Exam 2 Flashcards

Question

Panic Disorder - Cognitive Approach

Answer 1

Individual misinterprets bodily sensations - Panic-prone individuals are very sensitive to certain sensations and interpret them as a medical catastrophe * “Overbreathe”- hyperventilate - Biological Challenge Tests * Make people hyperventilate and see how they react * Participants with panic disorder experience greater distress - Anxiety sensitivity: * Focus on bodily sensations, unable to assess logically, interpret as potentially harmful

Answer 2

- Psychoeducation - Teach about accurate interpretations of bodily sensations - Coping skills: relaxation and breathing techniques - Can combine with behavioral therapy * Exposure: Induce panic sensations in the client so that their new skills can be tested in vivo - Effectiveness: * 80% of clients who receive cognitive treatment become panic-free * Useful for panic disorder with agoraphobia (more expos

Answer 3

Made up of two components: Obsessions Persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness Compulsions Repetitive and rigid behaviors (or mental acts) that people feel they must perform to prevent or reduce anxiety

Answer 4

``` Take various forms: Wishes Impulses Images Ideas Doubts ``` ``` Have common themes: Dirt/contamination Violence and aggression Orderliness Religion Sexuality ```

Answer 5

-Intrusive image: Stabbing a loved one -Thought: I will get HIV if I touch the chair where the infected person sat. -Impulse: I am going to jump off a high place.

Answer 6

Compulsions - “Voluntary” behaviors or “mental acts” * Feel mandatory / unstoppable - Most persons recognize that such behaviors are unreasonable * Believe, though, that something terrible will occur if they do not perform the compulsive acts - Performing behaviors reduces anxiety * But only for a short time - Behaviors often develop into rituals

Answer 7

- Cleaning (e.g., hand washing, showering and grooming in ritualized manner) - Checking (e.g., locks, lights, stove) - Order or balance (e.g., need for symmetry) - Touching, verbal, and / or counting (tap or touch or rub object or body part) - Can be observable (cleaning) or silent (like counting) - Rituals can be secretive

Answer 8

Most people with OCD experience both Compulsive acts often occur in response to obsessive thoughts - Compulsions seem to represent a yielding to obsessions - Compulsions also sometimes serve to help control obsessions

Answer 9

Diagnosis is called for when symptoms: - Feel excessive or unreasonable - Cause great distress - Take up much time - Interfere with daily functions Between 1% and 2% of U.S. population suffer from OCD in a given year; as many as 3% over a lifetime Disorder ‘waxes and wanes’

Answer 10

Anxiety disorders develop when children come to fear their impulses and use ego defense mechanisms to lessen their anxiety OCD differs from other anxiety disorders in that the “battle” is not unconscious; it is played out in overt thoughts and actions - Id impulses = obsessive thoughts (e.g., reaction formation) - Ego defenses = counter-thoughts or compulsive actions (e.g., undoing)

Answer 11

Goals are to uncover and overcome underlying conflicts and defenses Main techniques are free association and interpretation Research has offered little evidence -Some therapists now prefer to treat these patients with short-term psychodynamic therapies

Answer 12

Behaviorists have concentrated on explaining and treating compulsions rather than obsessions - Argue that compulsions begin as random acts… * In a fearful situation, they happen to perform a particular act (washing hands) * When the threat lifts, they associate the improvement with the random act - After repeated associations, they believe the compulsion is changing the situation * Bringing luck, warding away evil, etc. -The act becomes a key method to avoiding or reducing anxiety

Answer 13

Exposure and response prevention (ERP) - Clients are repeatedly exposed to anxiety-provoking stimuli and are told to resist performing the compulsions * Many behavior therapists now use this technique in individual and group therapy formats * Homework is an important component - Between 55-85% of clients have been found to improve considerably with ERP, and improvements often continue indefinitely * But: As many as 25% fail to improve at all * And the approach is of limited help to those with obsessions but no compulsions

Answer 14

Everyone has repetitive, unwanted, and intrusive thoughts -People with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result - To avoid such negative outcomes, they attempt to “neutralize” their thoughts with actions (or other thoughts) * Seeking reassurance * Thinking “good” thoughts * Washing * Checking - When a neutralizing action reduces anxiety, it is reinforced

Answer 15

