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1

A made-up word that has meaning only to the person who made it up

Neologism

2

Referring to yourself in the second or third person, often associated with children and autism

Pronominal Reversal

3

A process of worsening psychological symptoms associated with loss of self-esteem, increased dependence, and increased passivity as a result of poor custodial care

Social Breakdown Syndrome

4

Treating people in an environment which strives to make available all conditions of everyday living which are as close as possible to the regular ways of life or society

Principle of Normalization

5

Uncontrolled body movements caused by taking conventional antipsychotics for a long time

Tardive Dyskinesia

6

A type of rigid body posturing found in some people with Schizophrenia

Catatonia

7

Two points-of-view that appear opposite and can be true at same time

Dialectics

8

Rapid shifts from one topic of conversation to another associated with Schizophrenia

Loose Associations

9

When parents communicate pairs of messages that are mutually contradictory

Double Bind

10

An experience involving the apparent sensory perception of something not present

Hallucinations

11

A belief firmly maintained despite being contradicted by what is generally accepted as reality or rational

Delusions

12

A pattern of speaking very little, and in very basic and brief terms

Alogia

13

Conditions that negatively impact physical development of a child during prenatal or perinatal periods

Teratogens

14

Impaired ability to recognize people or common objects

Agnosia

15

Impaired voluntary movement despite adequate sensory and muscle functioning

Apraxia

16

10 Personality Disorders?

-1. Paranoid Personality Disorder (schizophrenia-spectrum)

-2. Schizoid Personality Disorder (schizophrenia-spectrum)

-3. Schizotypal Personality DIsorder (schizophrenia-spectrum)

-4. Avoidant Personality Disorder (anxious - do not map on genetically to matching disorder?)

-5. Dependent Personality Disorder (anxious)

-6. Obsessive-Compulsive Personality Disorder (anxious)

-7. Histrionic Personality Disorder (Dramatic - tends to create conflict)

-8. Narcissistic Personality Disorder (Dramatic)

9. Antisocial Personality Disorder (Dramatic)

-10. Borderline Personality Disorder (Dramatic)

17

Paranoid Personality Disorder

-Deep distrust and suspicion of others
-As a result → cold and distant

-Critical of weakness and fault in others (esp., work)
-Unable to recognize own mistakes
-Extremely sensitive to criticism
-Blame others for own difficulties
-Bear grudges

-Causes
-Psychodynamic Theory:
-Parents that crush & insult (ex: you accidentally burn down neighbor’s house; no one knows; you feel guilty; you’re scared someone will find out and hurt you)
-Parents as models of paranoid behavior (if you have parents who are really paranoid, don’t trust others, … then you probably develop that)

-Treatment
-Difficult to develop therapeutic trust
-Client Centered Therapy
-Relaxation and Mindfulness
-Relationship Skills Therapy
-Antipsychotics?

18

Schizoid Personality Disorder

-Persistent avoidance of social relationships and limited emotional expression; these people are happy hermits
-Focus mainly on themselves
-Viewed as flat, cold, humorless, dull; don’t like to hang out with others, so they are not great at relationships (they don’t give)

-Causes
-Psychodynamic Theory
-Unaccepting, abusive parents
-Prefer abandonment to engulfment
-Cultural Theory
-Sass (1992): A Postmodern condition (not a thing with the person, but a cultural problem)

-Treatment
-Robbins (1988)
-Literary & Artistic Sources of Shared Understanding; these people are very aesthetic and broadly defined
-Social Skills & Role Playing

19

Schizotypal Personality DIsorder

-Extreme discomfort in close relationships; this is schizophrenia-light

-Odd (even bizarre) ways of thinking, behavioral eccentricities
-Ideas of reference,bodily illusions, loose associations
-Difficulty keeping attention focused
-Vague conversation

-Causes
-Physiological similarities to Schizophrenia (just haven’t acquired as many struggles)

-Treatment
-Antipsychotics → for Perception oddities
-CBT: build connections to social world
-Normalize behavior & appearance thru Skills training

20

Avoidant Personality Disorder

-Very uncomfortable & inhibited in social relationships
-Feel unappealing or inferior
-Often have few close friends
-Avoidant PLY: fear close social relationships (can be okay coming to class because can put head down, sit on edge or in back, don’t have to talk to them; but if someone tries to ask you a question, it’s a problem
-Social phobia: fear social circumstances
-Avoidant and schizoid are loners; but schizoid are happy alone (happy hermits), but avoidant want to be in relationships, but it’s difficult (sad/lonely hermits)

-Cause:
-Childhood experiences of Criticism & Shame
-Little positive support & affection

-Treatment: Gain Trust
-Building Trust
-Exposure and Social Skills Training
-Antidepressants and Antianxiety Medication (benzodiazepines) (but sometimes have to give them in higher doses)

21

Dependent Personality Disorder

-Pervasive, excessive need to be taken care of; opposite of avoidant
-Clinging & obedient
-Cannot make smallest decisions for themselves
-Central feature: Difficulty with separation (or autonomy?)
-Feel distressed, lonely, and sad
-Often dislike themselves
-At high risk for depression, anxiety, eating disorders, suicidal thoughts
-Want to be alone, but being alone causes great anxiety
-Want to receive instructions on what to do/how to do it

-Causes
-Clinging behavior rewarded
-Early parental rejection or abandonment
-Cognitive Distortions

-Treatments
-Assertiveness Training
-Challenge Helplessness Cognitions
-Acceptance of Responsibility

22

Obsessive-Compulsive Personality Disorder

-Preoccupied w/ order, perfection, & control
-Unreasonably high standards for self/others
-Rigid & stubborn
-Trouble expressing affection
-Relationships stiff & superficial (don’t do well in emotions; contradictory, messy; difficult to form good, deep relationships)
-White, educated, married, employed (do well, move up, and now, have to apply your standards to other people, and it doesn’t go well)
-Rarely seek treatment
-OCD is about repetitive, compulsive behaviors (ex: every paragraph has to have five sentences in it, and every sentence has 10 words; it doesn’t come out very well, so you don’t get good great); obsessive-compulsive personality is black and white (ex: read instructions really closely and do it really precisely, and get high marks)

