CH 5/6 - Anxiety, Trauma, Stress, Somatoform Disorders

Question 1

phbias

Answer 1

• disrupting, fear-mediated avoidance that is out of proportion to the danger actually posed; is recognized by the sufferer as groundless
• many specific fears do not cause enough hardship to compel and indv to seek treatment
• named by greek word for the feared object/situation followed by phobia (derived from greek god phobos who frightened his enemies)
• new ones emerge with societal changes

Question 2

nomophobia

Answer 2

pathological fear of remaining out of touch by technology that is experienced by ppl who have become overly dependent on mobile phones/personal computers

Question 3

phobias considered from different paradigms

Answer 3

phsychoan: focus on content of phobia and see phobic object as symbol of unconscious fear
beahv: focus on the function of phobias and how they impact one’s behaviours

Question 4

specific phobias

Answer 4

-unwarranted fears caused by presence/anticipation of specific object/situation
-tend to be long-lasting, possible bc only a v small minority actually receive treatment
most common: animals, heights, closed spaces, flying, water, dentist, blood/needles, storms/thunder/lightning
-may vary cross culturally (chinese pa-leng worries a loss of body heat might be life threatening, japanese taijin kyofusho is an extreme fear of embarrassing others)

Question 5

5 categories of fear

Answer 5

• agoraphobia
• fear of height/water
• threat fears (blood/needles/storms/thunder)
• fear of being observed
• speaking fears

Question 6

social phobia

Answer 6

• persistent, irrational fears linked generally to presence of other ppl
• those with social phobias try to avoid situations in which they might be evaluated bc they fear revealing signs of anxiousness or behaving in an embarrassing way (ex. public eating/speaking, using public lavatories)
• can be generalized of specific
• onset usually in adolescence and more prevalent in women

Question 7

behavioural theories of phobia

Answer 7

• avoidance conditioning: rxns are learned avoidance responses and phobias develop through classical and operant conditioning
• modelling: vicarious learning of fear thr imitation of others’ reactions
• prepared learning: classical conditioning to stimuli to which and organism is physiologically prepared to be sensitive (snakes and heights vs lambs)
• cognitive diatheses (ex tendencies to believe sim traumatic events will re-occur) may be important

Question 8

cognitive theories of phobia

Answer 8

• focus on how thought processes can serve as a diathesis and maintain a phobia
• anxiety as related to being more likely to attend to negative stim, interpret ambiguous info as threatening, and believe negative events are more likely to reoccur

Question 9

social anxiety

Answer 9

• more concerned about evaluation
• highly aware of the image they present to others
• high in public self-consciousness
• preoccupied with need to seem perfect/not make mistakes in from of others
• tend to view themselves negatively even if they’ve actually performed well in a social interaction
• less certain about positive self-views
• see their positive attributes as being less important (rel to ppl w/o social phobia)

Question 10

cognitive behavioural model of social phobia

Answer 10

• link to attention bias to focus on negative social info, perfectionist standards for accepted social performance, and high degree of public self consciousness
• fear the “the self is deficient”
• linked with excessive self-criticism

Question 11

post-event processing (PEP) of negative social experiences

Answer 11

• form of rumination abt previous experiences and responses to situations, esp ones involving other ppl that didn’t turn out well
• there’s a link btw social anxiety and PEP

Question 12

phobia: predisposing biological factors

Answer 12

• ppl w specific phobia (also PTSD/SAD) have greater activity in the amygdala and insula (areas as’d w negative emotional response)
• ANS stability-lability: labile/jumpy indvs have ANS readily aroused by wide range of stim; is also to an extent hereditary
• genetic factors: behavioural patterns such as shyness, agitation to stim that arise in some infants may set stage for development of phobias; these patterns may be inherited, but no specific susceptibility genes

Question 13

psychoanalytical theory of phobia

Answer 13

• a defence against the anxiety produced by repressed id impulses
• anxiety is displaced from the feared impulse and moved to an object/situation that has some symbolic connection (this becomes the phobic stimuli)
• avoidance allows the indv to deal with repressed conflicts