Cognitive therapists focus on the cognitive processes that help to produce and maintain obsessive thoughts and compulsive acts - May include: * Psychoeducation * Guiding the client to identify, challenge, and change distorted cognitions - Research suggests that a combination of the cognitive and behavioral models is often more effective than either intervention alone - These treatments typically include psychoeducation as well as exposure and response

Answer 16

Family pedigree studies suggest that OCD may be linked in part to biological factors -Studies of twins find a 53% concordance rate in identical twins, versus 23% in fraternal twins More direct evidence: - Abnormal serotonin activity * Serotonin-based antidepressants reduce OCD symptoms * Abnormal brain structure and functioning * OCD linked to orbitofrontal cortex and caudate nuclei brain circuit that converts sensory information into thoughts and actions

Answer 17

Biological therapies - Serotonin-based antidepressants * Clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox) * Bring improvement to 50–80% of those with OCD * Relapse occurs if medication is stopped - Research suggests that combination therapy (medication plus cognitive behavioral therapy approaches) may be most effective

Answer 18

In recent years, a growing number of clinical researchers have linked some excessive behavior patterns (e.g., hoarding, hair pulling, shopping, sex) to Obsessive Compulsive Disorder DSM-5 has created the group name “Obsessive-Compulsive-Related Disorders” and assigned four patterns to that group: hoarding disorder, hair-pulling disorder, excoriation (skin-picking) disorder, and body dysmorphic disorder Theorists typically account for OCD-related disorders by using the same kinds of explanations that have been applied to OCD Similarly, clinicians treat clients with these disorders using the kinds of treatment used with OCD, particularly antidepressant drugs, exposure and response prevention (ERP), and cognitive therapy

Answer 19

Subclinical: 7-22% Adult Clinical Rate: 1.5-3.4% Child Clinical Rate: ≤ 9.25% Onset during early childhood OR adolescence

Answer 20

Much more common in women (9:1 ratio) Possible reasons: treatment bias, culture norms Similar across cultures

Answer 21

Moderate impact across social, occupational (or academic), and psychological domains. - Up to 78% lifetime comorbidity, 39% current comorbidity (Houghton et al., unpublished manuscript) - Can have physical impact (scarring alopecia, trichobezoars)

Answer 22

Automatic Pulling Focused Pulling

Answer 23

- Support for genetic vulnerability * Shared genetic etiology with OCD - Abnormalities in brain structures involved in motor control and learning, affect regulation, and reward learning * Cortico-striatal-thalamic pathways - Monoaminergic and glutamate systems * Decreases with serotonin reuptake inhibitors * Increases with dopamine agonists * Responds to glutamate modulators in adults (but not children)

Answer 24

Cognitive system – inhibitory control Behavior – operant learning model Can be thought of as a pathological habit!

Answer 25

Moderate to little response to SSRIs Some response to N-acetylcysteine (glutamate) Large response to behavior therapy (and cognitive behavior therapy) (McGuire et al., 2014) - Habit reversal therapy (HRT) - HRT + Cognitive Behavior Therapy, Acceptance and Commitment Therapy, and Dialectical Behavior Therapy

Answer 26

Awareness Training Competing Response Training Social Support Stimulus Control (not a core component)

Answer 27

Repetitive picking or scratching at the skin resulting in skin damage

Answer 28

High comorbidity with TTM (around 15.5-20.8%) Lifetime prevalence of 7.3-11.8% in clinical samples Onset during early adolescence Chronic but fluctuating course Gender ratio biased toward females (7-9:1) Not enough cultural research Similar sub-patterns (automatic vs. focused)

Answer 29

- Possible genetic link to TTM and OCD (Sapap3 region of chromosome 1p35) * TTM and ExD likely have common and unique genetic associations - Imaging: reduced blood-oxygen flow in regions involved in motor inhibition (anterior cingulate cortex), increased activation of ventral striatum (reward learning) in ExD compared to TTM - Possible involvement of serotonin and GABA

Answer 30

Cognitive System – Possible motor inhibition deficits Behavior – Problems with emotion regulation (operant learning model) -Harm avoidance vs. reward dependence

Answer 31

- Gelinas & Gagnon (2013) – meta-analysis * Both pharmacological and behavioral approaches are effective (significantly larger effect for behavioral approaches: ES .78 vs 1.52) * Effective medications: SSRIs and anticonvulsants * Effective psychotherapy: Cognitive-Behavior Therapy, Habit Reversal Training, Acceptance and Commitment Therapy

Answer 32

Tourette and OCD Clinic at TAMU (touretteclinic.tamu.edu; 979-458-4218) Director: Dr. Doug Woods Trichotillomania Learning Center trich.org StopPulling.com

Answer 33

Neuropsychological traits across body focused repetitive behavior disorders (inhibitory control, executive functioning, memory, attention) Sensory processing dysfunction across OC-spectrum (sensory phenomena, sensory thresholds, sensorimotor integration)

Answer 34

