Psychopathology Test 2

Gender dysphoria

• Incongruence between person’s assigned (natal) gender and subjective experience of their gender -> causing distress

• Typically begins in childhood

• Act in ways accordance with experienced gender, not assigned gender

  • More consistent with how they see themselves and feel

• Many people w/ gender dysphoria in childhood do  not have it later in life

• Many report being heterosexual relative to gender identity

• 3x more common in natal males than natal females

DSM-5 Criteria for children

• Must have 6/8 symptoms and persistent for 6 months

• Requires the symptoms to cause significant distress

  • Experience is often caused by other people & their responses

DSM-5 for adolescents and adults

• 2/8 symptoms and persistent for 6 months

• May feel uncomfortable living as natal gender in adulthood

• Symptoms cause significant distress often caused by other people and their response

Brain differences

• Study on a specific neuron in the bed nucleus of the stria terminalis

  • Men typically have 2x of these neurons as many as females

  • In MTF transexuals had the typical female number of the neurons

  • In FTM transexuals had the typical male number

Hormones and play

• Studies have found that boys are more likely than girls  to engage in rough-and-tumble play, and to have higher activity level

  • Bio boys w/gender dysphoria do not have as high an activity level

  • Bio girls w/gender dysphoria are more likely to engage in rough-and-tumble play and have a high activity level

  • Associated with testosterone

Facial Photographs

• Study where college students rate photographs of natal boys with gender dysphoria and natal girls with gender dysphoria

• Physical attractiveness of boys and girls

• Boys with gender dysphoria rated as “cuter and prettier” than they did boys without

Treating Gender Dysphoria*******

• Psychological

  • Help them understand themselves and their options

  • Goals for living publicly as the opposite gender

    • Address potential reactions from others

  • Info about medical and surgical options

  • Treatment for other needs (depression, anxiety)

  • Help understand whether they want to live as the opposite gender (If they feel more like self)

• Social

  • Family therapy

    • Communication and education for family members to better understand and support

  • Group therapy

    • Meet other people going through the same thing

    • Discuss relationship issues/problems that arise from living as the opposite gender

• Neurological (offered last but in conjunction with the other therapies)

  • Hormone therapy

    • Women: lower voice, stop menstruation, begin facial hair growth

    • Men: Enlarge breasts, redistribute fat to hips and bottom

  • Sex reassignment surgery

    • Alter breasts and genitals

    • Facial surgery (less common)

    • More effective for men-women (Difficult to create satisfactory stimulation)

    • Up to 10% of people regret it

Paraphilic Disorders

• Intense and persistent sexual interest in things that are different from normal sexual stimulation or normal physically mature consenting human partners

• Unusual preferences in either: sexual activity/the target of the activity

• Lead to distress (but doesn’t need to be distress on the individual), impaired functioning, harm to oneself/others 

• Further classified:

  • Nonconsenting adults or children, nonhuman objects, suffering or humiliating oneself or partner

Diagnosing paraphilic disorders

• Must be persistent for at least 6 months

• Must cause distress (Does not have to be to the individual, can be other people)

• Must impair functioning in some way (does not need to be overall functioning)

• Almost exclusively men

Nonconsenting people

• Exhibitionistic disorder: arousal from exposing genitals to a nonconsenting person

• Voyeuristic disorder: arousal from watching someone taking their clothes off or engaging in sexual activity (target is unaware)

• Frotteuristic disorder: arousal form non-violent physical contact with a nonconsenting person (touching someone's genitals on the bus)

• Pedophilic disorder: arousal from sexual activity with a child who has not reached puberty

Pain and humiliation

• Sexual sadism disorder: arousal from giving psychological/physical pain -> causing someone else to suffer

  • Arousal/actions cause distress

  • Nonconsenting persons has been subjected to the acts

• Sexual masochism disorder: arousal from being made to suffer -> being humiliated or suffer

  • Only one with a measurable rate in women*

Nonhuman objects

• Fetishistic disorder: arousal from the use of nonliving objects (shoes) or non-genital body parts (feet)

  • Can be used to achieve/maintain sexual arousal and can be used with a partner or alone

• Transvestic disorder: arousal from dressing in clothes for the opposite gender and experience distress based on the enjoyment of it

  • Different form gender dysphoria dressing as opposite gender bc these individuals do it for sexual arousal

  • Transvestic disorder

    • Gender identity is bio gender

    • Comfortable with own bio gender

    • Cross-dress for sexual arousal/to feel calmer

  • Gender dysphoria

    • Gender identity diff from bio gender

    • Want to be other gender

    • Cross-dress for congruence between appearance and identity

Sexual dysfunctions

• Characterized from problems in sexual response cycle

  • Can be diminished (or lack of) sexual desire

  • Can be difficulties related to sexual arousal or performance

• 4 stages

Sexual desire/arousal disorders

• Women: Female sexual interest/arousal disorder

  • Persistent/recurrent lack of, or reduced sexual interest or arousal

  • Could include no interest in sexual activity, no sexual thoughts/fantasies, no pleasure from sexual activity or a lack of physical arousal