Question 14

panic attack

Answer 14

• sudden, often inexplicable onset of alarming symptoms (laboured breathing, heart palpitations, nausea, chest pain, feelings of choking, dizziness, trembling, sweating, intense apprehension, terror, feelings of impending doom)
• may be paired with depersonalization/derealization
• may occur frequently
• may be situationally predisposed or uncued

Question 15

agoraphobia

Answer 15

• comes from greek “gora”, meaning marketplace
• cluster of fears centering on public places and being unable to escape or find help should one become incapacitated
• even leaving the house can be extremely distressing
• more common in women

Question 16

panic disorder

Answer 16

• indv avoids situations in which a panic attack could be dangerous or embarrassing
• diagnosed as with or without agoraphobia; if avoidance becomes widespread, it is with agoraphobia
• more common in women

Question 17

biological theories of panic disorder

Answer 17

• runs in families and has greater concordance in MZ than DZ twins
• may be linked to loci w/in / near COMT gene (potentially Val158Met polymorphism)
• Noradrenergic activity theory: panic caused by overactivity in noradrenergic system (panic attacks may be caused by stimulation of the locus ceruleus)
• GABA problems: GABA generally inhibits NA activity and PET study found fewer GABAR binding sites in ppl with panic disorder
• cholecystokinin (CCK): a peptide that occurs in the cerebral cortex, amyg, hippo and brain stem that induces anxiety-like effects and can be blocked by benzos; panic disorder might be due in part to CCK hypersensitivity and exposure increases panic attacks

Question 18

psychological theories of panic disorder

Answer 18

• fear of fear hypothesis: suggests agoraphobia isn’t a fear of public places per se, but rather/more specifically the fear of having a panic attack in public
• misinterpretation of physiological arousal symptoms: autonom NS might be predisposed to be overly active; when coupled with a tendency to be quite upset every time it happens, panic can result

Question 19

anxiety sensitivity

Answer 19

-risk factor for anxiety psychopathology and predicts development of spontaneous panic attacks

Question 20

generalized anxiety disorder

Answer 20

• persistent anxiety, often about minor things; chronic, uncontrollable worry (most frequent are health and daily life)
• difficulty concentration, tiring easily, restlessness, irritability, muscle tension
• typically begins in mid teens and stressful life events play role in onset
• few ppl seek help and hard to treat
• highly comorbid with other anxiety and mood disorders
• attention easily draw to stim that suggest possibly physical harm or social misfortune (criticism, embarrassment, rejection)

Question 21

cognitive-behavioural perspectives of GAD

Answer 21

• learning view: anxiety as classically conditioned to external stimuli, but with a broader ranger of conditioned stimuli
• cognitive: focuses on control and helplessness, emphasizes perception of not being in control as a central characteristic of all forms of anxiety

Question 22

GAD two-factor model

Answer 22

• two factors are intolerance of uncertainty and fear of anxiety
• GAD prone ppl with this intolerance desire to engage in approach behaviors to reduce their feelings of uncertainty, but also characterized simultaneously by a fear of anxiety that promotes the use of avoidance strategies to limit the experience of anxious arousal

Question 23

biological perspectives of GAD

Answer 23

• may have genetic component
• neurobiol model based on the fact that benzos are often effective for treating anxiety; receptors in the brain for benzos have been linked to decreasing anxiety by increasing the release of GABA (an inhibitory NT)
• drugs that block/inhibit the GABA system may increase anxiety

Question 24

psychoanalytical perspectives of GAD

Answer 24

• an unconscious conflict btw the ego and id impulses (which are usually sexual or aggressive in nature and struggling to be expressed, but the ego can or will not allow this because it fears punishment)
• the true source of the anxiety (the id desires) are ever present, but the indv will be clueless as to why

Question 25

obsessive compulsive disorder

Answer 25

-disorder in which the mind is flooded with persistent and uncontrollable thoughts and the indv is compelled to repeat certain acts again and again

Question 26

obsessions

Answer 26

• intrusive and recurring thoughts, impulses, images
• most frequent fears are contamination, expressing sexual/aggressive impulse, hypochandria/bodily dysfunction
• can take form of extreme doubting, procrastination, indecision