The state of stress has two components: - Stressor: event that creates demands - Stress response: person’s reactions to the demands * Influenced by how we judge both the events and our capacity to react to them effectively * People who sense that they have the ability and resources to cope are more likely to take stressors in stride and respond well

Answer 35

The features of arousal and fear are set in motion by the hypothalamus -Two important systems are activated: *Autonomic nervous system (ANS) An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all other organs of the body *Endocrine system A network of glands throughout the body that release hormones There are two pathways through which arousal and fear are produced: Sympathetic Nervous System Pathway Hypothalamic-Pituitary-Adrenal (HPA) Pathway

Answer 36

Pathway 1: Sympathetic Nervous System Stressor  Sympathetic nervous system  Key organs are stimulated directly (e.g., heart) or indirectly (e.g., adrenal glands) -When the perceived danger passes, the parasympathetic nervous system helps return body processes to normal

Answer 37

Pathway 2: Hypothalamic-Pituitary-Adrenal (HPA) Stressor  Hypothalamus  Pituitary gland releases adrenocorticotropic hormone (ACTH; “major stress hormone”)  Adrenal cortex releases corticosteroids (stress hormones) into bloodstream

Answer 38

The reactions on display in these two pathways are collectively referred to as the fight-or-flight response Each person has a particular pattern of autonomic and endocrine functioning - Trait anxiety: person’s general level of arousal and anxiety. - State or situation anxiety: person’s sense of which situations are threatening

Answer 39

The physical disorders of stress are typically called psychophysiological disorders - These disorders are listed in DSM-5 under “psychological factors affecting medical condition” * Significant stressors trigger an interaction of biological and psychological factors to help produce or worsen a physical illness or ailment

Answer 40

It is important to recognize that these psychophysiological disorders bring about actual physical damage -They are different from “apparent” physical illnesses like factitious disorders or somatic symptom disorders (discussed in Chapter 7)

Answer 41

Before the 1970s, the best known and most common of the psychophysiological disorders were ulcers, asthma, insomnia, chronic headaches, high blood pressure, and coronary heart disease Recent research has shown that many other physical illnesses may be caused by an interaction of psychosocial and physical factors

Answer 42

Chronic headaches - Frequent intense aches of the head or neck that are not caused by another physical disorder * Tension headaches affect 45 million Americans each year * Migraine headaches affect 23 million Americans each year - Causal psychosocial factors: * Environmental pressures; general feelings of helplessness, anger, anxiety, depression - Causal physiological factors: * Abnormal serotonin activity, vascular problems, muscle weakness

Answer 43

Hypertension - Chronic high blood pressure, usually producing few outward symptoms - Affects 75 million Americans each year - Causal psychosocial factors: * Constant stress, general feelings of anger or depression - Causal physiological factors: * 10% caused by physiological factors alone * Obesity, smoking, poor kidney function, collagen (rather than elastic) tissue in an individual’s blood vessels

Answer 44

A number of variables contribute to the development of psychophysiological disorders, including: - Biological factors - Psychological factors - Sociocultural factors

Answer 45

- Defects in the autonomic nervous system (ANS) are believed to contribute to the development of psychophysiological disorders - Other more specific biological problems may also contribute * For example, a weak gastrointestinal system may create a predisposition to developing ulcers

Answer 46

- According to many theorists, certain needs, attitudes, emotions, or coping styles may cause people to overreact repeatedly to stressors – increasing their chances of developing psychophysiological disorders * Examples: a repressive coping style, a Type A personality style – particularly hostility and time urgency

Answer 47

Sociocultural factors | Adverse social conditions (e.g., poverty, unemployment, quality of medical care).

Answer 48

Since the 1960s, researchers have found many links between psychosocial stress and a wide range of physical illnesses Researchers have increasingly looked to the body’s immune system as the key to the relationship between stress and infection This area of study is called psychoneuroimmunology

Answer 49

Researchers now believe that stress can interfere with the activity of lymphocytes, slowing them down and increasing a person’s susceptibility to viral and bacterial infections Several factors influence whether stress will result in a slowdown of the system, including biochemical activity, behavioral changes, personality style, and degree of social support

