks

• often accompanied by agoraphobia: fear of locations which escape may be difficult or help is unavailable

  • people typically develop agoraphobia in their 20s or 30s

panic attacks

bouts of panic that appear suddenly, reach a peak, and pass

• comes with fear of dying or losing control

• occurs in absense of a real threat

• physiological symptoms include dizziness, nausea, heart palpitations, shaking, and depersonalization

overview of panic disorder treatment

• cognitive approach

  • normal bodily changes are viewed as a sign of medical catastrophe; clients are educated about anxiety and are taught healthy coping mechanisms

  • 80% of clients become panic-free for 2 years

  • As helpful as antidepressants, but a combination of therapy and medication may be most effective

• biological approach

  • antidepressants reduce panic attacks by 80%

  • benzodiazepines (valium, xanax) mimic action of GABA

  • considation of a genetic component; concordance rates:

    • identical twins: 31%

    • fraternal twins: 11%

obsessive-compulsive disorder (OCD)

disorder comprised of obsessions and compulsions

• obsessions: defined as persistent, anxiety-inducing thoughts

  • common themes include hygiene and orderliness

• compulsions: defined as repeated behaviors/mental acts (rituals) performed to reduce anxiety caused by obsessions

  • common forms/themes include cleaning, double/triple checking things, finding order or balance, needing to touch things, verbalizing thoughts, counting

biological perspective of OCD

~OCD is linked to low serotonin activity in the orbitofrontal cortex (OFC) and overactivity of caudate nuclei

• serotonin-based antidepressants (SSRIs) increase serotonin and have a quieting effect on the OFC and caudate nuclei, reducing OCD symptoms

• concordance rates:

  • identical twins: 53%

  • fraternal twins: 23%

cognitive perspective of OCD

~OCD is due to:

• beliefs in “magical thinking;” compulsive behaviors or thoughts will ward off danger

  • “what will happen if I don’t ____?” (perform mental or physical ritual)

• blaming oneself for normal thoughts under expectations that terrible things will happen

  • typical thinking of strongly religious people who are fixated on forbidden (but normal) thoughts and transgressions

  • there may be beliefs that having forbidden thoughts is the same as acting on it

• attempts to neutralize “bad” thoughts with other actions/thoughts

overview of OCD treatment

• behavioral approach

  • exposure and response prevention (ERP): involves exposing a client to an anxiety-producing stimulus (dirtiness, disorderliness, etc.) and preventing them from responding with compulsive behaviors

    • the therapist will model the act of excessive uncleanliness, then ask a client to do the same

  • yields successful results; 70% of clients improve considerably with ERP, and improvements often. continue indefinitely

• biological approach

  • pharmacological therapies typically involve serotonin-based antidepressants (SSRIs)

    • prozac, paxil, lexapro

    • significant improvement; 50-80% of patients improve

  • still, there are better ways to get at the root of the problem instead of purely medicating a client

overview of OCD-related disorders

• hoarding disorder

• hair-pulling disorder

• excoriation (skin-picking) disorder

• body dysmorphic disorder

body dysmorphic disorder (BDD)

obsessive-compulsive disorder characterized by an extreme concern over an imagined or minor defect in one’s appearance; facial features or body parts

overview of BDD treatment

• biological approach: antidepressants (SSRIs)

• cognitive approach: restructuring way of thinking, challenging irrational thoughts

• behavioral approach:

  • ERP

  • seeing your exaggerated appearance in virtual reality vs. seeing yourself in real life

stress

a complex reaction to external events and the demands of living; two components:

• stressor: event-creating demands

  • can be positive or negative

  • differs in severity

  • differs in amount of personal control

• stress response: reactions to the demands of the stressor

  • stressor is perceived

  • results in fight/flight response

autonomic nervous system

the involuntary branch of the peripheral nervous system and comprises the sympathetic and parasympathetic nervous systems

sympathetic nervous system

a branch of the autonomic nervous system that stimulates key organs; associated with fight or flight

• increases blood pressure, stimulating skeletal muscle, pupil dilation, etc.

• *it is harmful to always be in a fight or flight state

parasympathetic nervous system

a branch of the autonomic nervous system that returns the body to a normal, calm state; associated with rest and digest(ion)

endocrine system

organ system responsible for hormone seecretion and comprises the relevant hypothalamic-pituitary-adrenal (HPA) pathway for flight/flight response

overview of the hypothalamic-pituitary-adrenal (HPA) pathway

1. the hypothalamus receives info from the amygdala → HPA pathway activation or intensifaction of stress response

2. the pituitary gland releases chemical signals to stimulate the adrenal glands

3. in the adrenal glands:

   1. the adrenal cortex releases cortisol to trigger stress response

   2. the adrenal medulla releases epinephrine (adrenaline) and norepinephrine (noradrenaline) to increase arousal and trigger fear response

• The prefrontal cortex and hippocampus (brain region associated with memory) can have inhibitory/regulating effect on HPA pathway activation, thus decreasing intensity of stress response

posttraumatic stress disorder (PTSD)

anxiety disorder characterized by the following components:

• exposure to a traumatic event; actual or threatened serious injury to self or others

  • combat, natural disasters, SA/physical abuse

• re-experiencing of the event through nightmares, intrusive thoughts, flashbacks, etc.

