psych final - combined notes

Chapter #10 - Sexual Behavior

· Normal vs. Abnormal Sexual Behavior

- Normative data

- Gender

- Age

Look for normal and compare to what a person is experiencing

If large difference and it is making them uncomfortable then may lead to diagnosis

· Sexual and Gender Related Disorder come in three sub-categories:

1. - Sexual Dysfunctions
2. - Paraphilias
3. - Gender Dysphoria

I. Sexual Dysfunctions - may be more medical than psychological (a physical impairment) in the DSM b/c the underlying reason why they are experiencing this is a psychological basis

· Lifelong vs. acquired

· Generalized vs. situational - if happens generally vs specific situations; greater likelihood to be generalized if occurs when the person masturbates; more inconsistent = more situation = the greater the manifestations are more psychological

· Medical conditions

· Psychological factors

EX: men claim to have ED even tho they are able to get an erection when asleep

Dysfunction in the sexual response cycle:

Potential diagnosis at every stage & a gender divide

- Desire:

- Arousal

- Orgasm

Or: Pain associated with sex - separate piece w/ diagnosis

A. Sexual Desire Disorders - gendered along a binary

1. Male Sexual Hypoactive Desire Disorder

2. Female Sexual Interest/Arousal Disorder

1 and 2 have similar symptoms w/ slight differences

§ Very common

§ Prevalence: Men = 5%

§ Prevalence Women = 22%

· Little to no desire in sexual activity - definition

· paired with Decreased frequency in:

- Sexual intercourse

- Masturbation

- Sexual fantasy

These dissipate or greatly lessen

· Apathy related to condition/Anxiety more likely related to response of others

Concern of how this will affect other ppl (partner)

· Age considerations (myth that ppl are less sexually active as u get older - often go to late adulthood)

· Medical rule-outs - Hypothalamic, metabolic

B. Sexual Aversion Disorder - not divided amongst gender but more common among women

· Very little interest in sex

· Active avoidance of sexual interaction → avoidance of relationships

· Fear, Panic, Disgust related to sex → thought of it can induce anxiety symptoms

· More likely to be concerning to client

· Erotophobia - general term means fear of sex / sexuality / ppl become obsessive about it (need to avoid thinking/talking about it)

· Relationship to trauma

· More common among women

C. Sexual Arousal Disorders - gender split; desire is present; both are similar, just a physiological difference

1. Male Erectile Dysfunction Disorder

· Difficulty achieving and/or maintaining an erection

· Situational? Or is it generalized (if generalized, it is more likely to be a medical condition)

· Relationship to anxiety/stress - drugs + alc can affect this

A lot of men who rely on viagra the condition they experience is more psychological. Easier to take a pill than to have a difficult conversation w/ partner

· Medical rule outs?

Diet, sleep, stress, weight → prob need to attend to these to fix ED

2. Female Sexual Arousal Disorder

· Difficulty achieving and maintaining proper lubrications

· Situational?

· Medical rule outs? Age?

Age component (more so than compared to men) - women dont lose sexual desire, but after menopause there are physiological changes

· Relationship to sexual communication with partner

D. Orgasm Disorders - gender split (+ additional one for men)

1. Delayed Ejaculation (Males)

2. Female Orgasmic Disorder (Females)

- Adequate desire and arousal

- Unable to achieve orgasm (or delayed in males)

- 8% Prevalence in males; 25% in females

25% may be skewed b/c focus on vaginal orgasms

- Diagnostic issues related to gender

- Situational? Masturbation?

Women often report orgasm by themselves but not w/ partner

- Medical rule-outs?

Bullets for both 1 and 2 ^

3. Premature Ejaculation (no female equivalent)

· Ejaculating prior to when wished - has to happen frequently

· < 1 Minutes after stimulation

· Most Prevalent Male Disorder (prevalence rate 21%)

· Improves with age/experience

More common in younger men compared to older men

• Younger men prob skewed the prevalence rate

· Responds well to treatment - not medication - physiological + psychological exercises that can be done

E. Sexual Pain Disorders

1. Genito-pelvic pain/penetration disorder (no male equivalent)

· Regular pain during intercourse

· At times, extreme pain

· May lead to avoidance

· No other noticeable issues related to sexual stages

Medical rule outs are imperative here; could be cyst, different cancers, endometriosis

· 15 % Prevalence rate

Has to be repeated to be diagnosed

No psych disorder for men - ie if have pain during an erection / sex - see doc

II. Paraphilic Disorders (Paraphilias) - group of diagnosis that look at what a person is primarily attracted to and what causes arousal;

One does not need to act on paraphilia in order to be diagnosed (not diagnosed based on behavior, diagnosed based on the arousal + attraction) moral compass is such that they don’t act on their desire; can be damaging b/c know that they shouldn't be thinking that way

· Involve sexual attraction and arousal

· Socially inappropriate people/objects

· Associated with distress and/or harm/threat of harm to others

Person thinks that it is a problem for themself / want to change; or directly harm others

· Gender splits vary, but ALL more common among men : significantly more common among men

Depend on the disorder w/ varying gender split;

· High co-morbitity:

- Anxiety (social phobia)

- Depression paraphilias disconnect us from other ppl

- Substance abuse

- Personality disorders - more common in non consensual disorders

· > 50% of people with paraphilia have more than one

• Exclusive = more significant b/c object of paraphilia HAS to be present during arousal to achieve orgasm; much harder to treat
• non exclusive paraphilia = are attracted to it but does not have to be present to be aroused

A. Frotteuristic Disorder

When ppl are aroused or attracted by the unwanted touching of other ppl in public

EX: person will go out in public (crowded) and then rub up against strangers to be aroused

Immediate leap from paraphilia to committing sexual assault (legal matter)

B. Fetishistic Disorder

The attraction is overwhelming; it causes distress to them or other people; it has the risk of being exclusive → it needs to be present to achieve arousal

Sexual attraction to a non-living object or parts of a living object

- Inanimate - object; common example is shoes; furies (attracted to stuffed animals → often dress as stuffed animals)

- Partialism - at times a fetish is about part of an object (often a body part) ie. feet, hair, legs; often causes problems in a committed relationship

- Tactile - driven more by the sense of touch than anything else; EX: certain fabrics like rubber and latex; a balloon fetish

Usually the item in question is not inherently dangerous

C. Voyeuristic Disorder

Becoming sexually aroused by the unsuspected watching of other ppl who are privately in the nude or engaging in sexual behavior;

• A peeping tom: goes to great lengths to watch others (setting up cameras)

Risk of being caught and need for the person to be unsuspecting is part of the diagnosis

The thrill of the hunt = increased HR, flow of adrenaline

They like sneaking around

This can lead to breaking law b/c doing something without consent

D. Exhibitionism Disorder

When someone achieves sexual arousal and gratification by exposing themselves to unsuspecting strangers

Also a desire to masturbate in front of unsuspecting people

Unsuspecting piece is very important to this → this is the high motivator → they are aroused by making others uncomfortable

