1 Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Flashcards
(98 cards)
1
Q
_____ is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future.
A
Anxiety
2
Q
_____ is an immediate emotional reaction to current danger characterized by strong escapist action tendencies and, often, a surge in the sympathetic branch of the autonomic nervous system.
A
Fear
3
Q
Intense fear or intense discomfort that reaches a peak within minutes:
1) Palpitations, pounding heart, or accelerated heart rate
2) Sweating
3) Trembling or shaking
4) Shortness of breath or smothering
5) Feeling of choking
6) Chest pain or discomfort
7) Nausea or abdominal distress
8) Dizzy, unsteady, lightheaded, or faint
9) Chills or heat sensations
10) Paresthesias (feelings of numbness or tingling sensations)
11) Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12) Fear of losing control or going crazy
13) Fear of dying
A
Panic Attack (4+)
4
Q
In psychopathology, a _____ is defined as an abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.
A
panic attack
5
Q
Two basic types of panic attacks are described in DSM-5:
A
- Unexpected attacks—panic disorder, no clue or when
2. Expected attacks—specific phobias or social phobia
5
Q
Two basic types of panic attacks are described in DSM-5:
A
- Unexpected attacks—panic disorder, no clue or when
2. Expected attacks—specific phobias or social phobia
6
Q
Biological Contributions of Panic Attack
No single _____ seems to cause anxiety or panic. Instead, contributions from collections of genes in several areas on chromosomes make us vulnerable when the right psychological and social factors are in place.
A
gene
7
Q
Biological Contributions of Panic Attack
Depleted levels of _____, part of the _____–benzodiazepine system, are associated with increased anxiety, although the relationship is not quite so direct.
A
gammaaminobutyric acid (GABA)
8
Q
Biological Contributions of Panic Attack
The _____system has also been implicated in anxiety, and evidence from basic animal studies, as well as studies of normal anxiety in humans, suggests the serotonergic neurotransmitter system is also involved.
A
noradrenergic
9
Q
Biological Contributions of Panic Attack
_____ system as central to the expression of anxiety (and depression) and the groups of genes that increase the likelihood that this system will be turned on.
A
Corticotropin-releasing factor (CRF)
10
Q
Biological Contributions of Panic Attack
The area of the brain most often associated with anxiety is the _____ system which acts as a mediator between the brain stem and the cortex.
A
limbic
11
Q
Biological Contributions of Panic Attack
The late _____, a prominent British neuropsychologist, identified a brain circuit in the limbic system of animals that seems heavily involved in anxiety. The system that Gray calls the behavioral inhibition system (BIS).
A
Jeffrey Gray
12
Q
Psychological Contributions of Panic Attack
_____ thought anxiety was a psychic reaction to danger surrounding the reactivation of an infantile fearful situation.
A
Freud
13
Q
Psychological Contributions of Panic Attack
_____ theorists thought anxiety was the product of early classical conditioning, modeling, or other forms of learning
A
Behavioral
14
Q
Psychological Contributions of Panic Attack
A general _____ may develop early as a function of upbringing and other disruptive or traumatic environmental factors.
A
“sense of uncontrollability”
15
Q
Psychological Contributions of Panic Attack
Parents who provide a _____ but allow their children to explore their world and develop the necessary skills to cope with unexpected occurrences enable their children to develop a healthy sense of control.
A
“secure home base”
16
Q
Social Contributions of Panic Attack
_____ life events trigger our biological and psychological vulnerabilities to anxiety. Most are social and interpersonal in nature—marriage, divorce, difficulties at work, death of a loved one, pressures to excel in school, and so on. Some might be physical, such as an injury or illness
A
Stressful
17
Q
Social Contributions of Panic Attack
DSM-5 now makes it explicit that panic attacks often co-occur with certain medical conditions, particularly _____ disorders, even though the majority of these patients would not meet criteria for panic disorder
A
cardio, respiratory, gastrointestinal, and vestibular (inner ear)
18
Q
Based on epidemiological data, Weissman and colleagues found that _____ of patients with panic disorder had attempted suicide
A
20%
19
Q
A. Excessive anxiety and worry (apprehensive expectation) on more days than not on at least 6 months in work or school performance
B. Difficulty to control worry
C. Anxiety and worry with at least 3, more days than not at least 6 months (only 1 for children)
1) Restlessness or feeling keyed up or on edge
2) Easily fatigued
3) Difficulty concentrating or mind going blank
4) Irritability
5) Muscle tension
6) Sleep disturbance (difficulty falling or staying sleep or restless, unsatisfying sleep)
D. Anxiety, worry, physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. Disturbance is not due to physiological effects of substance or general medication
F. Disturbance is not better explained by another mental disorder (anxiety, worry about panic attacks in panic disorder, negative evaluation in SAD)
A
Generalized Anxiety Disorder
20
Q
Whereas panic is associated with autonomic arousal, presumably as a result of a sympathetic nervous system surge (for instance, increased heart rate, palpitations, perspiration, and trembling), _____ is characterized by muscle tension, mental agitation, susceptibility to, fatigue (probably the result of chronic excessive muscle tension), some irritability, and difficulty sleeping.