Answer 50

Biochemical activity - Stress leads to increased activity by the sympathetic nervous system, including a release of norepinephrine * In addition to supporting nervous system activity, this chemical also appears to slow down the functioning of the immune system - Similarly, the body’s endocrine glands reduce immune system functioning during periods of prolonged stress through the release of corticosteroids * In addition, corticosteroids also trigger increased cytokines, which lead to chronic inflammation

Answer 51

Behavioral changes -Stress may set in motion a series of behavioral changes poor sleep patterns, poor eating, lack of exercise, increase in smoking and/or drinking – that indirectly affect the immune system Personality style -An individual’s personality style (including their level of optimism, constructive coping strategies, and resilience) experience better immune system functioning and are better prepared to fight off illness

Answer 52

People who have few social supports and feel lonely seem to display poorer immune functioning in the face of stress than people who do not feel lonely Social support and affiliation with others may protect people from stress, poor immune system functioning, and subsequent illness, and speed up recovery from illness or surgery

Answer 53

Clinicians have applied psychological treatment to more and more medical problems - The most common of these interventions are relaxation training, biofeedback training, meditation, hypnosis, cognitive interventions, support groups, and therapies designed to increase awareness and expression of emotion - The field of treatment that combines psychological and physical interventions to treat or prevent medical problems is known as behavioral medicine

Answer 54

Combination approaches - Studies have found that the various psychological interventions for physical problems tend to be equal in effectiveness * Psychological treatments are often of greatest help when they are combined and used with medical treatment * With these combined approaches, today’s practitioners are moving away from the mind–body dualism of centuries past

Answer 55

- Known popularly as Munchausen syndrome, people with a factitious disorder often go to extremes to create the appearance of illness * Many secretly give themselves medications to produce symptoms * Patients often research their supposed ailments and are impressively knowledgeable about medicine - In a related pattern, factitious disorder imposed on another, known popularly as Munchausen syndrome by proxy, parents make up or produce physical illnesses in their children

Answer 56

People with this disorder display physical symptoms that affect voluntary motor or sensory functioning, but the symptoms are inconsistent with known medical diseases -In short, the individuals experience neurological-like symptoms – blindness, paralysis, or loss of feeling – that have no neurological basis

Answer 57

- Conversion disorder often is hard to distinguish from genuine medical problems * It is always possible that a diagnosis of conversion disorder is a mistake and the patient’s problem has an undetected medical cause - Physicians sometimes rely on oddities in the patient’s medical picture to help distinguish the two * For example, conversion symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesia

Answer 58

People with somatic symptom disorder become excessively distressed, concerned, and anxious about bodily symptoms that they are experiencing Two patterns of somatic symptom disorder have received particular attention: - Somatization pattern - Predominant pain pattern People with a somatization pattern experience many long-lasting physical ailments that have little or no organic basis *Also known as Briquet’s syndrome Patients with this pattern often describe their symptoms in dramatic and exaggerated terms * Most also feel anxious and depressed * Patients usually go from doctor to doctor in search of relief

Answer 59

- If the primary feature of somatic symptom disorder is pain, the individual is said to have a predominant pain pattern - Although the precise prevalence has not been determined, this pattern appears to be fairly common * The pattern often develops after an accident or illness that has caused genuine pain - The pattern may begin at any age, and more women than men seem to experience it

Answer 60

The psychodynamic view - Psychodynamic theorists propose that two mechanisms are at work in hysterical disorders: * Primary gain: bodily symptoms keep internal conflicts out of conscious awareness * Secondary gain: bodily symptoms further enable people to avoid unpleasant activities or receive sympathy from others

Answer 61

The behavioral view - Behavioral theorists propose that the physical symptoms of hysterical disorders bring rewards to sufferers * May remove individual from an unpleasant situation * May bring attention from other people

Answer 62