Greater potential of getting caught the more excited they are

Difficult to treat → ppl w/ it are relentless

Violating law b/c no consent

E. Transvestic Disorder

Not necessarily harmful to others more likely to harm the individual

Def: someone who becomes sexually aroused by the act of dressing in clothes of the opposite sex

Has nothing to do with sexual orientation or gender identity

NOT like drag queens / trans ppl

95% are men

Majority of them are slightly older, straight men, in committed relationships

In the DSM b/c the shame and anxiety it often causes the individual

• Fear of getting caught
• Don't want others to see them in this
• Having an honest conversation about it with a partner may be difficult

F. Sexual Sadism

Specifically when someone achieves sexual arousal related to the causing of suffering, pain, or humiliation to another person

Most ppl who are sexually violent do not fit this b/c their first motive is not to do this (they want power) (ex rapist)

G. Sexual Masochism

Someone who is sexually aroused by experiencing extreme pain

- Hypoxyphilia - experience loss of oxygen, not being able to breathe while having sex, enjoy cutting off oxygen

G. Pedophilic Disorder - sexual attraction to prepubescent children

Often leads to the sexual abuse of children

Ppl get arrested for child molestation

Is a clinical condition

There are ppl who have the disorder but do not act on it b/c of moral compass (dont want to hurt someone, some go to therapy b/c they dont like thats what they are attracted to)

Not everyone that sexually abuses a child is a pedophile (Ex: some ppl will hurt a child b/c it's easier, or that's who they have access to, and they wanted to commit violence)

· Sexual attraction to pre-pubescent children

· 90-95% Males

· Can be attracted to children of one sex or both

· Pedophiles with victims of both sexes = worse prognosis/higher recidivism

Pedophiles that are exclusive = more dangerous

Pedophiles that dont care about sex = more dangerous

There is a test that shows higher risk for offending again

· 12% of men; 18-20% of women report being touched inappropriately as children

· In addition to causes listed below, also associated with frontal lobe impairment

Prefrontal impairment is connected to pedophilia

· Causes of Paraphilic Disorders: - these ppl may have underdeveloped frontal lobes that affect their empathy, maturity, communication skills, problem solving skills; this does not affect their intelligence

o Low levels of arousal to appropriate stimuli

o Sexual problems - may be related to anxiety or self consciousness; may have had negative experiences with sex → uncomfortable

o Social deficits

o Early experiences - behaviorism related to classical conditioning; often during puberty when sexual arousal is related to an object; over time the non sexual object begins to be paired with sexual arousal

Becomes a hyperfixation on the paraphilia (quantity of thinking becomes intense)

Inappropriate arousal / fantasy

CLASSICAL CONDITIONING

o High sex drive - hyperfixation

o Low suppression of urges / drive - dont have a well developed frontal lobe to suppress drive

o Reinforcement via orgasm

OPERANT CONDITIONING

Do something good and get a reward

· Treatments of Paraphilic Disorders:

o Behavioral Therapy

- Modification

- Orgasmic reconditioning - retrain yourself to be aroused by normal things

o Cogntive Behavioral therapy

Understand that when you act on your arousal you are putting other people in harm

- Coping mechanisms

- Cogntive modification

- Emapthy training - can be valuable if the paraphilia can harm others

o Treating co-morbid conditions

- Social anxiety

- Substance abuse - ppl with paraphilias turn to these to help but it worsens it

o Chemical Castration - medication to reduce sex drive (often used on ppl who are sexual predators)

Worst Prognosis:

- Sexual sadism – rapists

- Predatory pedophiles

- Early onset

- Significant Co-mobordity

- Multiple Paraphilias common in about 50%

In terms of treatment, seeking a specialist is a good idea

III. Gender Dysphoria

Oftentimes ppl that struggle with gender identity (non binary) and trans ppl struggle with this at some point in their life

· Feels trapped in the body of the wrong sex

· Identifies with non-biological sex - feels distress b/c of this

NOT: Intersex

NOT: Transvistic Disorder

· Prevelence = rare (unlikely to exist in ppl that are not transgender; also doesnt occur in all transgender ppl)

· More common among biological males (more common for bio males → trans female)

· Seen across all cultures

· Gender non-confirmity begins in early childhood; increases throughout childhood

Gender dysphoria peaks at early adolescence and goes into adulthood

· Strong genetic causes

· High heritability rate

· Slightly higher levels of testosterone or estrogen at certain critical periods of development might masculinize a female fetus or feminize a male fetus - physiological explanation

· Increasingly de-stigmatized; but still diagnostic - would lower the prevalence rate

· Preferred treatment = gender reassignment treatments/surgery - gender affirming care ( create environments w/ support and care)

If want to have gender reassignment treatments/surgery must have:

- At least two years of stated desire

- Psychologically stable

- Hormone replacement

- Surgery option:

75% satisfied

1-7% regret

Better adjustment = female to male

Chapter # 11

I. Overview of Substance-Related and Addictive Disorders

Psychoactive Substance: Any substance(s) that alters mood, behavior, cognitive ability or all three. - come generally in 3 categories

Legal examples: Alcohol

Illegal examples: Marijuana, Heroin, Cocaine etc.

Legal substances often used illegally: Xanax, Oxycontin, Aderall

Various Levels of Involvement According to DSM-5:

4 different levels - from least to most severe

o Substance Use - hardly ever diagnosed in and of itself; means its something you use but hasn't crossed over to a problem substance. Ex: may be used if have depression and then say you use a substance;

o Substance Intoxication - a transient acute, in that moment someone is intoxicated by that substance; to explain why someone is acting the way they are acting; EX: intoxicated and shows up to ER, ie behavior is explained due to using the substance and it will go away / get better, after its out of system

o Substance Abuse, repeated/persistent, problematic use of a substance that is effecting somebody, personally, socially, or occupationally; person is yet to show physical symptoms of the abuse

o Substance Dependence - shows physical symptoms of the abuse, and a physical need for it; brain and body are dependent on it; problematic excessive use of substance with a physical component; the worst level

Get diagnosed with the level of which youre using it, and the psychoactive substance you're using; Substance Abuse, cocaine (ex of how it would be diagnosed in an individual)

· Dependence related to:

- Tolerance - alcoholics late stage reverse tolerance (feel drunk after one drink)

- Withdrawal - feeling the effects of not using; EX: alc - will have tremors; cocaine - intense nausea and stomach issues when not on it; brain responding to not getting something that it is used to getting; coming off of a substance is really hard

- Measurable impact - extent to which it is affecting relationships, work, school, etc

- Drug seeking behavior - how desperate is the person to continue seeking out the drug; DSM doesn't care if the substance is legal or illegal; may put u in danger (going to dangerous neighborhood for drugs); being unwilling to be done for the night

* The diagnostic distinction is based on how many of these conditions are present; how severe the symptoms are; the length of time the symptoms have continued; length of time to see if it crosses into a dependent pattern