-Causes
-Exacting & demanding parents (perfectionistic parents are rewarding/punishing you to stay in thin line), OR
-Loose family environment (parents aren’t giving kids any real structure; don’t punish/reward; most kids don’t like this, they want structure)
-Rage (control) vs Fear (punishment)
-Perfectionism & dichotomous thinking

-Cognitive Treatments
-Challenge perfectionism, black & white thinking; try to redirect them into emotion (since they don’t like it because it’s a gray area)
-Avoid intellectualizing (they’re gonna use big words to describe what’s happening, but you have to ask questions that move away from that)

23

Histrionic Personality Disorder

-Extremely emotional & continually seek to be center of attention; the “actor” personality disorder
-Approval & praise; need attention
-Described as vain, self-centered, demanding
-Parasuicide attempts, often to manipulate; self-harm is common

-Causes
-Believe helpless, seek out others to meet needs → learned helplessness
-Exaggeration of femininity → performance of gender stereotypes

-Treatment
-Demands, tantrums, seductiveness in attempt to please the therapist; therapist has to establish really strong boundaries; may feel like you’re doing the right thing, but might just be feeding into their disorder; therapy can reduce it, but always going to be a part of their personality
-CBT
-Psychoeducation
-Boundaries & Responsibilities Important

24

Narcissistic Personality Disorder

-Grandiose, need admiration, feel no empathy w/ others
-Narcissistic wound - strong powerful reaction to feeling like somebody doesn’t think that you are wonderful; outcome of narcissism; we think these people do not have a strong sense of self, but deep down, they don’t have it; using reaction formation (something really terrible, weak about me, so I’ll reflect the opposite); self-protect against people who do not believe you
-Typical behavior for adolescents (and usually not young adult)

-Causes
-Family atmosphere of constant evaluation
-Too negatively or too positively
-Self-objects (Kohut - student of Freud; Freud thought narcissism was the only thing he couldn’t treat; Kohut thought it was developmental)
-Others valued for their function to client, not for themselves
-Objects are for me; they never learn there are some things are not just for them (ex: they don’t see water bottle and a person as distinct things)
-Need reparenting
-Relationships that provide
-(1) support (I’m gonna help you be more like me; I’m gonna value you), (2) mutuality (you like ice cream when it’s hot, and so do I), (3) ideals (not the same to me)

-Cognitive Treatment
-Very hard to treat!
-Acceptance of imperfections
-Redirect thoughts to others

25

Antisocial Personality Disorder

-AKA“psychopaths” or “sociopaths” (not diagnostic features; not in DSM)
-Sociopath - acquired through social encounters
-Psychopath - born with it; always this way
-Persistently disregard & violate others’ rights
-Likely to lie repeatedly, be reckless, impulsive
-Can be cruel, sadistic, aggressive, violent
-Most strongly linked to adult criminal behavior
-At least 18 years old
-Most display patterns of misbehavior before 15
-Conduct Disorder and/or ADHD likely as Child
-First starts to show at age 7 or 8

26

Borderline Personality Disorder

-Instability of interpersonal relationships, self-image, affects, and marked impulsivity w/ 5 or more of the following:
-Frantic efforts to avoid real or imagined abandonment; especially aware of signs of abandonment; I want you in my life → get away cycle
-Unstable and intense relationships
-Identity disturbance: unstable self-image or sense of self
-Impulsivity in at least 2 areas; like yelling
-Suicidal behavior, gestures, or threats, or self-mutilating behavior
-Affective instability due to reactivity
-Chronic feelings of emptiness
-Inappropriate, intense anger, difficulty controlling anger
-Stress-related paranoid ideation

-Could be biological; could be about identity, but we’re looking at DBT perspective (have emotions they don’t know how to regulate)

27

3 Courtship Paraphilia Disorders

-1. Voyeuristic

-2. Exhibitionistic

-3. Frotteuristic

28

Voyeuristic DO

-Observing unsuspecting person: naked, disrobing, or having sex
-Often masturbate while observing or remembering
-Chance of being caught enhances experience
-Key is that the person/people are not consenting

-Learned Behavior & Exercise of power

-At least 18 years old, viewed as age appropriate <18 (kids are curious; normal)

29

Exhibitionistic DO

-Exposure of one’s genitals to unsuspecting person

-Sexual contact rarely initiated or desired

-Starts before age 18, mostly men

-Specify

-Key is non-consent
-In front of Children or Mature Individuals

30

Frotteuristic DO

-Touching or rubbing against a nonconsenting person

31

Transvestic

-Recurrent intense sexual arousal from cross-dressing: fantasies, urges, or behaviors

-> 6 months

-Causes significant distress or impairment (ex: of Russel WIlliams; enjoyed wearing women’s undergarments, taking pictures, and letting them find the pictures

-Specify
-w/ fetishism: aroused by fabrics, materials, or garments
-not associated w/ gender dysphoria; still sexually attracted to women
-w/ autogynephilia: aroused by thoughts or images of self as female
-associated w/ gender dysphoria; when dressed as women, think of themselves as being women

-More typical in heterosexual men
-Begins in adolescence

-Operant Conditioning Causal Theory
-Tried on sister’s or mother’s clothing, were rewarded for it (cute, funny), and it started from there

32

Gender Dysphoria

-Separate Diagnosis:
-Children
-Adolescence/Adults

-Marked difference between person’s expressed gender & the gender others would assign to him or her or they

-> 6 months

-Significant distress or impairment in social, occupational, or other important areas

-2 : 1, men*
-NOT about sexual orientation

-Often suffer:
-Anxiety
-Depression
-Suicide Attempts

-Often targets of:
-Harassment
-Discrimination
-Violence

33

Schizophrenia

-Clinical picture is varied
-Different DOs?