• Men: Male hypoactive sexual desire disorder

  • Persistent/recurrent lack of erotic/sexual fantasies, an absence of desire for sexual activity

  • Can be generalized (all situations) or situational (one person)

• Erectile disorder

  • Arousal disorder -> difficulty obtaining/maintaining an erection until the end of sexual activity or decrease in erectile rigidity

Orgasmic disorders

• Women: Female orgasmic disorder

  • Woman's normal sexual excitement does not lead to orgasms or they are less intense

  • Must be persistent/recurrent, and not due to lack of stimulation

  • Can be generalized or situational

• Men: Delayed ejaculation

  • Delay or absence of ejaculation

  • Involves ejaculating with a partner (Masturbation is normal)

  • Typically involves problems ejaculating during vaginal intercourse

• Premature ejaculation

  • Occurs within 1 min of penetration and before wish for it to happen

  • Don’t feel a sense of control, become apprehensive about future encounters

Sexual pain disorder

• Genito-pelvic pain/penetration disorder

  • Women only

  • Pain, fear, anxiety abt vaginal penetration of intercourse

  • Vaginismus may occur (recurrent/persistent involuntary spasms of the muscles of the outer ⅓ of the vagina that interfere with intercourse)

Treating sexual dysfunctions

• Tends to use medication (viagra)

  • Would not help if problem was psychological

• Psych treatment

  • Educating patients about human sex response

  • Develop strategies to counter negative thoughts, beliefs and attitudes that interfere

  • Focus on increasing one’s view of self

  • Teaching couples better communication, intimacy and relationship skills

Neurodevelopmental and Disruptive Behaviors

• Intellectual disability

  • Neurodevelopmental disorder characterized by cognitive abilities that are significantly below normal, along with impaired functioning in daily life

    • Deficits must have begun before the age of 18

    • IQ of 70 or less -> 2 standard deviations below the mean (100)

      • Not enough on its own to constitute intellectual disability -> must also have impaired functioning

• 4 levels

Neurological factors

• Teratogens: Harmful substances and/or stimuli that affect fetal development and can increase the risk of intellectual disability

  • Drugs, cigarettes, some medications

• Environmental toxins: Mercury, lead, pesticides, alcohol, viruses etc

  • Exposure during the 1st trimester can interfere with the fetus’s central nervous system development

  • Fetal alcohol syndrome: Smaller head due to smaller frontal lobes, leading to deficits in planning, carrying out tasks and impulse control, along with other physical differences in the face

• Genetic Abnormalities: down syndrome, fragile X syndrome, Rett’s disorder (fatal for boys)

  • Fatal X syndrome is a sex linked disorder where boys are more severely affects due to lyonization since girls have another x chromosome to help buffer against the negative effects

Problematic behavior

• Stereotyped behaviors: Repetitive behaviors that don’t serve a function

  • Ex) Body rocking, hand flapping, jumping, finger fluttering etc

• Self-injurious behaviors: Actions that cause harm to the individual

  • Ex) Hitting one’s head on the wall, hitting self, biting self, skin picking etc

• People who display both types of behaviors have greater deficits in non-verbal social skills than those with only one 

Treating intellectual disability

• Prevention: Avoid teratogens at all costs (when possible)

  • Tests for phenylketonuria (PKU): Almost all babies in the US are tested for this metabolism defect right after birth -> brain damage and subsequent disability can be avoided with lifelong dietary modifications

  • Banning lead: No longer in paints, gas etc and not the rates of lead-induced intellectual disability have decreased

• Help people function as independently as possible

  • Improve specific skills

  • Can teach new ways of doing things (sign language, mood boards, picture systems etc)

  • IEPs: Children receive a comprehensive evaluation to determine their needs to best succeed in the classroom and are placed in the least restrictive environments so they benefit as much as possible

    • Facilitates inclusion

Punnett Squares

• Andrew and Sally want to have children. Sally has one autosomal dominant gene for a disorder and Andrew has none. What is the likely distribution of the disorder among 4 possible children

• 2 affected children, 2 unaffected children and no carriers

Autism spectrum disorder

• Neurodevelopmental disorder characterized by deficits in communication and social interaction skills as well as stereotyped behaviors and narrow interests

  • Impaired social interactions, impaired communication, and restricted and repetitive behaviors

  • Seems oblivious of others, tends to ignore them

• There are a variety of ways this can present and can differ in severity and developmental level

• Children with ASD are:

  • More/less reactive to sensory stimuli

  • Engage in repetitive play/behaviors: routines are important

  • Often display stereotyped behaviors

Neurological factors

• Associated with significant abnormalities in brain structure and function

  • Connections and communication among brain areas are abnormal -> Frontal lobes do not communicate effectively with other areas of the brain

Psych/social factors

• Neuro factors produce psych and social factors

• Cognitive deficits: Difficulty shifting attention, difficulty with mental flexibility

• These lead to difficulties transitioning from one activity to another and the tendency to focus on details rather than the big picture

• Theory of mind: Theory about other people’s mental states (beliefs, desires, feelings) that we use to predict how others will feel/act in different situations 