Question 27

compulsions

Answer 27

• repetitive behavioural/mental act that the person feels driven to perform to reduce the distress caused by obsessive thoughts or to prevent some calamity from occurring
• activity is not realistically connected with its apparent purpose and is clearly excessive
• often a fear of dire consequences if the action is not performed
• intensity and frequency of checking are worsened by a sense of personal responsibility, the probability of harm if checking doesn’t take place, and the predicted seriousness of harm
• mostly viewed by sufferers a foreign to their personality, ego-dystonic (not intrinsically pleasurable and counter to the ego)

Question 28

behavioural and cognitive theories of OCD

Answer 28

• learned behaviours are reinforced by fear reduction
• compulsive checking may result from a memory deficit (general research suggests inconsistent evidence of verbal memory deficit, but stronger evidence for impairments in memory for non-verbal info)

Question 29

retrospective memory

Answer 29

ability to remember recent events and experiences

Question 30

prospective memory

Answer 30

ability to look forward and to remember at the right place or time to perform an intended action when it is expected/required

Question 31

rachman’s theory of obsessions

Answer 31

-rachman identified range of cognitive factors involved in OCD in addition to the obsessions themselves (including inflated sense of personal responsibility for outcomes, cognitive bias involving thought-action fusion)
thought action fusion involves two beliefs: the mere act of thinking abt unpleasant events increases perceived likeliness they’ll actually happen, and that at a moral lvl, thinking something unpleasant is the same as actually doing it

Question 32

meta-cognition in OCD

Answer 32

-people with OCD have such highly developed cognitive self-consciousness that they reflect excessively on their cognitive processes (they think a lot about their own thinking)

Question 33

biological perspectives on OCD

Answer 33

• genetic evidence: highest rates of anxiety disorders occur among first-degree relatives
• brain structure: development of OCD as’d with encephalitis, head injury, brain tumor; PET scan shows greater activation in frontal lobes; link to basal ganglia, which controls motor behaviour (tourettes tics have been linked to basal ganglia dysf, and ppl with tourettes often have OCD too)
• related to decreased 5HT? (most clients treated w SSRIs don’t improve tho)

Question 34

psychoanalytical perspectives of OCD

Answer 34

• classical perspective views obsessions and compulsions as similar and as resulting from instinctual forces (sexual, aggressive) that aren’t under control bc of over harsh toilet training (anal fixation)
• others view OCD a result of feelings of incompetence due to an inferiority complex (unconsciously adopting compulsive rituals to care out a domain in which they exert control and can feel proficient)

Question 35

behavioural approaches to treating anxiety

Answer 35

• systematic desensitization (often used for phobias; indv imagines a series of increasingly frightening scenes while in a deep state of relaxation)
• in vivo exposure (out performed placebo and other psychotherapeutic responses, but as’d with high dropout rate and low treatment acceptance)
• in virtuo exposure (just a s effective as in vivo, and particularly helpful for fear of flying)

Question 36

PTSD

Answer 36

• extreme response to a severe stressor, including anxiety, avoidance of stimuli as’d with the trauma, numbing of emotional responses
• unlike other psychological disorders, includes traumatic event(s) that the person directly experienced/witnessed involving death of others, threatened death of self, serious injury or threat to physical integrity of self/others that created intense fear/horror/helplessness
• often experienced by first responders and military
• recognized the primary cause is an event, not some aspect of the person, but not everyone who encounters a traumatic life event develops PTSD

Question 37

acute stress disorder

Answer 37

• when a traumatic stressor causes significant impairment in social or occupational functioning that lasts for less than one month
• development depends on type of trauma experienced (extremely common for rape survivors, surprisingly low for motor vehicle accidents)
• some ppl get over it while others may go on to develop PTSD

Question 38

major clusters of PTSD symptoms

Answer 38

• re-experiencing the traumatic event
• avoidance of stimuli as’d with the event or numbing of responsiveness
• symptoms of increased arousal

Question 39

PTSD risk factors

Answer 39

• exposure to (by definition) and severity of trauma
• gender (more incidence in females)
• perceived threat to life
• family history if psychiatric disorders
• presence of pre-existing psychiatric disorders
• early separation from parents
• previous exposure to traumas
• dissociative symptoms at time of trauma
• repression of trauma
• tendency to take personal responsibility for failures
• coping with stress by focusing on emotions
• insecure attachment style