Focusing one’s attention is difficult, as the mind quickly switches from crisis to crisis.
A
GAD
21
Q
Statistics of GAD
About _____ of individuals with GAD are female in both clinical samples. But this sex ratio may be specific to developed countries. In the South African study mentioned here, GAD was more common in males.
median age of onset based on interviews is 31.
A
two-thirds
22
Q
Statistics of GAD
GAD is prevalent among _____. In the large national comorbidity study and its replication, GAD was found to be most common in the group over 45 years of age and least common in the youngest group, ages 15 to 24.
A
older adults
23
Q
Treatment for GAD
_____ are most often prescribed for generalized anxiety, and the evidence indicates that they give some relief, at least in the short term.
Risks: First, impair both cognitive and motor functioning. They don’t seem to be as alert on the job or at school when they are taking _____. May impair driving, and in older adults they seem to be associated with falls, resulting in hip fractures.
Produce both psychological and physical dependence, making it difficult for people to stop taking them.
A
Benzodiazepines
24
Treatment for GAD
There is stronger evidence for the usefulness of _____ in the treatment of GAD, such as paroxetine (also called Paxil) and venlafaxine (also called Effexor)
antidepressants
25
Treatment for GAD
_____ for GAD in which patients evoke the worry process during therapy sessions and confront anxiety-provoking images and thoughts head-on.
_____ and the antidepressant drug sertraline (Zoloft) were equally effective immediately following treatment compared with taking placebo pills for children with GAD and other related disorders.
cognitive-behavioral treatment (CBT)
26
A. Recurrent unexpected _____ attacks are present
B. At least 1 of the attacks followed by 1 month or more of 1 or both of the following:
1. Persistent concern or worry about additional _____ attacks or their consequences (losing control, having a heart attack, going crazy))
2. Significant maladaptive change in behavior related to the attacks (avoid panic attacks, avoidance of exercise or unfamiliar situations)
C. Disturbance is not attributable to the psychological effects of a substance (drug abuse, medication) or another medical condition (hyperthyroidism, cardiopulmonary disorders)
D. Disturbance is not better explained by another mental disorder (_____ attacks do not occur only in response to feared social situations as in social anxiety disorder)
Panic Disorder
27
A. Fear or anxiety about 2 or more: Public transportation, open spaces, enclosed places, standing in line, or being in a crowd, outside the home alone
B. Fears or avoid these situations due to escape is difficulty or help is not available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (fear of falling in the elderly, fear of incontinence—mapaihi)
C. _____ situations almost always provoke fear or anxiety
D. _____ situations are actively avoided, requires companion, or endured with intense fear or anxiety
E. Fear or anxiety is out of proportion to the actual danger in situations or sociocultural context
F. Fear, anxiety, or avoidance is persistent. 6 months or more.
G. Fear, anxiety, avoidance causes distress or impairment in social, occupational or other important areas of functioning.
H. If a medical condition is present (inflammatory bowel disease, Parkinson's) the fear, anxiety, avoidance is clearly excessive
I. Fear, anxiety, avoidance is not better explained by specific phobia, situation type, social situation (SAD) and not obsessions (ODC), perceived physical flaws (BDD), reminders of PTSD, or sepanx
Agoraphobia
28
_____, in which individuals experience severe, unexpected panic attacks; they may think they’re dying or otherwise losing control.
_____ is accompanied by a closely related disorder called agoraphobia, which is fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of a developing panic symptoms or other physical symptoms, such as loss of bladder control.