II. Alcohol Related Disorders

· CNS Depressant - means that it slows down HR, brain wave activity, makes it more difficult to focus/concentrate, harder to use muscles, harder to speak; CNS keeps us ready/alert and alc diminishes that

· Paradoxical substance - a depressant that makes us feel better; more lively, more social, more engaged; makes feel better outwardly in the short term but is a depressant b/c of effects on GABA and serotonin

Related to depression b/c effects serotonin (long term effects) even tho in short term makes u happier person

· Neurotransmitter systems

- GABA (memory; information processing)

- Serotonin (Depression)

· Short-term effects

· Withdrawal (Delirium Tremens)

· Social/Occupational effects

· Long Term effects

· Dementia – Korsakoff’s Syndrome - long term alc abuse

· Stats:

- > 50% of adults = light drinkers or non-drinkers 0-6

- 22 % of adults = binge drinkers - drink in excess

- 5 % = alcohol dependency; alcoholism

Males > Females

III. Sedative Related Disorders

· Barbituates (i.e. Nembutal; Queludes) popular in 70s 80s - less often used now; given as sleeping aids/anxiety meds

· Benzodiazepines (i.e. Valium, Xanax, Ativan, Klonopin) - as needed anxiety meds;

· Maladaptive behavioral changes

· Effects similar to alcohol use (Physiologically)

· Outward effects: calming; relaxing etc.

· Negative Effects

o Mood Instability

o Impaired judgment

o Impaired function

- Speech

- Coordination

- Gait - way u walk

· High risk for dependency

· Withdrawal can be difficult - brain gets used to these quickly and wants them once its used to it

· Statistics:

- 2 % of all substance abusers

- More common among women

- More common among Caucasians

- Mean = 35 years of age

IV. Stimulant-Related Disorders - activate CNS (opposite of a depressant)

· Increase alertness and energy

• Increase HR, sweating

· Stimulates the CNS

· Many types:

- Caffeine

- Nicotine is a slight stimulant

- Amphetamines (Meth etc.)

- MDMA - extoci (molly)

- Cocaine and crack cocaine

· Up period - really apparent

· Crash period - the coming down = often have headaches,

EX: benign version, if hav headache b/c dont have caffeine

Crash period is worse with stronger drugs such as cocaine / meth

Cocaine and meth high mirrors a manic episode, its shorter,

A. Amphetamines including methamphetamines

· Changes in sociability - make ppl a lot more chatty + extroverted (like mania) volatilia and aggression or chatty

· Increased sensitivity highly emotional

· Anxiety, tension, anger often after repeated use

Symptoms are acute but over time can gradually become more long term traits

· Impaired function

· Very high level of dependency

· Disturbances to sleep cycle tweking; not sleeping, highly agitated, highly anxious; awake 40-60 hrs at a dime

· Impact of Norepinephrine increased

· Impact of Dopamine increased

Excitability + pleasure part of brain being hit

· Hallucinations & Delusions - similar to schizophrenia

· Physiological symptoms - long term bad side effects especially to the heart

B. Cocaine

· Block Dopamine reuptake - so more dopamine around, it lingers

· Feeling of euphoria , feeling of a constant high

Increased sensitivity - can relate to sexual behaviors

· Feelings of power and confidence - talking a lot, sort of obnoxiousness

· Increased blood pressure

· Insomnia

· Decreased appetite - ppl often lose weight b/c of this

· Paranoia

· Overdose could lead to heart attack/cardiac arrest

· Highly addictive

· Gradual tolerance uptick

· Develops less slowly than Meth

Meth a quicker way to abuse and addiction

Occasional cocaine user (recreational) b/c develops slower than meth but still highly addictive

C. Opioids (Heroin, Oxycontin; Morphine etc.)

Oxycontin and morphine are legal drugs but often used illegally

Fentanyl (used a lot today)

• Ppl were putting fentanyl in heroin to make it last longer → shift to ppl wanting the “side ingredient” just fentanyl

· Significantly slows the CNS - HR slows, brainwave activity slows

· Blocks pain receptors; hits on pleasure terminals

When used effectively by doctors they are pain killers

· Temporary euphoria

· Drowsiness/Sleep

· Feelings of calmness/detachment - self medicating for anxiety depression etc

· Highly addictive

· Often lethal (stops heart)

Gate theory

• Symbolic gate between brain and body
• When not using drugs there is open communication between brain + body
• EX: put hand on hot stove
• In terms of experiencing sensations
• Opioids close this gate
  • Ie when experiencing pain, gate closed, so brain doesnt know its there
• Opioids are very relaxing and calming (physically and psychologically)
• Ppl chase more and more of the feeling → death
• Tricks body into not experiencing pain

· Debilitating withdrawal symptoms

- Excessive yawning

- Nausea/Vomiting

- Chills

- Muscle aches

- Diarrhea

- Insomnia

Meds that mitigate w/ drawal effects

V. Other Substances

Marajuana

· Cannabis - mainstreaming and legalization of cannabis → research; stuff legal now is a lot stronger than what it was when it was used illegal

• Does not lead to physical dependency
• No withdrawal effects
• No physiological dependence but can have psychological dependence

· Hallucinogens

LSD, acid, mushrooms

Mushrooms - gradually becoming legalized, have been used in therapy

• Microdosing, specific types of mushrooms can be used to treat depression

Ketamine - a tranquilizer

• Was an illicit street drug
• Can now be used to effectively treat MDD under a doctor's order

· Inhalants

Whip its

• High from whip cream cans

· Designer Drugs

* Biological, psychological and social factors all contribute to substance addiction*

Use = environmental/psychological factors

• The social environment that you're in
• Peer pressure
• Psychological:
  • Ppl overwhelmed with negative thoughts
  • Dont like they way they feel
  • Ppl NOT told to do drugs based on biology (no overwhelming physical desire to try drugs (genetic))
  • Social, environmental reason for wanting to try drugs

Abuse and dependency = biological factors

• Use → abuse → dependence
• Family history
• Powerful heterability to substance use
• Proneness to addiction: predisposed to addiction if you try a drug

VI. Biological Causes

· Inheritability

· Family studies/twin studies

· “Proneness to addiction”

· Polygenetic vulnerability - not a single gene, there are lots of factors along different points

· Addiction gene/Disease model

• Addiction to alcohol as a disease?
• Addiction to heroin as a disease?
• Language used to remind ppl in recovery how serious it is
• The word disease to understand this addiction was used in anonymous groups to show the severity of it; u want to treat it / take care of it like any other disease such as diabetes

If you have an addiciton:

- Higher activity in pleasure/reward centers of the brain

Midbrain and frontal cortex

- Overactive dopamine and norepinephrine receivers - higher levels

- Increase in sensation-seeking behaviors

- Increase in impulsive behaviors

“Addictive personality” - addicted to one thing, likely to be addicted to another

EX: alcoholics, or addictive drug users once recovered may go to → gambling, shopping addiction, really into fitness