-Major dysfunction in work, interpersonal relations, or self care

-> 6 months

-2 or more of following symptoms:
-Positive
-Negative
-Psychomotor

-1 in 100 people in the world
-About 3 million US Americans
-1 : 1, gender
-~21 years onset, men
-~27 years onset, women
-More in Low SES Populations
-(1) Low SES Stress → vulnerability to physiology
-Maybe your gene lies dormant
-(2) Low SES Discrimination → vulnerability to labeling
-Don’t have money, go to basic psychologist, and get diagnosed; if have money, go to a psychologist who only sees people with a lot of money, they’ll ask a lot of questions to try to find something else that is the problem because they don’t want to diagnose you with schizophrenia
-(3) Downward Drift → DO’s dysfunctions cause SES drop
-Start out having money; develop symptoms; have hallucinations of throwing bottle at student → probably lose job → told developing symptoms → upset partner

-Often 3 phases (days to years):
-Prodromal–beginning of deterioration; mild symptoms
-Active–symptoms become apparent (psychotic break; significant display of having a psychotic break; person usually put into hospital)
-Residual–a return to prodromal-like levels (positive symptoms get better controlled; can sometimes return to regular functioning if respond well to medication)

-1 : 4 mostly recover, more likely if:
-(1) Good premorbid (before prodromal phase) functioning
-(2) Disorder was triggered by stress (getting fired, breakup, death of a loved one)
-(3) Abrupt onset (getting fired, breakup, death of a loved one)
-(4) Later onset (during middle age)
-(5) Receive early treatment

34

Schizoaffective

-(1) Major Mood DO (like bipolar or depression) concurrent WITH criteria A of Schizophrenia
-Positive
-Psychomotor
-Negative
-Specify
-Bipolar type
-Depressive type

-(2) Severe dysfunction not necessary, and often less than Schizophrenia

35

Oppositional Deviant DO

-Oppositional Defiant Disorder?

-Extreme hostility & defiance; kids who do not follow rules
-Repeated arguments w/ adults
-Loss of temper, anger
-Ignore adult requests & rules
-Try to annoy others
-Blame others for their mistakes and problems
-Resentment of others
-Boys > girls before puberty, equal after puberty
-Viewed as a relatively minor external disorder
-Causes them to get lower grades when they’re young, which has an effect on their life

36

Conduct DO

-Repeatedly violate basic rights of others
-Begins 7-15 yrs old
-Aggressive & physically cruel to people & animals
-Steal from, threaten, or harm their victims
-Criminal behavior
-Shoplifting
-Forgery
-Mugging
-Armed robbery
-Viewed as much more severe
-Escalating behaviors

37

ADHD

-Attention-Deficit/Hyperactivity Disorder

-Inattention(most easily underdiagnosed)
-Easily bored
-Easily distracted & forget things
-Frequently switch from one activity to another
-Difficulty completing a task or learning something new
-Most easily underdiagnosed because it’s normal and because kid not paying attention to you does not interfere with your tasks

-~50% also have:
-Learning or communication problems
-Poor school performance
-Difficulty interacting w/ other children
-Misbehavior, often serious
-Mood or anxiety problems

-Executive functioning
-Inhibition, visual imagery, talk to yourself, control emotions, problem solving
-The ability to have a goal and impulse control and using steps to get to goal, but these kids struggle with it

-5-10%

-3 : 1 boys

-~50% continue to struggle as adults

-ADHD is difficult to assess
-Behavior should be observed in multiple settings
-Informants
-Parents
-Teachers
-Parents and teachers are biased -- they want kids to be still and follow what they tell them; not very objective or expert
-Diagnostic interviews, rating scales, & psychological tests

-Over diagnosis?
-Assembly Line Education (Rogroff) & Funding of Schools
-Says that what we do in U.S. is assembly line education, which works well for adults, but it doesn’t work so well for young kids; they have to sit for hours, pay attention to a single thing, and be quiet; historically, other countries have done it very differently; the environments we’re putting kids in is putting kids in an environment where they behavior is seen as a problem, when it is not
-Neurodiversity Movement

38

Autism Spectrum

-These disorders endure

-First identified in 1943

-Extremely unresponsive to others, uncommunicative, repetitive, rigid

-Symptoms appear before age 3

-4 : 1, boys

-Can vary a lot

-Autistic Disorder: 6 Symptoms
-(1) Lack of responsiveness
-Extreme aloofness
-Lack of interest in people
-(2) Language & communication problems
-Echolalia
-Exact echoing of phrases spoken by others
-Pronominal reversal
-Confusion of pronouns
-Ex: Adult’s question “Are you hungry, Sam?”
-Child’s possible responses: “Are you hungry, Sam” or “Sam is hungry.”
-(3)“Self-stimulatory”behaviors
-E.g., jumping, arm flapping, making faces
-Can be self-injurious behaviors
-(4) Overstimulatedand/or understimulated
-Trying to fit in?

-Aspergers → No more
-Highly functioning ASD

-Types:
-Rule Boys
-Logic Boys
-Emotion Boys

-Causes of ASD
-Genetic Heritability
-But, also shared prenatal environment
-~150 genes linked to autism! (many, many genes, like schizophrenia, so things aren’t completely clear)

-Faulty Theory of Mind
-Attributing mental states to others
-Role of Mirror Neurons (normal people, when they see a friend cry, have mirror neurons that fire that mimic the feeling, which allows you to connect socially (but doesn’t make you cry); for people with autism, there is a dysfunction
-Early Treatment Best
-We start to believe other people do things for the same reason we want to do them. As a result, struggle to interact with other people.
-Ex: see somebody squirming in seat and believe it’s because they need to pee because that is what motivates you to squirm in your own seat

39

What are the common diagnostic problems with a categorical approach of PLY disorders?