Panic Disorder
29
In DSM-_____, panic disorder and agoraphobia were integrated into one disorder.
IV
30
The term agoraphobia was coined in 1871 by Karl Westphal, a German physician, and, in the original Greek, refers to fear of the _____.
marketplace
31
Agoraphobic _____ seems to be determined for the most part by the extent to which you think or expect you might have another attack rather than by how many attacks you actually have or how severe they are. Thus, agoraphobic _____ is simply one way of coping with unexpected panic attacks
avoidance
32
Most patients with panic disorder and agoraphobic avoidance also display another cluster of avoidant behaviors that we call _____ avoidance, or avoidance of internal physical sensations.
Some patients might avoid exercise/sauna baths because it produces increased cardiovascular activity or faster respiration, which reminds them of panic attacks and makes them think one might be beginning.
interoceptive
33
Statistics for Panic Disorder and Agoraphobia
_____ two-thirds of them women. Onset is in early adult life. Median age is between 20 and 24.
60% of the people with _____ have experienced such nocturnal attacks
(75% or more) of those who suffer from agoraphobia are women.
Panic Disorder
34
Causes of Panic Disorder and Agoraphobia
Clark said, although we all typically experience rapid heartbeat after exercise, if you have a _____, you might interpret the response as dangerous and feel a surge of anxiety.
psychological or cognitive vulnerability
35
Causes of Panic Disorder and Agoraphobia
One hypothesis that panic disorder and agoraphobia evolve from psychodynamic causes suggested that early _____ and/or separation anxiety might predispose someone to develop the condition as an adult.
object loss
36
Causes of Panic Disorder and Agoraphobia
_____ personality tendencies often characterize a person with agoraphobia. These characteristics were hypothesized as a possible reaction to early separation.
Dependent
37
Treatment for Panic Disorder and Agoraphobia
A large number of drugs affecting the noradrenergic, serotonergic, or GABA–benzodiazepine neurotransmitter systems, or some combination, seem effective in treating panic disorder.
High-potency benzodiazepines, the newer selective-serotonin reuptake inhibitors (SSRIs) such as Prozac and Paxil.
_____ are currently the indicated drug for panic disorder
SSRIs
38
Treatment for Panic Disorder and Agoraphobia
The strategy of _____ treatments is to arrange conditions in which the patient can gradually face the feared situations and learn there is nothing to fear.
exposure-based
39
Treatment for Panic Disorder and Agoraphobia
_____ exercises, sometimes combined with anxiety-reducing coping mechanisms such as relaxation or breathing retraining, have proved effective in helping patients overcome agoraphobic behavior whether associated with panic disorder or not.
Gradual exposure
40
Treatment for Panic Disorder and Agoraphobia
_____ developed at one of our clinics concentrates on exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks. The therapist attempts to create “mini” panic attacks in the office by having the patients exercise to elevate their heart rates or perhaps by spinning them in a chair to make them dizzy.
Panic control treatment (PCT)
41
Treatment for Panic Disorder and Agoraphobia
General conclusions from these studies suggest _____ to combining drugs and CBT initially for panic disorder and agoraphobia.
no advantage
42
Treatment for Panic Disorder and Agoraphobia
_____ seemed to perform better. _____ should be offered initially, followed by drug treatment.
psychological treatments
43
A. Marked fear or anxiety about a specific object or situation
B. Phobic object or situation almost always provokes immediate fear or anxiety. (Children's anxiety is crying, tantrums, freezing, or clinging)
C. Phobic object or situation is actively avoided or endured with intense fear or anxiety
D. Fear or anxiety is out of proportion to danger, and to sociocultural context
E. Fear, anxiety, or avoidance is persistent, 6 months or +
F. Fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
G. Not better explained by panic-like symptoms, or agoraphobia, OCD, PTSD, sepanx, SAD
Specific Type:
1. Animal
2. Natural environment (heights, water, storm)
3. Blood-injection-injury
4. Situational (planes, elevators, enclosed spaces)
5. Other (choking, vomit, contracting illness, children; loud sounds, costumed character)
Specific Phobia
44
A _____ is an irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function
specific phobia
45
_____, a fear of small enclosed places, is situational, as is a phobia of flying
Claustrophobia
46
Statistics for Specific Phobia
Fears of _____ rank near the top. Most female. Onset at 7. Declines with old age.