VII. Psychological causes

A. Family Systems - relatively common things may lead to increased risk for addiction

Healthing coping mechanisms

· Poor coping mechanisms - not encouraged to express emotion

· Poor communication - no open communication; talk it out, exercise, counseling

· Modeling

· Increased pressure

· Abuse (self medication; form of escape)

Families w/ poor boundaries around drugs + alcohol

Trauma

Using drugs + alc to help with self esteem

· Mistreatment (seeking attention/fulfillment elsewhere)

B. Behaviorism

- Positive reinforcement (enjoying the feeling of intoxication) - everytime do drug, it feels good, want to hav substance again

- Negative reinforcement (self medicating) - can be powerful b/c a person may want to seek it out

Something taken away, (ex stop feeling anxious/self conscious), → reinforced to take it again

o escape from unpleasant feelings

o tension reduction

o coping mechanism for negative affects - sadness, loneliness, anger

- Cravings – cues – environmental triggers

Environmental triggers are really powerful: EX: alcoholic dont want to walk into a bar

Ppl w/ opioid addiction recovered → after surgery takes tylenol instead of opiods

VIII. Social Causes

· Prerequisite for use - if gonna go to party, bar, and not drink; a social myth that you have to use when you're in certain settings

· Media - pushed by the media

· Social norms - ppl often think everyone around them is drinking more than they actually are

· “Social lubricant” - an understandable reason why ppl use, reduce social anxiety, dancing, → makes ppl more socially comfortable

· Peers - modeling

· Family

IX. Treatment Options

A. Medication

- Agonist substitution

o Safer drug - a safer version, ex drug that mirrors the effects of opioids but less strong

o Similar chemical composition

- Antagonistic treatment - used primarily for alc

o Blocks or counteracts pleasurable effects (Naltrexone)

Does Not necessarily feel bad but doesnt feel good

- Aversive medications - creates unwanted symptoms (primarily alc)

o counterconditioning

o Antabuse drug used for this

Take med, drink, = dont feel good

Recondition to not liking abusive substance

B. Withdrawal Medication

*In total, all medications have limited effects when acting alone; more effective when paired with therapy*

C. Counseling - therapy works a lot for addiction

· Inpatient or outpatient

· Multidisciplinary approach - see psychologist for therapy, an addiciton specialist, psychiatrist to help w/ meds, social worker to get life back on track

· Long-term therapy - to recovery from addiction

Why did this happen in the first place? Takes a long time to fully unmask

- Family systems therapy

- Cognitive-behavioral therapy CBT can be effective

- Interpersonal/dynamic therapy

· Support groups (AA, NA, ALANON) alc anonymous, narcotics anonymous, family members are addicted

· Most effective treatments are:

- long term - still go to meetings for lifetime

- multi-disciplinary

- Individual/Group/Family work in all of these

- Zero-tolerance generally means never using the substance again

- Strong focus on relapse prevention

X. Related Disorders

A. Pathological Gambling

· 2% Prev. Rate

· Gender split equal

· Gender differences

- women: addicted to slot machines, lottery, bingo, keno

- men: cards, poker, black jack, sports gambling

· Causes and treatments very similar to drug addiction

Heritability → increased activity of dopamine + norepinephrine

Not a substance so cannot become physically dependent on it

Feeling of euphoria riding out the bet

Double positive reinforcement → euphoria + winning (rewarded for gambling)

Social components

If modeled to you it looks appealing = EX: when younger being around sports betting, or gambling, taught at an early age

· Addictive personality model

B. Intermittent Explosive Disorder - not referred to as an addiction; impulse control disorder; only diagnosed if someone doesn't have another diagnosis that may explain this

Pathologically explosive temper w/ absence of other conditions

· Frequent aggressive outbursts

· Important rule-outs

· Often cause harm to others/property

· Tension/Release/Relief

· Similar biological mechanism to drug use/self-medicating

Psychologically someone feels really really tense and releases anger in a profound way, punching walls, yelling

Tends to be quick, then feel relief after

Instead of taking a drink, drugs, they lose it to release tension

C. Kleptomania

· Failure to resist urge to steal unnecessary items

Often leads to shoplifting

Want something (vs need something)

Like the idea that is risky (fear of getting caught) is anyone watching / did i get away from it

When get back home - spend time with item, hav hard time getting rid of item, may steal from ppl they know

· Co-morbidity with: mood disorders, substance abuse disorders, personality disorders

D. Pyromania

· Irresistible urge to set fires

· Only 3% of arsonists fit – very rare

· Little known about this disorder

· Often linked to other violent crimes (serial killer triad) - common early behaviors among serial killers in early childhood / adolesence → bedwetting, setting fires, killing animals

Most arsonists are not pyromaniacs

Link between pyromania + ppl with fire fetishes

Ppl feel empty / hollow and doing this makes them feel better

E. trichotillomania = ppl hav an impulse to pull their own hair out; a form of self harm; this is soothing for them

* Not in DSM-5, but under consideration:

Relationships and work struggle due to the addiction

- Video game addiction

- Sex addiction

Chapter # 12- personality disorders

Answers for in class worksheet

• Exploiting + deceiving = paranoid
• Success = narcissistic

Personality disorders Used to be diagnosed separately compared to other disorders (access 2)

Personality Disorders: A persistent pattern of emotions, cognitions, and behavior that result in enduring emotional distress for the person affected and/or for others and may cause difficulty professionally and interpersonally

Usually don't get better

Symptoms are emotional, cognitive, and behavioral

Result in enduring emotional distress, it is ongoing and always present

Primarily affect the person who has it

Everyone has a personality, ie introvert vs extrovert, humor vs non humorous, comfortable vs uncomfortable, many different traits

• There are different types of personalities that ppl hav
• There are groups that their personalities is in itself diagnostic; ie the way they interact with ppl
• The way somebody is: its their personality its who they are. They way they view themselves + others
• Can be treatable / be able to get better
  • Resistant to psychotherapy
  • No medications for treatment
  • Meds that can help with some symptoms

· In general, high levels of comorbidity - more prone to other things

· Therapist reactions (countertransference) - diagnose personality disorders based on gut; at a gut level how the person sitting across from them makes them feel; a sense that is there in terms of how these people relate to others

· 11 specific personality disorders

· In 3 separate Clusters similar diagnosis

· Personality Disorder NOS Not otherwise specified; may be a mixture of other things; EX: mix of narcissistic and histrionic if show some symptoms of both

· Prevalence rates vary by diagnosis; overall approx. 6% have a personality disorder - more research on some diagnosis compared to others, borderline PD, anti social, and narcissistic;

· Less likely to receive treatment

· In general, less responsive to psychotherapy and less responsive to medication

· Chronic diagnoses

· Origins begin in childhood; never formally diagnosed until adulthood (18 years of age) - dont want to diagnose when the person is still developing

· Symptom presentation may change over time; but condition unlikely to change

I. Cluster A

* Odd and Eccentric* - cluster #1

1) Paranoid Personality Disorder

· A pervasive pattern of unjustified mistrust and suspicion of others. Pathological levels of mistrust.