-(1) Similarity of disorders (rely on impressions of clinician)
-Different clinicians give same person different PLY DO diagnosis (Reliability & Validity Concern)
-Ex: Possibly get diagnosed with 5 different personality DOs, probably none of them are right

-(2) Disorder is diagnosed as present or not
-Must meet a certain number of criteria → no single feature is necessary
-But differ more in degreethan in type of dysfunction

-(3) Diagnoses can easily be overdone
-Personality diagnosis gets overdone and is stigmatized
-If therapist doesn’t like you, you’re more likely to get diagnosed with a personality DO

-(4) According to DSM, personality disorders must:
-“deviate markedly from the expectations of a person’s culture”
-But little multicultural research
-Why so many gender differences in rates (gendering)?
-Men: Antisocial, Narcissism, OCPD, entire ODD cluster
-Women:Borderline, Histrionic, Dependent
-This is what he is talking about when he says gendering of personality DOs

40

What are the pathological traits of the alternative dimensional model to PLY disorders?

-Impairment Areas
-Identity
-Self Direction
-Empathy
-Intimacy

-Pathological Traits (ON EXAM)
-Negative affect
-Detachment (socially withdrawn)
-Antagonism (like to create drama, issues with people)
-Disinhibition (you’ll do whatever)
-Psychoticism (disconnected cognitively from real world)

41

3 Clusters of PLY disorders? How do the 10 disorders fall into the clusters?

-1. “Odd” Personality Disorders (“Schizophrenia-Spectrum” Disorders)
-Paranoid
-Schizotypal
-Schizoid

-2. “Anxious” Personality Disorders
-Avoidant
-Dependent
-Obsessive-Compulsive
-Display anxious and fearful behavior
-Symptoms similar to anxiety and mood disorders
-But few heritable direct links
-Treatment outcomes better than for other PLY disorders

-3. “Dramatic” Personality Disorders
-Antisocial
-Borderline
-Histrionic
-Narcissistic
-Interpersonal Relationships Very Hard
-More commonly diagnosed now
-Ego Syntonic

42

“Gendering” (Gender Imbalance) of Personality Disorders?

-Men: Antisocial, Narcissism, OCPD, entire ODD cluster

-Women:Borderline, Histrionic, Dependent

43

What is the central difference between schizoid and avoidant PLY DO?

-Avoidant and schizoid are loners
-Schizoid are happy alone (happy hermits)
-Avoidant want to be in relationships, but it’s difficult (sad/lonely hermits)

44

What is the central difference between avoidant personality DO and social phobia DO?

-Avoidant PLY: fear close social relationships (can be okay coming to class because can put head down, sit on edge or in back, don’t have to talk to them; but if someone tries to ask you a question, it’s a problem

-Social phobia: fear social circumstances

45

What is the central difference between OCD and Obsessive Compulsive PLY DO?

-OCD is about repetitive, compulsive behaviors
-Ex: every paragraph has to have five sentences in it, and every sentence has 10 words; it doesn’t come out very well, so you don’t get good grade

-Obsessive-compulsive personality is black and white
-Ex: read instructions really closely and do it really precisely, and get high marks

46

Which PLY DO is most like schizophrenia?

-Schizotypal Personality Disorder
-Extreme discomfort in close relationships
-Schizophrenia-light

47

What PLY DO can be viewed as an exaggerated performance of femininity?

-Histrionic Personality Disorder

48

What is the narcissistic wound?

-Strong powerful reaction to feeling like somebody doesn’t think that you are wonderful

-Outcome of narcissism

-We think these people do not have a strong sense of self, but deep down, they don’t have it

-Using reaction formation (something really terrible, weak about me, so I’ll reflect the opposite)

-Self-protect against people who do not believe you

-Under the section “Grandiose, need admiration, feel no empathy w/ others”

49

Why does CBT not work for borderline PLY DO? How does DBT overcome this?

-(1) Learn to invalidate themselves
-Intolerant of primary emotions
-Punishing, suppressing, & judging their emotions
-Even when normative
-Produces“secondary emotions”
-E.g., Shame for feeling sad (sad, but know think something is wrong with feeling sad, so they feel shame)
-E.g., Guiltfor being angry
-(2) Easily “feel invalidated” by others
-Ex: want to go watch this movie, person says they can’t, so they feel invalidated
-(3) Influence w/ extreme behaviors
-E.g., self-injury/suicidality/aggression to get help, or get others to back off

-DBT was developed to overcome these problems
-(1) Clients resist therapeutic efforts to create change, while insisting therapist help them change
-(2) Direct focus on changing thoughts (CBT) is ineffective because _______?
-It invalidates client, causing them to engage in extreme behaviors (like by commiting suicide)
-(3) Parasuicidal (& other extreme) behaviors destroy therapy
-(4) All this leads to Therapist burnout & negative reactions by Therapist
-Contributes to client engaging in more harmful, ineffective behaviors
-Frequently Comorbid w/
-Major depression
-Anxiety Disorders
-Eating disorders,
-Substance abuse…
-Borderline diagnosis associated w/ worse outcomes for these other disorders

50

What are the 4 phases of sexual response?

-1. Desire - Do you wanna have sex? Fantasize about it? (disorder)

-2. Excitement - Does your body get turned on? (disorder)

-3. Orgasm - Able to have an orgasm? (disorder)

-4. Resolution - Able to experience resolution? Body returns to normal state

51

Besides deviant or dangerous fantasies and behavior, what extra thing is often needed for diagnosing sex and gender DOs?

-Distress (? Not sure)

52

What is the spectator role theory of sexual dysfunction? What disorders is it most commonly associated with?

-Performance anxiety (really concerned you’re doing the right thing and if they’re enjoying it, and as a result, no longer embedded in your own body, and you struggle feel satisfaction; to have more fulfilling sexual roles, don’t have pics of parents; don’t be overly removed)
-*Spectator Role (is this okay?; psychological cause)

-Most commonly associated with disorders of excitement

53

Who researched and created the first approach to sex therapy?

-William Masters and Virginia Johnson

54

Common treatments for rapid or premature ejaculation?

- → “Stop-start”procedure

-SSRIs

55

Common treatments for female arousal and orgasmic DOs?