In response to such rewards, people learn to display symptoms more and more This focus on rewards is similar to the psychodynamic idea of secondary gain, but behaviorists view the gains as the primary cause of the development of the disorder Like the psychodynamic explanation, the behavioral view of these disorders has received little research support

Answer 63

A possible role for biology -The impact of biological processes on somatoform disorders can be understood through research on placebos and the placebo effect *Placebos: substances with no known medicinal value *Treatment with placebos has been shown to bring improvement to many – possibly through the power of suggestion, or because positive expectations trigger the release of endogenous chemicals

Answer 64

Many therapists focus on the causes of the disorders and apply techniques including: - Insight – often psychodynamically oriented - Exposure with response prevention – client thinks about traumatic event(s) that triggered the physical symptoms - Drug therapy – especially antidepressant medication

Answer 65

Other therapists try to address the physical symptoms of these disorders, applying techniques such as: - Suggestion – usually an offering of emotional support that may include hypnosis - Reinforcement – a behavioral attempt to change reward structures - Confrontation – an overt attempt to force patients out of the sick role

Answer 66

People with illness anxiety disorder, previously known as hypochondriasis, experience chronic anxiety about their health and are concerned that they are developing a serious medical illness, despite the absence of somatic symptoms They repeatedly check their bodies for signs of illness and misinterpret bodily symptoms as signs of a serious illness - Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating - Although some patients recognize that their concerns are excessive, many do not

Answer 67

Theorists explain this disorder much as they explain various anxiety disorders: --Behaviorists: classical conditioning or modeling Cognitive theorists: oversensitivity to bodily cues Individuals with illness anxiety disorder typically receive the kinds of treatments applied to OCD: - Antidepressant medication - Exposure and response prevention (ERP) - Cognitive-behavioral therapies

Answer 68

People with this disorder, also known as dysmorphobia, become deeply concerned about some imagined or minor defect in their appearance -Most often they focus on wrinkles, spots, facial hair, swelling, or misshapen facial features (nose, jaw, or eyebrows)

Answer 69

Theorists typically account for BDD by using the same kinds of explanations – both physical and psychological – that have been applied to anxiety disorders and OCD Similarly, clinicians typically treat clients with this disorder by applying the kinds of treatment used with OCD, particularly: - Anti-depressant drugs, exposure and response prevention, and cognitive therapy

Answer 70

“A very difficult or unpleasant experience that causes someone to have mental or emotional problems for a long time …..” “A mechanism or event that causes trauma” APA – “An emotional response to a terrible event….” - An event, or a response? - Defined by its consequences? Only traumatic if you experience it as such?

Answer 71

Exposure to combat 20% of veterans report symptoms of PTSD Exposure to natural disasters (Hurricane Katrina, Aug 2005) Involvement in accidents (Bonfire collapse Nov 19, 1999) Civilian traumas 10 times more frequent than combat-related traumas Sexual assault and other victimization Exposure to terrorism (September 11, 2001)

Answer 72

Criterion A – Exposure to trauma -Direct exposure to death, threatened death, actual or threatened serious injury or violence -May be indirect exposure, for example: *By learning that a close relative was exposed to trauma *Repeated or extreme indirect exposure to aversive details ~As in first responders collecting body parts from disaster scene ~Professionals repeatedly exposed to details of child abuse

Answer 73

Criterion B – Intrusion symptoms such as: - Recurrent, involuntary, intrusive memories - Traumatic nightmares - Dissociative reactions (e.g., flashbacks) occurring on a continuum from brief episodes to complete loss of consciousness - Intense or prolonged distress – which may be emotional or physiological – after exposure to traumatic reminders

Answer 74

Criterion C – Persistent avoidance of stimuli associated with the trauma - Avoidance of trauma-related thoughts or feelings - Avoidance of trauma-related reminders (e.g., people, places, activities, objects)

Answer 75

Criterion D – Negative alterations in cognitions and mood associated with the traumatic event - Dissociative amnesia - Persistent (often distorted) negative beliefs – e.g., self-blame or global negative expectancies of others - Persistent negative emotions – e.g., fear, horror, anger, shame - Emotional numbing * Diminished interest in pre-traumatic significant activities * Alienation (detachment or estrangement) from others * Constricted affect – inability to experience positive emotions

Answer 76