Not trusting other ppl is their default - an intense mistrust

· Highly incapable of forming meaningful relationships with others

Hard to get close to someone when you dont trust them

Remarkable guarded and always waiting for the other shoe to drop

· Assuming the motivations of others are always malevolent and deceptive

Dont understand why somebody else would do something nice

If giving me something youre expecting something in return

If youre kind youre a phony

Think the world is a pretty cruel place / ppl are cruel to one another

· High levels of jealousy in interpersonal relationship

Paranoid of infidelity

· Tendency to volatile and; Described by others as distant and unfriendly

Ppl w/ it are not super violent but have a tendency to obsess over infidelity and may lead to domestic violence

· Not psychotic paranoia

b/c the paranoia is based in reality ( it could happen, although there is no evidence of it)

· More common among men

· Tends to worsen with age - bitter when young; think bad things are always happening

Causes:

- History of abuse and trauma

- Parental modeling; families that have themes of mistrust etc.

Modeling - how parents think gets pushed onto the kids

- Family history of schizophrenia

Very different diagnosis but have in common paranoia

Treatment:

Hard to do b/c wont trust the therapist

- Unlikely to seek treatment on own

- May do so when in crisis - may show up to therapy when in crisis

- CBT moderately effective - irrationally thinking about ppl out to get you; some data to show its a bit helpful but overall poor improvement

- Overall, very poor improvement rate

2) Schizoid Personality Disorder rare

Borderline of having psychotic symptoms

· A pervasive pattern of detachment from social relationships and restricted range of expression of emotions in interpersonal settings

When think of the negative symptoms of schizophrenia

· Unable or unwilling to express emotion

· Described by others as loners

· Apathetic about forming relationships ; neither desires of enjoys close relationships

· At times, uninterested in sexual/relational interactions

· Takes pleasure in few, if any, activities

· Emotionally cold, detached, and flat in affect

Described by others as dull or boring

Will not seek out therapy

May be reffered to therapy

May go for other reasons - ie at work if forced to interact w/ others cant do it

No treatment - ppl that hav it dont really get better

· Limited research on causes

- Parental modeling

- Childhood shyness - reinforced

Rather than be encouraged to get out of shell and interact w/ others, instead their shell is reinforced

Not gonna make you play / talk to others / get involved

- Relationship to Autism Spectrum Disorder

No neurological , physical , or intelligence

But the social interaction piece fits

3) Schizotypal Personality Disorder rare

Flat affect, limit range of emotions,

Reserved for ppl who are very very unusual

· Similar to Schizoid Personality Disorder as well as cognitive or perceptional distortions and eccentric behaviors

· Described as odd or unusual by others; often make others feel uncomfortable

· Excessive social anxiety

· Odd thinking patterns and speech patterns

· Odd beliefs/magical thinking inconsistent with subcultural norms

Ghosts, telepathy

· Ideas of reference

Look for things that dont exist; ie a coincidence find the meaning of it

EX: as youre reading you get to the same word that the tv says - they would think woah, this means something, this is powerful

· Non-psychotic paranoia

· Odd, stereotyped behaviors, dress, presentation style etc.

Uniform, a similar outfit everyday,

Dress loud, it fits with their personality

· Limited research on cause:

- Schizophrenia phenotype?

· Limited success of treatment:

- Treating co-morbid disorders

- Social skills training

- Antipsychotic medication - some respond well b/c on the edge of psychosis

II. Cluster B - the “dramatic and erratic” (cluster #2)

1) Antisocial Personality - does not mean shy

· A pervasive pattern of disregard for rand violation of rules, laws , and the rights of other people; Social predators

Predatory and volatile

· Irresponsible, Impulsive, Deceitful

· Lacking in: conscience, empathy, and remorse

· Common diagnosis among criminals (>80%)

80-85%

Disorder that describes a criminal mindset

· ASP vs. Psychopathy vs. Sociopathy

ASP = antisocial personality disorder

Psychopath = as a construct / concept that forensic psychologists use; acknowledge ppl who are psychopaths (the worst of the worst of ppl with antisocial PD); test with PCLR

Sociopath = not used anymore in psychology

· Glibness/superficial charm/verbally facile

Quick on their toes when talking to other ppl, good at manipulating ppl, turning on charm in quick doses

· Early behavioral problems

· Need evidence of Conduct Disorder in childhood

Causes:

Biopsychosocial - multiple conspiring causes

· Gene-environment interaction

· Genetic predisposition

· Increased testosterone levels

Men w/ this disorder often have high T

· Under-arousal: Fearlessness; need for stimulation

Underdeveloped amygdala - cannot experience fear like others do so can do things

Get bored easily and need a lot of excitement in their lives

· Frontal lobe damage – information processing deficits

· Family stress and dysfunction

· Parental modeling

· Lack of good role models

Treatments

Gets better w/ age

Age out of the behaviors but maybe not the thinking styles

· Unlikely to seek treatments

· High recidivism

· Therapy unlikely to help

· Mood stabilizing medication may have minor effects

2) Borderline Personality Disorder

· Pervasive pattern of instability, especially as it applies to mood, behavior, interpersonal relationships, and sense of identity

· Intense mood; rapid mood swings - high highs and low lows

· Turbulent relationships

Feel hurt when the other person pulls away

Feel hurt when the other person doesnt do the same when they do other things

· Intense fear of abandonment (real or imagined)

Greatest fear is abandonment

• Get very close to ppl very quickly and have very intense + feeling about them → worry that that person does not like them, or they will abandon them. Then act in ways that ultimately leads to abandonment. → that normal person ends up pulling away
• Simultaneously push ppl away with behavior but at the same time mourning the loss of a potential person in their life
• Leads to self harm, suicidal threats, manipulative barganing, but what it really does is push the person away

· Self-sabotage

· Self mutilation; suicidal gestures

Need to be told over and over again that ppl love you

Bargain with ppls approval and love

· Impulsivity

More likely to drive recklessly

· Very poor self-image; feelings of emptiness; highly impressionistic

Describe this as feelings of emptiness

Dont really feel anything

No identity

→ b/c of this they are impressionistic → take on the personalities that they become close to

Meet someone new → that person becomes their favorite, wear similar clothes, have same interests, talk the same

· 1-2% prevalence rate

· More common among women; diagnostic bias?