- → Self-exploration

-Enhancement of body awareness

-Directed masturbation training

56

What is a paraphilia?

-Intense sexual urges, fantasies or behaviors that involve:
-Anomalous activity preferences
-Courtship disorders: distorted courtship
-Algolagnic: pain and suffering
-Anomalous target preferences
-Other humans
-Nonhumans

-Most require distress for diagnosis
-Counter example: Pedophilia

-Needs some level of dysfunction and some level of distress

-Ex: You like to be whipped as foreplay:
-Normal

-Ex: You need to be whipped to have an orgasm:
-Paraphilic

57

How is Goffman’s frame theory used to explain S & M behavior?

-Complex set of rules and specific lingo signifies normal cultural activities; if we look at sado-masichism, it’s like performing in other domains of life; we follow rules, we have lingo, we have roles; it’s normative behavior; it becomes pathological when you violate the rules of your roles
-Ex: person uses safe word and you don’t stop, and you get more aroused by doing so, that’s sadism

58

What is Hirshfeld’s partial attraction theory? How is it related to fetishism?

-Theory: Attraction is the product of the interaction of many individual factors

-Relation to fetishism:
-Typical to express healthy fetishism
-Pathology only when aroused exclusively by one thing; unhealthy when attracted only when a teddy bear is in the room
-Healthy to have a fetish, as long as still attracted to penis or vagina (genital)

59

Common treatments for paraphilia? Most effective treatment? Why is this treatment controversial?

-Aversion therapy
-Experience something bad

-Covert sensitization
-Think of something bad; ex: think of parents having sex

-Masturbatory satiation
-Until bored, extinguish response

-Orgasmic reorientation
-Appropriate stimulation

-*Chemical castration (most effective)
-AntiAndrogenics: block or reduce male sex hormones
-E.g., Triptorelin
-Very Effective
-Bad Side effects; too much of this = you die
-Some consider unethical (controversy; never able to enjoy/have sex again?)

60

What are the steps in treating Gender Dysphoria with sexual reassignment surgery in the United States?

-(1) Psychological Evaluation
-Major nongender problems should delay surgery option

-(2) Hormone Therapy (get hormone from other sex; ex: testosterone; and receive blockers)

-(3) Real Life Experience

-(4) Surgery

61

What is the relationship between sexual orientation and transvestic DO?

-More typical in heterosexual men
-Begins in adolescence

62

What is the relationship between sexual orientation and gender dysphoria?

-There is no relationship

-Gender Dysphoria DO is NOT about sexual orientation
-2:1, men

63

What is the relationship between transvestic DO and gender dysphoria?

-For transvestic DO, can specify:
-w/ fetishism: aroused by fabrics, materials, or garments
-not associated w/ gender dysphoria; still sexually attracted to women
-w/ autogynephilia: aroused by thoughts or images of self as female
-associated w/ gender dysphoria; when dressed as women, think of themselves as being women

-Under “Transvestic DO”

64

3 Explanations for the association between social economic status and schizophrenia?

-More in Low SES Populations
-(1) Low SES Stress → vulnerability to physiology
-Maybe your gene lies dormant
-(2) Low SES Discrimination → vulnerability to labeling
-Don’t have money, go to basic psychologist, and get diagnosed; if have money, go to a psychologist who only sees people with a lot of money, they’ll ask a lot of questions to try to find something else that is the problem because they don’t want to diagnose you with schizophrenia
-(3) Downward Drift → DO’s dysfunctions cause SES drop
-Start out having money; develop symptoms; have hallucinations of throwing bottle at student → probably lose job → told developing symptoms → upset partner

65

Core positive symptoms of schizophrenia?

-Pathological additions to a person’s behavior

-(1) Disordered thinking and speech
-Loose associations (use same word in different ways; hard to understand what they’re saying/meaning)
-"I think someone's infiltrated my copies of the cases. We've got to case the joint. I don't believe in joints, but they do hold your body together.”
-Neologisms (make up words)
-”I'm going to the park to ride the wallywhoop.”
-Perseverations
-Repeat words and statements again and again
-Clang (combining words together that have the same literal kind of sound)
-”He went in entry in trying tieing sighing dying ding-dong dangles dashing dancing ding-a-ling!”

-(2) Heightened perceptions
-Senses flooded by sights and sounds

-(3) Hallucinations
-Sensory perceptions in the absence of external stimuli
-Auditory most common
-Seem to be spoken directly to, or overheard by, the hallucinator
-Others: tactile, somatic, visual, gustatory, olfactory

-(4) Delusions
-Faulty interpretations of reality
-Control - common; thinking you can control world in some way or people
-Persecution - completely delusional; idea that other people are observing you with ill-intent, wanting to hurt you
-Reference - think things in environment are put there uniquely for you
-Grandeur - extreme form of control; god-complex; can control and know everything going on

-(5) Inappropriate affect
-Emotions unsuited to the situation
-Ex: being angry when should feel gratitude; feeling happy when should be sad

66

Core negative symptoms of schizophrenia?

-Pathological deficits to a person’s behavior; doing less than a normal person

-(1) Blunted & flat affect
-Show less emotion, Avoid eye contact, Monotonous / Low voice, Expressionless face
-Anhedonia–general lack of pleasure or enjoyment; inability to express positive emotion

-(2) Alogia (Poverty of speech)
-Don’t talk much and when do talk, not good?

-(3) Loss of volition (Directedness)
-Feeling drained of energy and interest
-Inability to start or follow through on action
-Ambivalence –conflicted feelings about most things

-(4) Withdrawal from social environment
-Attend only to their own ideas and fantasies
-Breakdown of social skills--inability to recognize other people’s needs & emotions

67

Core psychomotor symptoms of schizophrenia?

-Pathological movement

-(1) Catatonia
-Stupor, rigidity, posturing, excitement; seem to not have control/agency over own body; other people can move their body, but they can’t

-(2) Psychomotor Retardation
-Slowing of movement; look like they’re literally walking in slow motion

-Examples of Diagnosed Individuals (watched videos in class)

68

What are the 2 core diagnostic differences between schizophrenia and schizoaffective DO?