Question 40

protective factors in PTSD

Answer 40

• being exposed to less severe events

- having high intelligence (IQ>115)

Question 41

psychological theories of PTSD

Answer 41

• arises from classical conditioning of fear avoidances that are built up and negatively reinforced by the reduction o fear that comes from not being in the presence of the conditioned stimulus
• anxiety sensitivity

Question 42

cognitive theories of PTSD

Answer 42

• some categorize it as a disorder of memory, the hallmark feature being constant involuntary recollection of the traumatic event
• several studies show an association with impaired memory of neural stimuli
• robust association btw PTSD and memory impairment that tends to be stronger for verbal than visual memory

Question 43

psychodynamic theory of PTSD

Answer 43

-memories of the traumatic event occur constantly in the person’s mind and are so painful that they are either consciously suppressed (ex by distraction) or repressed

Question 44

biological theories of PTSD

Answer 44

• some arguments in favour of genetic link
• specific domains or NA system (trauma may raise lvls of norepinephrine (a fairly natural fight or flight response), but PTSD patients seem to have an increased sensitivity of noradrenergic receptors

Question 45

prolonged exposure therapy

Answer 45

• designed specifically to treat PTSD
• combied CBT approach involving step by step process of exposure to imagery reflecting traumatic memories as well as actual life situations reflecting trauma
• exposure accompanied by changing thoughts and cog appraisals, as well as being taught specific skills such as regulating/controlling breathing
• effective; may lead to the extinction of the fear response of change the meaning that stimuli have for ppl

Question 46

somatoform disorders

Answer 46

• complaints of bodily symptoms that suggest physical defect/dysfunction but for which no physiological basis can be found
• reflect mind-body connection and growing realization that psych and phys functioning interact w each other
• thought to be linked to psych factors, presumably anxiety

Question 47

hypochondriasis

Answer 47

• preoccupation with persistent fears of having a serious disease/condition, despite medical reassurance to the contrary
• typically begins in early childhood and has chronic course
• comorbid with mood/anxiety disorders
• overreact to and misinterpret ordinary phys sensations/minor abnormalities and see as evidence for their beliefs
• now called Somatic Symptom Disorder of Illness Anxiety Disorder
• prevalence seems to be higher in females
• likely underdiagnosed in older adults and may go unnoticed in young children (who may have somatic complaints but don’t rly worry abt illness)

Question 48

health anxiet

Answer 48

• health related fears and beliefs, bases on misinterpretations of bodily signs and symptoms as being indicative of a serious illness
• best conceptualized on a continuum
• can be present in both hypochondriasis (fear of having an illness) and an illness phobia (fear of contracting an illness)
• moderately heritable, but most variance is due to environmental factors
• increases in relation to perceived likelihood of illness, and its perceived cost, awfulness or burden
• decreases with perceived ability to cope and perceived presence of rescue factors

Question 49

conversion disorder (functional nerological symptom disorder)

Answer 49

-phys healthy ppl experience sensory/motor symptoms suggesting illness related to neurological damage, but the body organs and NS are found to be fine
(ex sudden loss of vision, paralysis or extremities, seizures and coordination disturbances, sensation of prickling/tingling/creeping on skin, aphonia (loss of voice but whispered speech), anosmia (loss/impairment of smell)
-tends to appear suddenly in stressful situations
-name from freud, who believed anxiety and psych conflict were converted to phys symptoms
-more prevalent in women
-frequently comorbid with depression, SUD, anxiety, dissociative and personality disorders (esp BPD and histrionic)
-frequent reports of phys or sexual abuse

Question 50

malingering

Answer 50

• feigning a condition for secondary gain
• diagnosed when conversion-like symptoms are determine to be under voluntary control
• can sometimes be differentiated from true conversion disorder by la belle indifference (a relative lack of concern abt symptoms and willingness to talk seen in many conversion patients)

Question 51

factitious disorder

Answer 51

• people intentionally produce physical or psychological symptoms (either make them up or inflict injuries upon themselves)
• motivation is unclear and generally not linked to a recognizable goal/benefit