· Highly co-morbid:

Highest comorbidity overall in DSM

- Depression >20%

- Suicide 6-9%

- Bi-polar 40% (misdiagnosis?) - prob lower than that, this looks similar to borderline when you dont know the person that well

- Substance abuse 65%

- Eating disorders 35% - struggle w/ self image, eating disorders are more common among women with trauma history’s

Causes

· Underdeveloped limbic system - inability to regulate emotion

· Serotonin imbalance - similar to what we see in MDD

· Cognitive distortions - significant; often come from childhood trauma

Things / ppl are either all good or all bad

- irrational (EX think someone is going to leave when they dont tell u they love you 100x a day)

· Early childhood trauma

Things that they do to protect themselves end up pushing others away

- Sexual abuse (especially from trusted adult)

- Physical abuse

- Abandonment

· Integrated model

Treatment

· More likely to seek treatment than other PDs; often in treatment

· Often requires hospitalization

· Therapy can be very difficult

Form strong relationship w/ therapist; therapist needs to set strong boundaries

· Dialectic Behavioral Therapy - DBT an offshoot CBT → gradually trains ppl who have borderline personality disorder to challenge their feelings around this irrational self thinking

• HW assignments, writing,
• Can show really significant improvement

3) Histrionic Personality Disorder

· Pervasive pattern of intense attention seeking and superficiality in terms of interpersonal relationships physical appearance; pathologically superficial

Pathological → cannot feel / talk about things at a deeper level

“Hollywood” → is their anything they care about that cannot be monetized

· Intense discomfort when not the center of attention

Idea that another person is getting more attention makes them more uncomfortable

· More likely to be sexually provocative

Talk more about sex, use their sexually as a way to charm ppl, come onto ppl even if they arent attracted to them

· Shallow, shifting, artificial emotion

If asked them what was happening in ukraine and gaza rn they would have no idea / not be focusing on that

EX: women that was mad / upset b/c stores in NY city were closed the week after 9/11

· Obsessed with the one’s physical appearance. Bases value of other son physical appearance and materialistic factors

· Overly suggestive, impressionistic

Highly regarded

· Overly dramatic

· Misinterprets the nature of relationships

Have thousands of acquaintances and no friends

· Very little research on causes/treatment

· Likely to seek treatment/therapy ineffective

Likely to seek treatment but not for histrionic disorder

They often want more from life but dont realize the way they are intrapersonally to others

· Links with ASPD – gender bias?

More common in women,

Maybe in men that presents itself as narcissistic personality disorder

The way it presents itself is different based on gender

4) Narcissistic Personality Disorder

The asshole diagnosis, arrogant

· Pervasive pattern of grandiosity in which the person believes they are superior to other people and are entitled to praise and special treatment

Grandiosity - believe they are better than others, entitled to praise and special treatment; uncomfy when others get credit for things

Need to get credit for the things they do

· Exaggerated and unreasonable sense of self-importance

· Lacks sensitivity, empathy, compassion for others

Dont care very much about other ppl, basic inability to put self in other ppls shoes, not everyone is like them, not everyones likes / thinks the same as them

If u like something / are passionate about something → they may not like it

Humans → all passionate about something

Good skill to learn about what others are interested in

· Incapable of seeing things from the perspective of others

· Highly sensitive to criticism (narcissistic wound)

Freud referred to this

Can be hurt easily b/c sensitive despite the confidence

· Described by others as: arrogant and envious

· See it as sign of disrespect if others don’t attend to them or see things same they do

· Unconscious, intense insecurity; self-hatred (compensatory narcissism)

What drives this; narcissism is a compensatory mechanism

Causes:

· Similar physiological causes to ASPD

· Most likely to be a psychological condition originating in childhood

· Deficits in empathy; most likey come from parental modeling

Parents demonstrate a lack of empathy

Parents criticize empathy

Children that are spoiled and not told no → reinforced that they are special

They get whatever they want

Worse → when someone is told these things but deep down they dont believe it themselves

• Develops sense of insecurity

· Overly indulged parenting; spoiling

· Paired with: self consciousness, self-hatred

· Need to compensate

Treatment:

· Does not respond well to medication or therapy

· Patients may seek treatment but not for narcissism

Show up in therapy for something else

· Unlikely to follow through on therapy

· Some limited success with CBT

Common for narsassiic PD parents will pick a “godlen child” and then another child they are more dismissive towards → both children are at risk for developing the same PD

Gender expectations

Men

III. Cluster C

* Anxious and Avoidant*

1) Avoidant Personality Disorder - respond well to treatment

· Persistent pattern of avoidance of social situations and interpersonal relationships despite wishing to partake; Intense fear that one is inadequate or will be disliked by other people

· Pathological levels of shyness and uncertainty

Pol that are described as timid, lacking in confidence

Intense social phobia / social anxiety disorder

· Extremely sensitive to the opinions of others

Feelings are very easily hurt; irrational feeling that ppl dont like them

· Fearful of rejection

· Interpersonally anxious

· May appear similar to social phobia, but more intense and more generalized; noticeably shy

Anxious

· Sadness/worry over missed social opportunities → FOMO

· Equal gender distribution

Causes:

· Family history of schizophrenia

· Family history of shyness (especially parents); modeling

Shy, introverted, timid behavior being modeled

· Slow-to-warm temperament

Some infants are easy (happy go lucky) generally good mood; some are fussy

Slow to warm = very shy, wary of others (increased risk of getting this PD); something scary about interacting w/ others

· Early parental rejection paired with temperament

EX: hav a young child that experiences rejection early

· Significant isolation during childhood

Treatments:

· Similar to social phobia

· Increase social skills (CBT; Role playing)

· Interpersonal psychotherapy; building therapeutic reliance

· Moderate empirical support: worse than social phobia; better than other PDs

2) Dependent Personality Disorder - respond well to treatment

· Persistent pattern of dependence on other and unwillingness to assert oneself. Consistent tendency to disregard personal needs and best interests.

Dont thing they deserve to be listened to or heard

Dependent on others and not self

· Relying on others for major and minor decisions

· Unreasonable fear of abandonment

· Described as: clingy, submissive, timid, passive - sometimes push ppl away b/c of how emotionally weak they are

· Intense feelings of inadequacy

· Highly sensitive to criticism

· Often taken advantage of by other people - narcissistic PD is often attracted to dependent PD

· More common among women

Causes:

· Temperament-based timidness

· Insecure attachment – neediness

· Rejection by caregiver

· Negative messaging about ability

Treatment:

· CBT can be effective

· Increasing self-efficacy - make known they do have the ability to make their own decisions

· Gradually address: independence, confidence, personal responsibility

Hw assignments

Dependent on therapist

· Boundaries important in relationships

3) Obsessive-Compulsive Personality Disorder not OCD

· Persistent pattern of perfectionism and inflexibility. Preoccupation/obsession with: rules, lists, order, and need for control

· Become agitated and anxious if there is a perceived lack of control

· Described by others as: stubborn, rigid, difficult, frustrating

· Fixation on doing things “the right way”

· Fixated on order

· Preoccupied with details

· Poor interpersonal relationships; holds others to unreasonable standards; must to things “their way”

· Tend to be inefficient

· NOT OCD – no compulsive behaviors per se

· In severe cases, can become violent if they feel like “rules” have been violated or if they feel a loss of control

· More common among men

Causes:

· Parental modeling

· Growing up in a family with intense rules, structure etc.