snakes and heights
47
Causes of Specific Phobia
experiencing a false alarm (panic attack) in a specific situation, observing someone else experience severe fear (vicarious experience), or, under the right conditions, being told about danger.
pain results in an alarm response (a _____).
true alarm
48
Treatment for Specific Phobia
_____ exercises. For separation anxiety, parents are often included.
exposure-based
49
_____ is characterized by children’s unrealistic and persistent worry that something will happen to their parents or other important people in their life or that something will happen to the children themselves that will separate them from their parents (for example, they will be lost, kidnapped, killed, or hurt in an accident).
Separation Anxiety Disorder
50
It is also important to differentiate separation anxiety from _____. In _____, the fear is clearly focused on something specific to the _____ situation; the child can leave the parents or other attachment figures to go somewhere other than _____.
school phobia
51
A. Marked fear or anxiety about 1 or more social situations exposed to possible scrutiny (conversation, meet) being observed (eating or drinking) performing (speech) children occurs in peer settings not just adults
B. Fears that they will act in a way, show anxiety symptoms that will be negatively evaluated (humiliation, embarrass, rejection, offend others)
C. Social situations almost always provoke fear or anxiety. Children cry, tantrums, freeze, cling, shrink, failing to speak in social situations
D. Social situations are avoided or endured with intense fear or anxiety
E. Fear or anxiety is out of proportion to danger, social or sociocultural
F. Fear, anxiety or avoidance is persistent. 6 months or +
G. Fear, anxiety, or avoidance distress or impairment to social, occupational or other important areas of functioning
H. Fear, anxiety or avoidance is not substance or medical
I. The fear, anxiety, or avoidance not better explained by other mental disorders. PD, SAD, SepAnx
J. If another medical condition (stuttering, parkinsons, obesity, disfigurement from burns or injury) is present, fear, anxiety or avoidance is unrelated or excessive.
Specify if:
Performance only: restricted to speaking or performing in public
Social Anxiety Disorder (Social Phobia)
52
SAD is more than exaggerated shyness. Individuals with just _____ anxiety, which is a subtype of SAD, usually have no difficulty with social interaction, but when they must do something specific in front of people, anxiety takes over and they focus on the possibility that they will embarrass themselves.
performance
53
Other situations that commonly provoke performance anxiety are eating in a restaurant or signing a paper or check in front of a person or people who are watching.
The most common type of performance anxiety, to which most people can relate, is _____.
public speaking
54
Statistics for SAD
This makes SAD _____ only to specific phobia as the most prevalent anxiety disorder
second
55
Statistics for SAD
Unlike other anxiety disorders for which females predominate, the sex ratio for SAD is nearly _____.
SAD also tends to be more prevalent in people who are young (18–29 years), undereducated, single, and of low socioeconomic class.
50:50
56
Causes of SAD
socially anxious individuals more quickly recognized angry faces than “normals”, whereas “normals” remembered the accepting expressions.
Jerome Kagan and his colleagues have demonstrated that some infants are born with a temperamental profile or trait of inhibition or shyness that is evident as early as _____ months of age.
_____ infants with this trait become more agitated and cry more frequently when presented with toys or other age-appropriate stimuli than infants without the trait.
Four-month-old
57
Treatment for SAD
Clark and colleagues evaluated a _____ therapy program that emphasized real-life experiences during therapy to disprove automatic perceptions of danger. This is a superior treatment.
CBT, Interpersonal Psychotherapy (IPT), Clark's cognitive therapy, with SSRI drug Prozac.
cognitive
58
Now grouped with the anxiety disorders in DSM-5, _____ is a rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected.
In order to meet diagnostic criteria for SM, the lack of speech must occur for more than one month and cannot be limited to the first month of school.
Selective Mutism (SM)
59
DSM-5 consolidates a group of formerly disparate disorders that all develop after a relatively stressful life event, often an extremely stressful or traumatic life event.
This set of disorders—_____—include attachment disorders in childhood following inadequate or abusive childrearing practices, adjustment disorders characterized by persistent anxiety and depression following a stressful life event, and reactions to trauma such as posttraumatic stress disorder and acute stress disorder.
Trauma-and Stressor-Related Disorders
60
Note: The following criteria apply to adults, adolescents, and children older than 6 years.