-(1) Major Mood DO (like bipolar or depression) concurrent WITH criteria A of Schizophrenia
-Positive
-Psychomotor
-Negative
-Specify
-Bipolar type
-Depressive type

-(2) Severe dysfunction not necessary, and often less than Schizophrenia

69

What is the evidence for the dopamine hypothesis of schizophrenia? What symptoms does it explain?

-Best for explaining positive symptoms

-Neurons using dopamine fire too often → Evidence:
-(1) Parkinson’s treatment can cause positive psychotic symptoms
-(2) Amphetamine Psychosis
-(3) Autopsies of Schizophrenia
-High # of dopamine receptors
-High amount of dopamine
-(4) Effectiveness of antipsychotic medications
-Medication hinders activity of dopamine in brain, so if antipsychotics decrease hallucinations, they interrupt dopamine functioning and person gets better, dopamine must be problem
-Dopamine antagonists

70

What brain structure abnormalities are commonly associated with schizophrenia? What symptoms do they explain?

-Best for negative symptoms

-Enlarged ventricles
-Brain cavities filled w/ cerebrospinal fluid
-Poor development, or
-Damage in brain regions

-Smaller
-Temporal and frontal lobes
-Amounts of grey matter

-Abnormal blood flow to certain brain areas

-Viral problems
-(1) More likely to be born during winter months
-But healthy subgroups too → chess players
-(2) Link between schizophrenia & viruses in animals

71

What family environment characteristics are associated with schizophrenia?

-(a) Family stress:
-More conflict & difficulty (communicating?)
-Parents more critical of and over involved w/ children (overly critical, highly expressive → more likely to have children with schizophrenia)
-High in “expressed emotion”
-4 times more likely to relapse living in such families

-(b) Double binds (Bateson)
-Verbal message / Nonverbal metamessage
-Parents communicate something verbally but express opposite physically (ex: tell Johnny you love them but at the same time, they are picking up a stick with studs to beat their kid; child breaks from reality cognitively)

72

How does the Rosenhan study suggest schizophrenia is partly a cultural problem of labeling?

-Rosenhan’s“pseudo-patient” study

-Found that when you go to hospital and say you hear voices, admitted immediately and diagnosed with schizophrenia

-Once acted normally (which was right away), they were not let out

-Help us set up more rigorous standards of admitting people; clinians were more comfortable over diagnosing than underdiagnosing because if they miss it, person could be dangerous)

73

What category of symptoms do typical (i.e., first generation, conventional) antipsychotics work best for?

-Affects positive symptoms more than negative

-Help ~ 65% of patients
-More effective than any other approach used alone
-Affects positive symptoms more than negative
-Improvement levels off after 1st six months
-Symptoms (likely) return if clients stop taking drugs
-Powerful Side Effects

74

What are the common side effects of typical antipsychotics?

-Extrapyramidal effects:impact extrapyramidal areas of brain
-Medication-induced reduction of dopamine in basal ganglia & substantia nigra
-Parkinsonian symptoms:
-Muscle tremor & rigidity, bizarre movements of face, neck, tongue, back
-Great restlessness, agitation, & discomfort in the limbs
-Prescribed anti-Parkinsoniandrugs

-Neuroleptic malignant syndrome (~ 1% of patients, esp. elderly)
-Improper functioning of autonomic nervous system
-Muscle rigidity, fever, impaired consciousness
-Can be fatal
-Drug use immediately discontinued
-Given dopamine-enhancing drugs

- Tardive dyskinesia
-Writhing or tic-like involuntary movements
-Affect mouth, lips, tongue, legs
-More than 10% of patients
-Difficult, sometimes impossible, to eliminate
-Prescribe lowest effective dose possible

75

What are the 2 main advantages of atypical (i.e., second generation) antipsychotics?

-(1) More effective, esp. for negative symptoms

-(2) Fewer movement effects
-Less extrapyramidal effects
-Less tardive dyskinesia

-Atypical (2nd generation) antipsychotic drugs (help enhance serotonin and decrease dopamine)
-Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, Abilify
-Dopamine & Serotonin Antagonist
-(1) More effective, esp. for negative symptoms
-(2) Fewer movement effects
-Less extrapyramidal effects
-Less tardive dyskinesia
-BUT Other side effects
-Agranulocytosis → severe drop in white blood cells
-Metabolic issues
-Weight gain
-High blood sugar

76

What are the 2 common elimination disorders? What is the common course of treatment?

-1. Enuresis
-Repeated involuntary (or intentional) bedwetting or wetting of clothes
-More typical at night
-May be triggered by a stressful event
-5 years or older
-Causes
-Basic anxiety
-Disturbed Family Interactions
-Improper toilet training
-Physiology of urinary system
-Common Treatment: Just wait for brain & developmental maturation
-Behavioral Therapy can speed up course

-2. Encopresis
-Repeatedly defecating in one’s clothing
-Usually involuntary
-Seldom occurs during sleep
-Only diagnosed after age of 4
-More common in boys
-Creates intense social problems, shame, embarrassment
-Causes
-Stress (especially family conflict)
-Constipation
-Improper toilet training
-Treatments
-Behavioral
-Medical approaches
-Family therapy

77

What is school phobia often caused by?

-Separation Anxiety
-Kids not scared of school, but scared parents will not return to pick them up

78

What are the 3 clusters of ADHD symptoms? Which cluster is most easily underdiagnosed?

-1. Inattention(most easily underdiagnosed)
-Easily bored
-Easily distracted & forget things
-Frequently switch from one activity to another
-Difficulty completing a task or learning something new
-Most easily underdiagnosed because it’s normal and because kid not paying attention to you does not interfere with your tasks

-2. Hyperactive
-Talk nonstop
-Fidget & squirm in their seats
-Dash around, touching or playing with anything and everything in sight

-3. Impulsive
-Very impatient
-Interrupt & Blurt out inappropriate comments
-Act w/out regard for consequences
-Difficulty waiting for things they want or waiting their turns in games

79

What type of stimulants work best for ADHD? What do these specific drugs help avoid compared to conventional drugs?