· Lack of sense of self

· Family history of OCD; anxiety

Treatments:

· Similar to OCD; Less effective

· CBT

Chapter # 14

* Neurodevelopmental Disorder is new category name used in DSM-5*

Neuro = Brain

Development = Effecting development

* Referred to as Childhood Disorders in DSM-IV*

Rare to develop as an adult

If people get diagnosed later there needs to be evidence that it was there during childhood

Two important caveats about Neurodevelopmental Disorder:

Difficult to get a grasp of numbers of people actually having these

Under diagnosed and over diagnosed

Trying to find common ground of how prevalent these really are “walking the line”

Don’t want to diagnose young children just for being hyper and running around

Diagnosing at the perfect time

I. Attention Deficit/Hyperactivity Disorder (ADHD)

Two Major Symptom Categories:

A. Problems of Inattention

• Unable to focus for expected periods of time (school or play)
• Consistent daydreaming
• Self talk or self play
• Forgetfulness
• Giving up on work easily – low frustration tolerance
• Hyperfocus on exciting things, immediately frustrated on unexciting things
• No correlation between this and intelligence
• Less resilience
• Impatience
• Easily distractable

B. Problems of hyperactivity/impulsivity

• Inability to sit still
• Wander, walk around classroom
• Unable to control outbursts – subtle or pronounced
• Impatience
• Shouting out an answer, cutting in line at play time
• Bodily movement- toe and finger tapping
• Doodling
• Having something in hands
• Perceived as immature by others

These symptoms will go away with age more so than the problems of inattention

Impairs patients:

· Behaviorally

· Academically

· Socially more so due to hyperactivity

Statistics:

· Approximately 6% of children

· Twice as prevalent in US, compared to other Western Nations

Could be from underdiagnosed

· Onset 3-4 years of age

· Boys : Girls 3:1

Expected in boys more than girls

Could be missing it in girls

· Gender variations in symptom presentation

Boys – hyperactive when younger

Girls – inattentive when younger

Adult Statistics:

· Lower-level jobs

· 2.5 fewer years of education

· Higher prevalence of:

- divorce

- substance abuse

- high risk behaviors

· Higher co-morbidity with:

- Personality disorder (ASPD)

- Mood disorders

Causes of ADHD:

A. Physiological Causes

· Nearly 50 % heritability rate

· Low levels of dopamine

· High levels of norepinephrine

· Smaller brain volume

B. The Role of Toxins

· Maternal smoking

· Maternal drug-use (cocaine)

· NO evidence linking ADHD to sugar or food additives

C. Reinforced through environment

· Negative responses (parents, teachers, peers)

· Lower self-esteem, Poorer self-image

· Increases symptoms

· Parental over-reaction

· Self-fulfilling prophecy

Treatments of ADHD

A. Psychosocial

· Behavioral interventions

· Token economies

Rewards and punishments

Seen a lot in specialty schools

· Play-therapy

Color, do blocks, talk about likes and dislikes

· Parental training

· Re-focusing

Symptom refocusing

B. Medication

· Stimulants (Ritalin; Adderrall)

· Have paradoxal impact

· Improved compliance

· Improved focus

· Decrease of negative behaviors

· Do not DIRECTLY help academic performance

· Possible abuse issues/dependency

II. Autism Spectrum Disorders (ASD)

* ASD affects how one perceives and socializes with others*

* DSM-5 combined the following into one, broad disorder, that we now call Autism Spectrum Disorder:

• Most important change in DSM 5

- Autism

- Sutistic Disorder

- Asperger’s Disorder

Two Major Characteristics of ASP:

A. Restricted communication and social interaction

• Broad
• Struggling w/ eye contact / social cues
• Speaking / talking at people vs with ppl (difficult to have collaboration)
• Highly emotional around others they don't know
• Frightened by others
• No outward interest of connecting with others but internal desire for connection
• Social awkwardness, intense shyness, etc

B. Restricted, repetitive patterns of behavior, interests, or activities

• Broad
• Physical repeated behaviors → tapping, rocking, flapping (w/ hands)
• Verbal outbursts / ticks
• Screaming
• Difficult time adjusting patterns + schedule, very rhythmic, the order in which they do things, eat, wear. Struggle w/ change in routine.
• EX: ppl with aspergers attach onto 1-2 activities such as Pokemon, cars, baseball statistics, etc. Hyperfocus on these hobbies / activities

Three Levels of Severity:

Changed language b/c dont really say high functioning vs low functioning

1) Requiring support - goes to school, interacts w/ ppl, but their autism may affect their school + social skills

Support - Try to keep themselves aware of their presentation

2) Requiring substantial support - capable of going to school + learning, and may be sent to a class to help with learning, may have more stuff that is comorbid with ASD. may go to school in a less traditional way

3) Requiring very substantial support

• May be potentially self harming behavior
• Non verbal
• Less capable of learning in a traditional way / school
• Found out some ppl that are nonverbal are able to answer questions and do things mentally but cant express those outwardly through behavior and social interactions
  • New tool to help those communicate
  • Others non verbal cannot do this

Statistics Related to ASD:

· One in every 50 births in US - 2% prevalence rate; high prevalence rate in US

· Exists worldwide; Significantly more prevalent in US

Diagnostic if they are 2 full standard deviations below average IQ (avg is 100)

· 38% have intellectual disabilities = IQ below 70, difficult w/ memory + processing speeds

· Recent increase in diagnosis has multiple causes

Causes of ASD:

· Strong family component – 20% risk among siblings

If u have it there is 20% chance siblings hav it

10x more likely to run in families

· Polygenetic vulnerability

· Underdeveloped oxytocin production

Primarily in the lymbic system (hypothalamus / amygdala

· Leads to difficulty with social bonding and social memory

· Older mothers at increased risk of child with ASD

· Enlarged amygdala - on brain scans; difficulty to process emotion clearly / effectively

- Higher fear, anxiety

- Elevated cortisol

- Poor emotional control

· Vaccination hypothesis has been debunked - some of the initial research on this theory was manipulated intentionally; lying about data to make a name for themselves in science

· May be other environmental toxins that contribute that have not been discovered - some is awareness, more well defined, can identify better. However, the prevalence rates are exponentially higher in the US than other states. Ingestion during pregnancy? In the air environmentally?