``` Criterion E – Alterations in arousal and reactivity that began or worsened after the traumatic event Irritable or aggressive behavior -Self-destructive or reckless behavior -Hypervigilance -Exaggerated startle response -Problems in concentration -Sleep disturbance ``` Criterion F – Significant impairment in functioning, with persistence of symptoms for more than 1 month

Answer 77

- Pharmacotherapy – Management of most acute anxiety (or comorbid depressive) symptoms - Prolonged exposure – Aimed at extinction of emotional and physiological reactivity (EMDR) - Cognitive processing therapy * Provides information about causes, symptoms of PTSD * Encourages labeling of impact: thoughts and feelings * Promotes changes in beliefs, attributions regarding the traumatic event * Promotes self-regulation and coping skills

Answer 78

Combat exposure is a risk factor for posttraumatic stress disorder (PTSD) Veterans with higher levels of support report fewer PTSD symptoms Spouses and intimate partners often serve as a primary source of social support Research question: Are effects of partner support on PTSD “mediated” by communication and self-disclosure?

Answer 79

Partner Support ---> Disclosure and PTSD Symptoms Disclosure ---> PTSD Symptoms Triangle

Answer 80

Service members and veterans may benefit from disclosure of traumatic experiences to an intimate, supportive partner Disclosure may facilitate the cognitive and emotional processing of combat and deployment related experiences Initial support for the encouragement of disclosure in post-deployment couple interventions

Answer 81

Can various “interpersonal” or “intimate relationship” injuries be traumatic? The case for sexual infidelity: - High lifetime prevalence (21% of men, 11% of women) - One of leading causes of divorce - Rated as among most difficult marital problems to treat - High rates of negative impact * Depression, suicidality, PTSD symptoms * Physical aggression, alcohol/substance abuse

Answer 82

Stage 1 - Absorbing the blow Stage 2 - Giving meaning, establishing new assumptions Stage 3 - Moving forward

Answer 83

Your own risk for exposure to PTSD - About 50% of individuals will experience a traumatic event during their lifetime - Many (but not all) of those will develop symptoms of PTSD - In general (civilian) population, lifetime rates of PTSD: * Clinical levels: 8-10% * Subclinical levels: 15-20% Most individuals will have close, indirect experience with someone suffering from PTSD For your neighbor, friend, or loved one … - Offer understanding - Provide information to normalize symptoms - Offer encouragement regarding treatment resources For yourself ... - Offer self-acceptance and patience - Engage in physical, emotional, spiritual self-care - Share with intimate others - Seek out qualified professional help - Retain hope

Answer 84

Dissociative disorders are each characterized by significant memory loss or identity disruption -Dissociative amnesia (and dissociative fugue) -Dissociative identity disorder (DID) (multiple personality disorder) -Depersonalization - derealization disorder

Answer 85

People with dissociative amnesia are unable to recall important information, usually of an upsetting nature, about their lives - The loss of memory is much more extensive than normal forgetting and is not caused by physical factors - Often an episode of amnesia is directly triggered by a specific upsetting event Dissociative amnesia may be: - Localized – most common type; loss of all memory of events occurring within a limited period - Selective – loss of memory for some, but not all, events occurring within a period - Generalized – loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends - Continuous – forgetting continues into the future; quite rare in cases of dissociative amnesia In all types, memory for abstract or encyclopedic information – usually remains intact

Answer 86

An extreme version of dissociative amnesia is dissociative fugue - People with dissociative fugue not only forget their personal identities and details of their past, but also flee to an entirely different location - For some, the fugue is brief – a matter of hours or days – and ends suddenly - For others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics Dissociative fugue disorders are rare: ~0.2% of the population -It usually follows a severely stressful event Fugues tend to end abruptly - When people are found before their fugue has ended, therapists may find it necessary to continually remind them of their own identity - The majority of people regain most or all of their memories and never have a recurrence

Answer 87

A person with dissociative identity disorder develops two or more distinct personalities (subpersonalities) each with a unique set of memories, behaviors, thoughts, and emotions At any given time, one of the subpersonalities dominates the person’s functioning - Usually one subpersonality –the primary or “host” personality – appears more often than the others - The transition from one subpersonality to the next (“switching”) is usually sudden and may be dramatic

Answer 88

Most cases are first diagnosed in late adolescence or early adulthood - Symptoms generally begin in childhood after episodes of abuse * Typical onset is before age 5 Women receive the diagnosis three times as often as men

Answer 89

The relationship among subpersonalities varies from case to case Generally there are three kinds of relationships: - Mutually amnesic relationships – subpersonalities have no awareness of one another - Mutually cognizant patterns – each subpersonality is well aware of the rest - One-way amnesic relationships – most common pattern; some personalities are aware of others, but the awareness is not mutual * Those subpersonalities that are aware (“co-conscious subpersonalities”) are “quiet observers

Answer 90

Subpersonalities often display dramatically different characteristics, including: - Identifying features (age, sex, race, family history) - Abilities and preferences (ability to drive, speak a foreign language, play a musical instrument) - Physiological features (autonomic nervous system activity, blood pressure levels

Answer 91

The number of people diagnosed with the disorder has been increasing Although the disorder is still uncommon, thousands of cases have been documented in the U.S. and Canada alone - Two factors may account for this increase: * A growing number of clinicians believe that the disorder does exist and are willing to diagnose it * Diagnostic procedures have become more accurate

Answer 92

Psychodynamic theorists believe that dissociative disorders are caused by repression, the most basic ego defense mechanism -People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness Most of the support for this model is drawn from case histories, which report brutal childhood experiences, yet: -Some individuals with DID do not seem to have these experiences of abuse