-Methylphenidate (Ritalin), a stimulant
-Decreases restlessness
-Increases focus
-Ritalin and meth are very similar, but they have differences

-BEST TYPE OF STIMULANT = Slow-release versions best & most expensive! → Help avoid the rebound effect (kid ends up being even worse when they go off the drug)

-Most common are ritalin and adderall

80

What are the big 3 environmental conditions that enhance treatment of ADHD?

-(1) Be Organized
-At home
-Schoolwork

-(2) Be Clear (with how you communicate things)
-Structure all activities

-(3) Be Consistent
-Routine schedule

-Create Opportunities to Practice & Reward Self-Regulation
-Active Play & Imagination with Operant Conditioning
-Something that involves stimulants, has good environment at home, uses play, goes to therapy = best

81

6 core features of Autistic Spectrum Disorder?

-(1) Lack of responsiveness
-Extreme aloofness
-Lack of interest in people

-(2) Language & communication problems
-Echolalia
-Exact echoing of phrases spoken by others
-Pronominal reversal
-Confusion of pronouns
-Ex: Adult’s question “Are you hungry, Sam?”
-Child’s possible responses: “Are you hungry, Sam” or “Sam is hungry.”

-(3)“Self-stimulatory”behaviors
-E.g., jumping, arm flapping, making faces
-Can be self-injurious behaviors

-(4) Overstimulatedand/or understimulated
-Trying to fit in?

-(5) Perseveration of sameness
-Limited imaginative play
-Very repetitive and rigid behavior
-Play a lot, but do the same thing over and over again

-(6) Strongly attached to particular objects
-E.g., plastic lids, rubber bands, buttons, water
-Collect, carry, or play with them constantly

82

3 common autism “boy types”?

-1. Rule boys
-How does the child interact with the circumstance? Rules
-Easiest to treat
-Ex: If wanted to treat rule boy on spectrum, and you want them to understand how they interact, you introduce yourself, shake hand, look at their face, ask name; somebody with this type, they practice, and they can do it

-2. Logic boys
-These boys are a little harder
-They want to know why
-Have to come up with reasons
-Ex: shaking hands is good because it lets you know they won’t hurt you (historically)

-3. Emotion boys
-Most difficult to treat
-Go based off of how they feel
-Ex: if sad in classroom, you don’t cry there, you regulate your emotions; but it’s hard telling a kid to express emotions only in certain situations

83

4 D’s of Abnormal Behavior

-Deviant

-Dysfunctional

-Dangerous

-Distress

-Don’t need all four to be diagnosed, but having majority is seeked

-All four exist on a spectrum

84

Deviant

-Occurs infrequently in person’s culture

85

Dysfunctional

-Interferes with person’s ability to maintain:
-Relationships (get with and hold friends, romantic partners, family)
-Jobs (get a job, hold it, keep it)
-Life (hygiene, finances, cook for yourself)

86

Dangerous

-Physically harmful to the person or others

87

Distress

-Causes the person or others psychological pain
-Required for all disorders
-For most, causes the person themselves pain, not others

88

What is moral treatment? How did it differ from earlier asylum conditions? What time period was it emphasized in?

-Moral Treatment: Care that emphasized moral guidance and humane and respectful techniques

-Difference between asylums and moral treatment:

-Emphasized in 19th century

89

What is mass madness? When was it most common?

-Groups of individuals afflicted at the same time with the same disorder or abnormal behaviors

-Includes tarantism and lycanthropy

-Most common when high levels of fear and panic, believing they’re “taken over”; eating substances such as fungi on food that led to odd beliefs and visions; during last half of Middle Ages

90

Two competing perspectives on psychopathology in the early 20th century?

-(1) Somatogenic Perspective
-Abnormal functioning has PHYSICAL causes
-Untreated syphilis leads to general paresis
-Kraepelin - 2 forms of mental illness:
-Manic Depression (today, bipolar disorder)
-Dementia Praecox (today, schizophrenia)

-(2) Psychogenic Perspective
-Abnormal functioning has PSYCHOLOGICAL causes
-Mesmer → hypnosis
-Freud → the talking cure, outpatient

91

Hippocrates - Contributions?

-Said illness had NATURAL causes

-He came up with the 4 humours
-Said illness was imbalance of the 4 fluids, or humours
-Must “rebalance” humours

92

Philippe Pinel - Contributions?

-(France)

-Said instead of just giving them basic needs, he said we need to interact with them as human beings, show them care, and they’ll get better; give them tasks; moral treatment

-Worked with Tuke (England) who had friends die with mental illness; said they should open their own moral treatment place

93

Dorothea Dix - Contributions?

-Boston school teacher; nurse

-Advocated for treatment centers for mental illness, for state mental hospitals; used her connections and was influential

94

Kraepelin - Contribution?

-Said fatigue causes mental dysfunction

-Said there were 2 forms of mental illness
-(1) Manic Depression (today, bipolar disorder)
-(2) Dementia Praecox (today, schizophrenia)

-Termed “syndrome” - Said we’re gonna know a disorder not by common symptoms, but common patterns of symptoms

95

According to Freud, what are the 3 core parts of the mind? What guides them?

-Id
-Guided by the Pleasure Principle → What you want to do (instincts)
-Creates (ex: kid likes to build legos)
-Destroys (ex: kid likes to destroy legos)

-Ego
-Guided by the Reality Principle → What you can do (reality)
-Plans
-Compromises (how can I get what I want and still be good)

-Superego
-Guided by the Morality Principle → What you shouldn’t do (morality)
-Punishes (when doing bad things, or even thinking it)

-Unconscious nature is big part

96

From the biological model, problems in what 3 aspects of the body produce psychopathology?

-(1) Brain anatomy

-(2) Brain chemistry

-(3) Genes

97

What are the 3 areas of distorted thinking for Beck?