For children 6 years and younger, see corresponding criteria below.
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains: police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Note: In children, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
Note: In children, trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” ‘The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings)
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
2. Dereaiization: Persistent or recurrent experiences of unreality of surroundings
(e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
Specify if:
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Posttraumatic Stress Disorder (PTSD)
61
PTSD victims reexperience the event through _____.
memories and nightmares
62
In PTSD with delayed onset, individuals show few or no symptoms immediately or for months after a trauma, but at least _____ afterward develop full-blown PTSD
6 months later, and perhaps years
63
As we noted, PTSD cannot be diagnosed until _____ after the trauma. In DSM-IV a disorder called acute stress disorder was introduced. This is really PTSD, or something very much like it, occurring within the first month after the trauma, but the different name emphasizes the severe reaction that some people have immediately.
a month
64
Statistics for PTSD
The _____ are associated with experiences of rape; being held captive, tortured, or kidnapped; or being badly assaulted.
highest rates
65
Causes of PTSD
A _____ history of anxiety suggests a generalized biological vulnerability for PTSD. Nevertheless, as with other disorders, there is little or no evidence that genes directly cause PTSD.
family
66
Causes of PTSD
Family instability is one factor that may instill a sense that the world is an uncontrollable, potentially dangerous place.
The results from a number of studies are consistent in showing that, if you have a _____ group of people around you, it is much less likely you will develop PTSD after a trauma.
strong and supportive
67
Treatment for PTSD
In psychoanalytic therapy, reliving emotional trauma to relieve emotional suffering is called _____.
catharsis
68
Treatment for PTSD
Therefore, _____, in which the content of the trauma and the emotions associated with it are worked through systematically, has been used for decades under a variety of names.
imaginal exposure
69
Treatment for PTSD
_____ therapy to correct negative assumptions about the trauma—such as blaming oneself in some way, feeling guilty, or both—is often part of treatment.
SSRI din
Cognitive
70
_____ describe anxious or depressive reactions to life stress that are generally milder than one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of interfering with work or school performance, interpersonal relationships, or other areas of living.
Unable to cope with the demands of the situation.
If the symptoms persist for more than six months after the removal of the stress or its consequences, the _____ would be considered “chronic”.
Adjustment disorders
70
_____ describe anxious or depressive reactions to life stress that are generally milder than one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of interfering with work or school performance, interpersonal relationships, or other areas of living.
Unable to cope with the demands of the situation.
If the symptoms persist for more than six months after the removal of the stress or its consequences, the _____ would be considered “chronic”.
Adjustment disorders
70
_____ describe anxious or depressive reactions to life stress that are generally milder than one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of interfering with work or school performance, interpersonal relationships, or other areas of living.
Unable to cope with the demands of the situation.
If the symptoms persist for more than six months after the removal of the stress or its consequences, the _____ would be considered “chronic”.
Adjustment disorders
71
_____ refers to disturbed and developmentally inappropriate behaviors in children, emerging before five years of age, in which the child is unable or unwilling to form normal attachment relationships with caregiving adults.
Due to inadequate or abusive child-rearing practices.
The result is a failure to meet the child’s basic emotional needs for affection, comfort, or even providing for the basic necessities of daily living.
Attachment disorders
72
In _____ disorder the child will very seldom seek out a caregiver for protection, support, and nurturance and will seldom respond to offers from caregivers to provide this kind of care.
Generally they would evidence lack of responsiveness, limited positive affect, and additional heightened emotionality, such as fearfulness and intense sadness.
reactive attachment
73
In _____ disorder, a similar set of child rearing circumstances— perhaps including early persistent harsh punishment—would result in a pattern of behavior in which the child shows no inhibitions whatsoever to approaching adults.
Such a child might engage in inappropriately intimate behavior by showing a willingness to immediately accompany an unfamiliar adult figure somewhere without first checking back with a caregiver.
disinhibited social engagement
74
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Specify if:
With good or fair insiglit: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
With absent insight/deiusionai beiiefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
Specify if:
Tic-reiated: The individual has a current or past history of a tic disorder.
Obsessive-Compulsive and Related Disorders
75
In other anxiety disorders, the danger is usually in an external object or situation, or at least in the memory of one. In _____, the dangerous event is a thought, image, or impulse that the client attempts to avoid as completely as someone with a snake phobia avoids snakes.