Answer 93

Behaviorists believe that dissociation grows from normal memory processes and is a response learned through operant conditioning: - Momentary forgetting of trauma leads to a drop in anxiety, which increases the likelihood of future forgetting - Like psychodynamic theorists, behaviorists see dissociation as escape behavior Also like psychodynamic theorists, behaviorists rely largely on case histories to support their view of dissociative disorders

Answer 94

People who are prone to develop dissociative disorders may have state-to-memory links that are unusually rigid and narrow; Each thought, memory, and skill is tied exclusively to a particular state of arousal Hence, they recall a given event only when they experience an arousal state almost identical to the state in which the memory was first acquired

Answer 95

Although hypnosis can help people remember events that occurred and were forgotten years ago, it can also help people forget facts, events, and their personal identity -Called “hypnotic amnesia,” this phenomenon has been demonstrated in research studies with word lists

Answer 96

People with dissociative amnesia often recover on their own -Only sometimes do their memory problems linger and require treatment In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality -Treatment for DID tends to be less successful than treatment for dissociative amnesia

Answer 97

Therapists usually try to help the client by: -Recognizing the disorder -Recovering memories -Integrating the subpersonalities *Integration into a single identity *Integration is a continuous process *Following integration, further therapy is typically needed to ~Maintain the complete personality, and ~Teach social and coping skills to prevent later dissociation

Answer 98

Depersonalization: Individual feels as though they have become separated from their body and are observing themselves from outside In contrast to depersonalization, derealization is characterized by the feeling that the external world is unreal and strange Depersonalization and derealization experiences by themselves do not indicate a disorder - Transient depersonalization or derealization reactions are fairly common - The symptoms of a depersonalization - derealization disorder are persistent or recurrent, cause considerable distress, and interfere with social relationships and job performance The disorder occurs most frequently in adolescents and young adults, hardly ever in people older than 40

Answer 99

Western society today often equates thinness with health and beauty -Thinness has become a national obsession There has been a rise in eating disorders in the past three decades -The core issue is an irrational fear of weight gain Two main diagnoses: - Anorexia nervosa - Bulimia nervosa

Answer 100

About 90%–95% of anorexia and bulimia nervosa cases occur in females The peak age of onset is between 15 and 21 years Symptoms may last for several years with periodic letup

Answer 101

Despite their dietary restrictions, people with anorexia nervosa are preoccupied with food -Excessive thinking about food and planning for meals Persons with anorexia also think in distorted ways: - Usually have a low opinion of their body shape - Tend to overestimate their actual size / proportions - Hold maladaptive attitudes and misperceptions * “I must be perfect in every way” * “I will feel better if I deprive myself” * “I can avoid guilt by not eating”