• avoidance of places and memories

• increased arousal: hypervigilance, insomnia

  • a veteran may still believe they’re in a combat situation

  • negative changes in thought/mood; self-blame, guilt, remorse

    • “I am a bad person,” “I am responsible for the traumatic event happening to me”

overview of diagnosis of stress disorders

• acute stress disorder (ASD): symptoms are evident from 3 days to a month after exposure of extreme severity

• PTSD: symptoms last at least a month after stressor of extreme severity

• adjustment disorder: symptoms arise within 3 months of exposure to stressor of any severity

• each cause the same symptoms

overview of PTSD neuroscience

• overactive amygala: determines emotional reaction to stimuli; is overactive in patients with PTSD and responsible for heightened arousal

• underactive prefrontal cortex: lowered regulation/dampening of emotional reactivity in patients with PTSD

• hippocampus shrinkage: cortisol, the stress hormone, released by adrenal glands can cause damage to the hippocampus, which impairs memory; may explain

  • memory loss for some or all trauma

  • dissociation experiences

  • difficulty in resetting fear response to normal levels

  • impaired ability to remember when things are okay

overview of PTSD prognosis

• 50% of adults with PTSD improve within 3 months

• 50% of adults with PTSD have persistent symptoms for over a year

overview of PTSD treatment

• strongly recommended treatment approaches

  • cognitive-behavioral approach: focuses on changing patterns of behaviors, thoughts, and feelings related to trauma-related memories

  • prolonged exposure approach: individuals repeatedly share trauma-related memories, and over time, memories and cues become less intense and no longer need to be avoided

• conditionally recommended treatment approaches

  • medication: includes all SSRIs (paxil, prozac, zoloft, effexor)

  • eye movement desensitization and reprocessing (EMDR) therapy: the patient briefly focuses on a traumatic memory while simultaneously experiencing bilateral stimulation (typically eye movement) associated with a reduction in intensity of emotion associated with trauma

  • “breakthrough therapy” designation: MDMA-assisted psychotherapy; aids in dampening fear response to traumatic memories, helping patients process trauma

somatic and related disorders

disorders where symptoms appear to be physical/medical but are due to psychological factors; typically in response to traumatic events or chronic stress

functional neurological symptom disorder

somatic related disorder characterized by paralysis, blindness, and numbness; occurs without medical basis, simply caused by stress/anxiety

somatic symptom disorder

somatic related disorder characterized by somatic symptom(s) (physical pain, GI distress, fatigue) that result in significant distress; severe anxiety about symptoms

illness anxiety disorder

formerly “hypochondriasis,” a disorder describing severe anxiety about having an illness despite somatic symptoms not being present or mild in intensity; individual has an unrealistic interpretation of bodily symptoms as signs of serious illness

overview of somatic symptom disorder vs. illness anxiety disorder

• somatic symptom disorder: real symptoms are present

• illness anxiety disorder: no real symptoms are present (or symptoms are mild); severe anxiety is associated with the mere idea of being ill

factitious disorder

the faking of symptoms due to a desire/wish to be a patient; “just plain faking it”

• AKA Munchausen syndrome

• may involve hurting/medicating oneself to produce symptoms

• factitious disorder by proxy: making others sick for attention

• not in the DSM-5

• malingering: faking illness for monetary gain; also not in the DSM-5

criteria for major depressive episode

mood episode criteria requiring 5 or more of the following symptoms to have been present within the same 2-week period and represent a change in previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure

• depressed mood most of the day, nearly every day

• anhedonia: markedly diminished interest or pleasure at all, or almost all activities most of the day, nearly every day

• either significant weight loss when not dieting or weight gain

• insomnia or hypersomnia nearly every day

• psychomotor agitation or retardation nearly every day

• fatigue or loss of energy nearly every day

• feelings of worthlessness or excessive/inappropriate guilt nearly every day

• diminished ability to think or concentrate, or indecisiveness, nearly every day

• recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation

criteria for manic episode

mood episode criteria requiring distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week; during the period of mood disturbance with 3 or more of the following symptoms having persisted