EX: Lead is dangerous and was in gasoline + paint = affected a whole generation of US children

Treatments for ASD:

* Varies significantly based on severity level*

A. Behavioral Approaches

· Skill building - around social outbursts and connection

· Reduction of problem behavior - token economy (operant conditioning)

· Communication and language training - Ex: around ppl we assumed were entirely nonverbal; physically nonverbal but could process language nearly perfectly

· Exploring alternative communication strategies

· Increase socialization - they are capable of social interaction but the way to get there is a bit more challenging

· Helping child to find niche

· Naturalistic teaching strategies - EX hydro therapy, swimming, surfing. Also arts like painting. Spending time in woods / water

· Early intervention is critical - early is better

B. Medical treatments have been limited

· Tranquilizers have been used to decrease agitation in severe cases - to quiet the severe behaviors

· SSRI’s have shown mild behavioral improvements

Chapter # 14

* Neurodevelopmental Disorder is new category name used in DSM-5*

Neuro = Brain

Development = Effecting development

* Referred to as Childhood Disorders in DSM-IV*

Rare to develop as an adult

If people get diagnosed later there needs to be evidence that it was there during childhood

Two important caveats about Neurodevelopmental Disorder:

Difficult to get a grasp of numbers of people actually having these

Under diagnosed and over diagnosed

Trying to find common ground of how prevalent these really are “walking the line”

Don’t want to diagnose young children just for being hyper and running around

Diagnosing at the perfect time

I. Attention Deficit/Hyperactivity Disorder (ADHD)

Two Major Symptom Categories:

A. Problems of Inattention

• Unable to focus for expected periods of time (school or play)
• Consistent daydreaming
• Self talk or self play
• Forgetfulness
• Giving up on work easily – low frustration tolerance
• Hyperfocus on exciting things, immediately frustrated on unexciting things
• No correlation between this and intelligence
• Less resilience
• Impatience
• Easily distractable

B. Problems of hyperactivity/impulsivity

• Inability to sit still
• Wander, walk around classroom
• Unable to control outbursts – subtle or pronounced
• Impatience
• Shouting out an answer, cutting in line at play time
• Bodily movement- toe and finger tapping
• Doodling
• Having something in hands
• Perceived as immature by others

These symptoms will go away with age more so than the problems of inattention

Impairs patients:

· Behaviorally

· Academically

· Socially more so due to hyperactivity

Statistics:

· Approximately 6% of children

· Twice as prevalent in US, compared to other Western Nations

Could be from underdiagnosed

· Onset 3-4 years of age

· Boys : Girls 3:1

Expected in boys more than girls

Could be missing it in girls

· Gender variations in symptom presentation

Boys – hyperactive when younger

Girls – inattentive when younger

Adult Statistics:

· Lower-level jobs

· 2.5 fewer years of education

· Higher prevalence of:

- divorce

- substance abuse

- high risk behaviors

· Higher co-morbidity with:

- Personality disorder (ASPD)

- Mood disorders

Causes of ADHD:

A. Physiological Causes

· Nearly 50 % heritability rate

· Low levels of dopamine

· High levels of norepinephrine

· Smaller brain volume

B. The Role of Toxins

· Maternal smoking

· Maternal drug-use (cocaine)

· NO evidence linking ADHD to sugar or food additives

C. Reinforced through environment

· Negative responses (parents, teachers, peers)

· Lower self-esteem, Poorer self-image

· Increases symptoms

· Parental over-reaction

· Self-fulfilling prophecy

Treatments of ADHD

A. Psychosocial

· Behavioral interventions

· Token economies

Rewards and punishments

Seen a lot in specialty schools

· Play-therapy

Color, do blocks, talk about likes and dislikes

· Parental training

· Re-focusing

Symptom refocusing

B. Medication

· Stimulants (Ritalin; Adderrall)

· Have paradoxal impact

· Improved compliance

· Improved focus

· Decrease of negative behaviors

· Do not DIRECTLY help academic performance

· Possible abuse issues/dependency

II. Autism Spectrum Disorders (ASD)

* ASD affects how one perceives and socializes with others*

* DSM-5 combined the following into one, broad disorder, that we now call Autism Spectrum Disorder:

• Most important change in DSM 5

- Autism

- Sutistic Disorder

- Asperger’s Disorder

Two Major Characteristics of ASP:

A. Restricted communication and social interaction

• Broad
• Struggling w/ eye contact / social cues
• Speaking / talking at people vs with ppl (difficult to have collaboration)
• Highly emotional around others they don't know
• Frightened by others
• No outward interest of connecting with others but internal desire for connection
• Social awkwardness, intense shyness, etc

B. Restricted, repetitive patterns of behavior, interests, or activities

• Broad
• Physical repeated behaviors → tapping, rocking, flapping (w/ hands)
• Verbal outbursts / ticks
• Screaming
• Difficult time adjusting patterns + schedule, very rhythmic, the order in which they do things, eat, wear. Struggle w/ change in routine.
• EX: ppl with aspergers attach onto 1-2 activities such as Pokemon, cars, baseball statistics, etc. Hyperfocus on these hobbies / activities

Three Levels of Severity:

Changed language b/c dont really say high functioning vs low functioning

1) Requiring support - goes to school, interacts w/ ppl, but their autism may affect their school + social skills

Support - Try to keep themselves aware of their presentation

2) Requiring substantial support - capable of going to school + learning, and may be sent to a class to help with learning, may have more stuff that is comorbid with ASD. may go to school in a less traditional way

3) Requiring very substantial support

• May be potentially self harming behavior
• Non verbal
• Less capable of learning in a traditional way / school
• Found out some ppl that are nonverbal are able to answer questions and do things mentally but cant express those outwardly through behavior and social interactions
  • New tool to help those communicate
  • Others non verbal cannot do this

Statistics Related to ASD:

· One in every 50 births in US - 2% prevalence rate; high prevalence rate in US

· Exists worldwide; Significantly more prevalent in US

Diagnostic if they are 2 full standard deviations below average IQ (avg is 100)

· 38% have intellectual disabilities = IQ below 70, difficult w/ memory + processing speeds

· Recent increase in diagnosis has multiple causes

Causes of ASD:

· Strong family component – 20% risk among siblings

If u have it there is 20% chance siblings hav it

10x more likely to run in families

· Polygenetic vulnerability

· Underdeveloped oxytocin production

Primarily in the lymbic system (hypothalamus / amygdala

· Leads to difficulty with social bonding and social memory

· Older mothers at increased risk of child with ASD

· Enlarged amygdala - on brain scans; difficulty to process emotion clearly / effectively

- Higher fear, anxiety

- Elevated cortisol

- Poor emotional control

· Vaccination hypothesis has been debunked - some of the initial research on this theory was manipulated intentionally; lying about data to make a name for themselves in science

· May be other environmental toxins that contribute that have not been discovered - some is awareness, more well defined, can identify better. However, the prevalence rates are exponentially higher in the US than other states. Ingestion during pregnancy? In the air environmentally?

EX: Lead is dangerous and was in gasoline + paint = affected a whole generation of US children

Treatments for ASD:

* Varies significantly based on severity level*

A. Behavioral Approaches

· Skill building - around social outbursts and connection

· Reduction of problem behavior - token economy (operant conditioning)

· Communication and language training - Ex: around ppl we assumed were entirely nonverbal; physically nonverbal but could process language nearly perfectly

· Exploring alternative communication strategies

· Increase socialization - they are capable of social interaction but the way to get there is a bit more challenging

· Helping child to find niche

· Naturalistic teaching strategies - EX hydro therapy, swimming, surfing. Also arts like painting. Spending time in woods / water

· Early intervention is critical - early is better

B. Medical treatments have been limited

· Tranquilizers have been used to decrease agitation in severe cases - to quiet the severe behaviors

· SSRI’s have shown mild behavioral improvements