Question 52

factitious disorder by proxy/muchausen syndrome by proxy

Answer 52

-factitious disorder involving a parent creating physical illnesses in a child

Question 53

psychoanalytic theories of conversion disorder

Answer 53

• proposed to be caused when a person experiences an event that creates great emotional arousal, but the affect is not expressed and the memory of the event is cut off from conscious experience
• specific symptoms said to related causally to the traumatic event that preceded them
• unresolved electra complex

Question 54

blindsight

Answer 54

-some patients with lesions in the visual cortex, rather than damage to the eye, said that they were blind but performed well on visual tasks; they have vision, but do not know that they can see

Question 55

beahvioural and cognitive theories of conversion

Answer 55

• may be similar to malingering in that the person adopts the symptom to secure some end
• they attempt to behave according to their conception of how a person with a disease affecting the motor or sensory abilities would act

Question 56

social and cultural factors of conversion disorders

Answer 56

• incidence of conversion has decreased over the last century (psychoanalytics believe this is bc the repressive sexual attitudes of the time may have contributed to greater prevalence)
• more prevalent among ppl with lower socioeconomic status and from rural areas
• diagnosis of hysteria has declined in industrialized societies to remained common in undeveloped ones

Question 57

biological factors in conversion disorder

Answer 57

• no real support for a genetic hypothesis
• may be some relationship btw the disorder and brain structure (symptoms are more likely to occur on the left side of the body, implying potential hemispheric relationship)

Question 58

therapies for somatoform disorders

Answer 58

• cognitive behavioural therapy is the most effective form of treatment across various conditions
• somatoform disorders are expensive and difficult to treat, and positive effects of treatment may be less durable and lasting than in other mental disorders

Question 59

dissociative disorders

Answer 59

• characterized by disruption of/discontinuity in normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behaviour
• symptoms include unbidden intrusions into awareness and behaviour with accompanying losses of continuity in subjective experience (positive, such as identity fragmentation, depersonalization, derealization) or inability to access information or to control mental functions that normally are readily amenable to access/control (typically amnesia)

Question 60

factors that can cause dissociation

Answer 60

-onset assumed to be related to stressful experience; stress and fatigue are key factors, as well as binge drinking, use of psychoactive drugs, hypnotic suggestion (esp in suggestible ppl)

Question 61

dissociative fugue

Answer 61

• specific form of dissociative amnesia in which the person is totally amnestic and suddenly leaves homes and work to assume a new identity (memory loss is more extensive in dissociative fugue than dissociative amnesia)
• often the new life doesn’t crystallize and the fugue is of brief duration
• consists of limited but apparently purposeful travel, during which social contacts are minimal or absent
• typically occur after severe stress (marital quarrel, personal rejection, financial/occupational difficulty, war service, natural disaster)
• recovery of memory is usually complete, and the indv doesn’t recollect what took place during the flight from their usual haunts

Question 62

dissociative amnesia

Answer 62

• inability to remember biological info that is inconsistent with normal forgetting; may be localized (to an event/time period), selective (a specific aspect of an event) or generalized (identity/life history)
• most are usually initially unaware of their amnesia and only occurs when personal identity is lost or when circumstances make them aware of missing autobiographical info
• info is not permanently lost, but cannot be retrieved during the episode of amnesia

Question 63

depersonalization

Answer 63

• person’s perception of experience of the self is disconcertingly and disruptively altered
• they have unusual sensory experiences (limbs seeming dramatically different, own voices sounding strange, impression of feeling outside the body or of being mechanical)
• typically triggered by stress

Question 64

derealization

Answer 64

essentially a fogginess or sense of detachment from the situational context or things in the situation

Question 65

depersonalization / derealization disorder

Answer 65

• characterized by clinically significant persistence of either condition
• alterations of experience are accompanied by intact reality testing
• no evidence of distinction btw predominantly one or the other (they can therefore have one, the other, or both)
• usually begins in adolescence and has chronic course
• frequently comorbid with anxiety and depressions

Question 66

dissociative identity disorder

Answer 66

(formerly MPD)

• presence or 2+ distinct personality states or experience of possession and recurrent episodes of amnesia
• recurrent, inexplicable intrusions into conscious functioning and sense of self, alterations of sense of self, odd changes of perception, intermittent functional neurological symptoms