  • People with ASD have a hard time viewing the world from someone else’s perspective

  • Leads to difficulty in communication with others

• Communication deficits

  • Difficulty recognizing faces and emotions

  • Difficulty recognizing facial and vocal expressions

  • Trouble with back-and-forth conversations

  • Lack of interest in other people

  • Do not look at people’s eyes, focus on the mouth instead

• Early childhood signs

  • Children do not respond to parents voices

  • Do not respond to their name

  • Do not make eye contact

The Shapes Video*****

• 3 shapes moving around the screen, moving in and around each other, interacting with each other

  • Healthy controls (No ASD) see the shapes as fighting each other: Anthropomorphizing

  • People with ASD see them as bumping into each other: No emotions conferred

• Why? 

  • Healthy controls process the video using the fusiform gyrus: responsible for processing emotion in faces, and why we anthropomorphize inanimate objects

  • People with ASD process the video using the inferior temporal gyrus: responsible for processing objects

    • Less activity in the fusiform gyrus, so there is no emotional explanation

Treating ASD

• No “cure”, treatment focuses on improving social/communication skills and behaviors

• Best outcomes if treatment begins as early as possible

• Everyone is different: Treatments are individualized to best suit the needs of the individual

Specific learning disorder

• Well below average skills in one of these areas:

  • Reading - dyslexia -> Difficulty with accuracy, speed or comprehension of reading

  • Writing -> Poor spelling, significant grammatical or punctuation errors, or problems writing clearly and keeping writing organized

  • Math -> difficulty understanding the relationships between numbers, memorizing math facts, accurately and fluently making calculations and reasoning effectively about math problems

• Based on age, general intelligence, cultural group, gender, and education level

• Deficits must interfere with school/work performance or daily living

Neuro/psych/social factors

• Dyslexia has been studied the most

  • Brain systems involved in auditory processing do not function as well as they should

  • Converting visual input to sounds

• Important to teach people (Esp kids) to persevere and give lots of encouragement

Conduct disorder

• Childhood psychological disorder characterized by violation of basic human rights or others or of social norms that are appropriate to the child’s age

• 4 categories

Min of 3/15 behaviors listed in the past 12 months and at least 1 in the past 6 months

Does no require distress for diagnosis

• Familiarize self with the 4 categories of DSM criteria

If the symptoms persist past the age of 18, diagnosis changes to antisocial personality disorder

Adolescent-onset type: Symptoms emerge after puberty

• Not likely to be violent towards people -> Minor theft, public intoxication, property offences

• An exaggeration of normal teen behaviors, transient

• Still maintain relationships with peers

Childhood onset type: Symptoms emerge before puberty

• Without callous and unemotional traits

  • Not callous, show emotions and remorse

  • Aggression is usually a reaction to threats

  • Difficulty regulating normal emotions

  • More emotional distress

  • More likely to misread social cues

  • More likely to act impulsively

• With callous and unemotional traits

  • Are callous, unemotional, do not feel guilt/remorse

  • Insensitive to punishment, low levels of fear, increased aggression, do not internalize social norms or develop conscience

  • Less likely to recognize sadness in others

Oppositional defiant disorder

• Characterized by angry irritable mood, argumentative/defiant behavior, vindictiveness

• Confrontational: Arguing with authority figures, annoying others on purpose, refusing to comply with authority figures/adults

• Disruptive behaviors of ODD:

  • Generally directed towards authority figures (parents, teachers etc)

  • Not usually violent, and do not usually cause severe harm

  • Often only in specific situations with well-known adults

• Mostly verbal

Attention-Deficit/Hyperactivity Disorder

• Characterized by inattention, hyperactivity, and/or impulsivity

• Must impair functioning in at least 2 settings

• Do not intentionally violate the rights of others

• Girls are underdiagnosed -> less behavioral problems, less rambunctious behavior, more inattention, often mistaken for other disorders such as depression

ADHD types

• Hyperactive/impulsive type

  • Disruptive behaviors, accidents, rejections from peers

• Inattentive type

  • Academic problems

  • Issues with executive functioning -> trouble shifting/maintaining attention

• Combined type

  • Behaviors from both categories

ADHD and the Brain

• Impaired frontal lobe functioning: Smaller than normal

• Evident in issues related to executive functioning (making and following plans, maintaining attention)

• Less dopamine than healthy controls, may explain the increased use of illicit substances in those with ADHD

  • Many illicit substances increase release of dopamine, which may have an even greater effect on those with ADHD due to having less naturally occuring in the brain

Treating ADHD

• Medication that treats ADHD can also treat comorbid conduct disorder and ODD

• Stimulants: Increase attention and reduce the general activity level and impulsive behavior

  • Disrupts the process of dopamine, resulting in more in the synapse to help to correct the lower levels of dopamine

  • Also improve functioning of impaired brain regions

• 2 types of stimulants are used:

  • Amphetamines: Promote more dopamine release in the brain to increase the overall levels

  • Methylphenidates: Interfere with the reuptake of dopamine, leaving more in the synapse to increase overall levels