• inflated self-esteem or grandiosity

• decreased need for sleep; feeling rested after only 3 hours of sleep

• more talkative than usual or finding pleasure in talking continuously

• flight of ideas or subjective experience that thoughts are racing

• distractibility; attention is too easily drawn to unimportant or irrelevant external stimuli

• increase in goal-directed activity or psychomotor agitation

• excessive involvement in pleasurable activities that have a high potential for painful consequences

criteria for hypomanic episode

mood episode requiring the same symptoms as a manic episode, except

• a distinct period of persistently elevated, expansive, or irritable mood lasts for at least 4 days

• mood disturbance is not severe enough to cause marked impairment in social or occupational functioning

major depressive disorder (MDD)

type of unipolar depression characterized by a history of at least one major depressive episode; average duration of episode is 3 months

• prevalence in the US

  • affects 13% of the population (12 and older)

  • highest susceptibility in young adults (12-19)

  • higher rates in women

  • low in adults over 60; difficult to diagnose due to lower willingness to report and depression occurs in the context of another serious illness

persistent depressive disorder (PDD)

type of unipolar depression characterized by chronic depression (over 2 years); less severe depressed mood and two others symptoms

• if a patient is experiencing intermittent or continuous MDD, then that is diagnosed separately and in addition to PDD

overview of causes of unipolar depression

• behavioral approach: depressive symptoms are learned and reinforced

  • modest amount of research support

• cognitive approach: thought distortions increase our likelihood of depression

  • considerable amount of research support

• biological approach: genetic factors; 40% of depression is inherited (strong genetic component)

  • first degree relatives (children, siblings, parents) have a 2-3x greater risk than the general population

  • chemical imbalance theory of depression: depression is caused by a serotonin deficiency

    • requires greater evaluation and reconsideration; the hypothesis led to antidepressant medications becoming a “first-line therapy" despite there not being sufficient evidence linking serotonin and depression

premenstrual dysphoric disorder

mood disorder characterized by repeatedly experiencing depressive symptoms during the week before onset of menstruation

• symptoms lesson after onset of menses

• symptoms minimal/absent in weeks postmenses

overview of types of depression

• endogenous depression: internal; recurrent, severe depression; more likely due to chemical imbalance

• exogenous depression: external; “reactive,” situational depression

bipolar I disorder

bipolar disorder characterized by a history of at least 1 full manic episode or a combination of mania and depression; a manic episode is required for the diagnosis of this bipolar disorder

• patient “rapid cycles” with 4 episodes of mania and depression within 1 year

• average duration of a manic episode is 2 months

bipolar II disorder

bipolar disorder characterized by at least 1 hypomanic episode and 1 major depressive episode

cyclothymic disorder

a bipolar disorder characterized by symptoms that aren’t severe enough to meet either hypomanic episode criteria or major depressive episode criteria; no history of manic, hypomanic, or major depressive episodes

overview of bipolar disorder course and prevalence

• prevalence: affects 2.8% of the population; less common than depressive disorders

• men and women are equally susceptible

• develops mainly in adulthood (18-29)

• 90% of manic episodes are followed by recurrent mood episodes

• 60% of manic episodes are followed by a depressive episode

the blunting hypothesis

the theory that antidepressants take away the intensity of all emotions, both positive and negative

• may explain how antidepressants medicate the effects of anxiety

• might also explain how antidepressants work better for severe depression more than mild or moderate depression

• in severe depression, blunting is a net benefit; meanwhile, in mild/moderate depression, blunting may make people feel less of the joy they’re able to enjoy

overview of factors of suicide

• personality and cognitive factors

  • impulsivity: tendency to act on one’s impulses rather than inhibiting them

  • hopelessness: feeling that the future is bleak and there is no way to make it more positive

• biological factors:

  • genetic component: family history adds to suicide risk

• those at risk

  • fortunately most people who have depression will not attempt

  • though women attempt more than men, men use more lethal means and a have higher “success” rate

overview of modeling suicide

• modeling is the contagion of suicide; people, particularly teenagers, may attempt after observing or reading about someone who has done so

  • family members, friends, celebrities, co-workers, and highly-publicized suicides are common triggers

suicide risk assessment

course of action for clinicians when their patient expresses having suicidal ideations

• plan: “What is your plan?”

• lethality: consider how dangerous their plan is; planning on overdosing vs. using a firearm

• access: “Do you have access to your means of harm?”

• intent: “Can you assure me that you’ll be here for our next appointment?”

  • “Yes”: typically, confidentiality is not broken; a clinician must assume the truth

  • “I can’t assure you that": confidentiality must be broken and the client must be hospitalized and provided care at the ER

• additional risk factors; nature and nurture must be considered