OCD
76
Based on statistically associated groupings, there are four major types of obsessions and each is associated with a pattern of compulsive behavior.
symmetry obsessions account for most obsessions (26.7%)
“forbidden thoughts or actions” (21%)—feel they are about to yell out a swear word in church, rituals, counting-complusion
cleaning and contamination (15.9%)
and hoarding (15.4%)
77
More complex tics with involuntary vocalizations are referred to as _____ disorder.
In some cases, these movements are not tics but may be compulsions, as they were in the case of Frank in Chapter 3 who kept jerking his leg if thoughts of seizures entered his head.
The obsessions in tic-related OCD are almost always related to symmetry.
Tourette’s
78
Statistics of OCD
1:1 m and f. Onset is childhood to 30. Median is _____. Onset age peak for m 13-15, f 20-24.
19
79
Causes of OCD
equate thoughts with the specific actions or activity represented by the thoughts, this is called _____. Thought–action fusion may, in turn, be caused by attitudes of excessive responsibility and resulting guilt developed during childhood, when even a bad thought is associated with evil intent.
thought–action fusion
80
Treatment for OCD
most effective seem to be those that specifically inhibit the reuptake of serotonin, such as clomipramine or the _____.
SSRIs
81
Treatment for OCD
most effective approach is called exposure and _____, a process whereby the rituals are actively prevented and the patient is systematically and gradually exposed to the feared thoughts or situations.
ritual prevention (ERP)
82
Treatment for OCD
_____, with or without the drug, produced superior results to the drug alone, with 86% responding to _____alone versus 48% to the drug alone.
Combining the treatments did not produce any additional advantage.
Exposure and Ritual Prevention
83
Treatment for OCD
_____ is one of the more radical treatments for OCD. “_____” is a misnomer that refers to neurosurgery for a psychological disorder.
surgical lesion to the cingulate bundle (cingulotomy), approximately 30% benefited substantially.
Psychosurgery
84
A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns
C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
Specify if:
With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
Specify if:
Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., “I look ugly” or “I lool< deformed”).
With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.
With absent insight/delusionai beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true.
Body Dysmorphic Disorder or “imagined ugliness” or somatoform disorder
85
Quite understandably, suicidal ideation, suicide attempts, and suicide itself are typical consequences of this disorder
Body Dysmorphic Disorder or “imagined ugliness” or somatoform disorder
86
Men tend to focus on body build, genitals, and thinning hair and tend to have more severe ______.
Body Dysmorphic Disorder or “imagined ugliness” or somatoform disorder
87
Women focus on more varied body areas and are more likely to also have an eating disorder.
Body Dysmorphic Disorder or “imagined ugliness” or somatoform disorder
88
Body Dysmorphic Disorder or “imagined ugliness” or somatoform disorder
Age of onset ranges from early adolescence through the _____, peaking at the age of 16–17
20s
89
degree of psychological stress, quality of life, and impairment were generally worse than comparable indices in patients with _____, diabetes, or a recent myocardial infarction (heart attack)
depression
90
First, drugs that block the re-uptake of serotonin, such as clomipramine (Anafranil) and fluvoxamine (Luvox), provide relief to at least some people.
Second, fluoxetine (Prozac), with 53% showing a good response compared with 18% on placebo after 3 months.
Only 2 treatments for Body Dysmorphic Disorder or “imagined ugliness” or somatoform disorder
91
Exposure and response prevention, the type of _____ therapy effective with OCD, has also been successful with BDD.
cognitive-behavioral
92
Other Obsessive-Compulsive and Related Disorders (3)
Hoarding Disorder
Trichotillomania
Excoriation
93
During teenage years, excessive acquisition of things, difficulty discarding anything, and living with excessive clutter under conditions best characterized as gross disorganization. Because of some potential use or sentimental value in their minds, or simply becomes an extension of their own identity.
Can be failure or inability to care for animals.
Hoarding Disorder
94
This behavior results in noticeable hair loss, distress, and significant social impairments. Genetic in small number. More on female.
Trichotillomania
95
Psychological treatments, particularly an approach called “habit reversal training”, has the most evidence for success with these two disorders. SSRI
Treatments for Trichotillomania and Excoriation