Answer 102

``` Psychological Depression Anxiety Low self-esteem Insomnia or other sleep disturbances Substance abuse Obsessive-compulsive patterns Perfectionism ``` ``` Medical Amenorrhea Low blood pressure Reduced bone density Metabolic and electrolyte imbalances Poor circulation Body swelling ```

Answer 103

Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges: -Repeated bouts of uncontrolled overeating during a limited period of time Also characterized by inappropriate compensatory behaviors, including: - Forced vomiting - Misusing laxatives, diuretics, or enemas - Fasting - Exercising excessively

Answer 104

People with bulimia nervosa may have between 1 and 30 binge episodes per week Binges are often carried out in secret - Binges involve eating massive amounts of food very rapidly with little chewing * Usually sweet, high-calorie foods with soft texture Although the binge itself may be pleasurable, it is usually followed by extreme self-blame, guilt, depression, and fears of being discovered

Answer 105

After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects - Many resort to vomiting * Fails to prevent the absorption of half the calories consumed during a binge * Repeated vomiting affects the ability to feel satiated  greater hunger and bingeing Compensatory behaviors may temporarily relieve negative feelings attached to binge eating -Over time, however, a cycle develops in which purging  bingeing  purging…

Answer 106

Similarities: Begin after a period of dieting Fear of becoming obese; drive to become thin Preoccupation with food, weight, appearance Feelings of anxiety, depression, perfectionism Distorted body perception Heighted risk of suicide attempts Differences: People with bulimia nervosa tend to be more sexually experienced and active People with bulimia nervosa are more likely to have histories of mood swings, low frustration tolerance, and poor coping

Answer 107

Like those with bulimia, individuals with binge eating disorder engage in repeated eating binges during which they feel no control -These individuals do not perform inappropriate compensatory behaviors As a result of their binges, two-thirds of people with this disorder become overweight or obese -It is important to recognize, however, that most overweight people do not engage in repeated binges

Answer 108

Parents respond to their children ineffectively, failing to attend to biological and emotional needs -Deficiencies in parenting contribute to a broad cognitive distortion underlying disordered eating (e.g., negative self-judgment based on body shape and weight) Anorexia stems from an effort to delay or interrupt sexual maturation Anorexia reflects a passive-aggressive response to conflicts around control and autonomy Bulimia reflects self-nurturing with food in the absence of adequate parental nurturing

Answer 109

There is also evidence that mood disorders set the stage for eating disorders: - Persons with an eating disorder have higher rates of major depressive disorder - Close relatives of those with eating disorders have higher rates of depressive disorders - People with eating disorders, especially those with bulimia nervosa, have serotonin abnormalities - Symptoms of eating disorders are helped by antidepressant medications

Answer 110

Biological factors: The hypothalamus and related brain areas may be responsible for weight “set point” or “weight thermostat” -Set by genetic inheritance and early eating practices, this mechanism is responsible for keeping an individual at a particular weight level *If weight falls below set point:  hunger,  metabolic rate  binges *If weight rises above set point:  hunger,  metabolic rate -Dieters end up in a battle against themselves to lose weight

Answer 111

Societal pressures: Western standards of female attractiveness may contribute to the emergence of eating disorders - Western standards have changed throughout history toward a thinner ideal (evidence in Miss American contestants, Playboy centerfolds) - Models, actors, dancers, and certain athletes are at higher risk for eating disorders * 9% of college athletes meet full criteria for an eating disorder while another 50% have one or more symptoms * 20% of gymnasts appear to have an eating disorder

Answer 112

The socially accepted prejudice against overweight people may also add to the “fear” and preoccupation about weight -About 50% of elementary and 61% of middle school girls are currently dieting Families may play an important role in the development of eating disorders -As many as half of the families of those with eating disorders have a long history of emphasizing thinness, appearance, and dieting

Answer 113

Some men develop eating disorders as linked to the requirements and pressures of a job or sport -For example: Jockeys, wrestlers, distance runners, body builders, swimmers Some men exhibit a new kind of eating disorder – reverse anorexia nervosa or muscle dysmorphobia

Answer 114

Eating disorder treatments have two main goals: - Correct dangerous eating patterns - Address broader psychological and situational factors that led to, and maintain, the eating problem With anorexia, treatment goals are to: -Promote normal eating behavior, regain lost weight, and recover from malnourishment With bulimia, treatment goals are to: -Eliminate binge-purge patterns, and promote normal eating behavior

Answer 115

The most popular weight-restoration technique has been the combination of supportive nursing care, nutritional counseling, and high-calorie diets In life-threatening cases, clinicians may need to force tube and intravenous feedings on the patient People with anorexia nervosa must overcome their underlying psychological problems to achieve lasting improvement In most treatment programs, a combination of behavioral and cognitive interventions are included - Clients monitor feelings, hunger levels, and food intake and the ties among those variables - Patients are encouraged to recognize their underlying feelings - Clients are helped to change their attitudes about eating and weight

Answer 116

Positive outcomes: - Weight gain is often quickly restored, with many patients maintaining improvements after several years - Menstruation resumes after return to normal weight Negative outcomes: - As many as 25% of patients fail to improve - Initial recovery is often not permanent * Anorexic behavior recurs in at least one-third of recovered patients, usually triggered by new stresses * Many patients still express concerns about their weight and appearance - Lingering emotional problems are common

Answer 117

Cognitive-behavioral therapy: - Behavioral techniques * Eating and purging diaries * Exposure and response prevention (ERP) is used to break the binge-purge cycle - Cognitive techniques * Help clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape * Teach individuals to identify and challenge the negative thoughts that precede the urge to binge Other interventions: - Group formats provide an opportunity for patients to express their thoughts, concerns, and experiences with one another - Antidepressant medications – may help as many as 40% of patients

Answer 118

Treatment provides immediate, significant improvement in about 40% of cases -An additional 40% show moderate response Relapse can be a significant problem, even among those who respond successfully to treatment - Relapses are usually triggered by stress - Relapses are more likely among persons who: * Had a longer history of symptoms * Vomited frequently * Had histories of substance use * Have lingering interpersonal problems

Exam 2 Flashcards

(142 cards)