-Beck’s Depression Therapy
-Challenge thoughts
-(1) Self: I am worthless
-(2) Future: I never will be good
-(3) World: Everyone hates me
-Assertiveness training

98

Roger’s therapy is called _____? How are conditions of worth problematic? What are 3 components of a supportive climate?

-Client-centered therapy

-Conditions of worth are problematic because they create anxiety and depression; health depends on unconditional positive regard
-I’m good IF I do or am “X”... (people think they’re only good IF…; Rogers tries to get rid of this

-3 components of a supportive climate:
-(1) Unconditional positive regard
-(2) Accurate empathy
-(3) Genuineness

-”The good life is a process, not a state of being. It is a direction, not a destination.”

-Cycle: Increased self-awareness → increased self-acceptance → increased self-expression → reduced defensiveness → increased openness

99

T. Szasz’ critique of abnormality?

-Psychological disorders are a way society enforces cultural norms and maintains existing distribution of power

100

What are the 2 dimensions of the family circumplex that help explain psychopathology?

-(1) Enmeshed-Disengaged
-Enmeshed = know too much
-Disengaged = don’t know much

-(2) Rigid-Chaotic
-Rigid = specific rules that need to be followed
-Chaos = no structure

-Family circumplex helps make up family system? (Abnormal family functioning leads to abnormal behavior)

101

Common risk factors?

-Risk factors: characteristics (personal or environmental) that precede the development of a disorder

-Fixed: (mostly) assigned at birth
-(1) Gender (for most disorders, women at greater risk)

-(2) Race and Ethnicity

-(3) Neuroticism (strongly, genetically informed)

-Dynamic: (can change over time)
-(4) Age (if not diagnosed with ADHD by age 40, probably don’t have it)

-(5) Socioeconomic Status (SES) (lower economic status = higher risk)

-(6) Quality and Quantity of Social Relationships (few people in life and low support quality = higher risk factor)

-(7) Locus of Control (what happened to you and how you influenced it; internal: I control my destiny; external: they control my destiny; if you have an external locus of control = higher risk)

-(8) Childhood Trauma

102

What are the 3 types of ACEs? How are they related to having a DO?

-ACE = Adverse Childhood Experiences

-(1) Abuse: emotional, physical, and sexual
-(2) Neglect: emotional and physical
-(3) Household Dysfunction: mental disorder, incarceration, divorce, and substance use (other family members in household did these things, not you)

-Environments of childhood trauma influence behavior and epigenetics

103

Common protective factors?

-Protective Factors: characteristics (personal or environmental) associated with lower rates of having a DO

-(1) Social Support (counter-example: co-rumination - talk with friend about how much life sucks, and they do the same)

-(2) Extraversion (counter-example: Narcissistic DO - people who are especially extraverted)

-(3) Financial Wealth (counter-example: Eating DOs - grow up with money, food is seen differently)

-(4) Intelligence (counter-example: bipolar DO - people who have manic episodes tend to be smarter; intelligence → greater sense of yourself, discern something is wrong sooner, and get help sooner)

-(5) Hardiness → i.e., transformational coping - if someone breaks up with me, I could think negatively OR be like “Now, I get to ask out this other person I’ve liked for a while”

-(6) U.S. Cultural Power Groups → e.g., being male and white

104

Not Guilty by Reason of Insanity

-Mentally unstable at time of crime

-M’Naghten rule: mental disorder prevented person from knowing right from wrong

-Guilty by Mentally Ill: Acknowledgement that mental disorder was involved, but you are still responsible for actions

105

Mentally Incompetent

-Mentally unstable at time of trial

-Person does not understand charges and is unable to help lawyers prepare defense

-Forced to receive treatment in mental institution until capable of standing trial

106

Therapeutic ethics of dual relationships, sexual relationships, and maintaining and breaking confidentiality?

-Dual Relationships - Must avoid dual relationships
-Cannot be therapist and friend, business partner, lover, etc.
-(Discussion of sexual relationships discussed right below)

-Sexual Relationships - No sexual relationship until 2 years after therapy ends (if a person calls you to ask you to be their therapist, you set an appointment, and they never show up, then the two year mark starts the day they called you

-Maintaining and Breaking Confidentiality: Must adhere to confidentiality (HIPPA)
-Who is the client?
-Legal obligation to inform when danger to self or others
-Can’t tell law officers about things done in the past (ex: killed someone), but yes, if the patient talks about doing it in future (ex: they are planning to kill someone)

107

How do projective tests work? What are the common tests reviewed in lecture?

-Ambiguous stimuli evokes unconscious
-Developed from psychodynamic approach
-Overall, poor reliability and validity for clinical use (can’t be reliable if two different researchers come up with different answers/conclusions)
-Excellent when used as ice breakers to generate conversation

-Ex: Rorschach inkblot
-Location: What part of image (blank space, whole image, detail of image) that the interpretation comes from
-Determinants: What aspect of the image (color, texture) that the interpretation focuses on
-Content: The interpretation itself

-Other Examples?:
-Thematic Apperception Test (TAT) - Images we looked at and analyzed in class
-Sentence Completion - “I wish ____________”
-Draw a Person (DAP)
-Placement of Figure:
-Right = future; left = past
-Lower left = depression; upper right = suppress past
-Face
-Big head = desire to be smart
-Large eyes or ears = paranoid
-Missing parts = identity confusion
-Legs and Feet
-Confidence vs. insecurity
-Age
-Younger = infantilism

108

What are the common psychophysiological tests? How do they help assess psychopathology?

-Physiological response as a sign of stress/anxiety
-Electrocardiogram → heart rate
-Galvanic Skin Conductance → sweat gland activity
-Electroencephalogram (EEG) → brain electrical activity
-Polygraph (lie detector) - no longer used in court because people likely to commit crimes, pass them, and regular people who wouldn’t are so nervous that they don’t pass

109

What are the 4 common neuroimaging tests?

-(1) Computerized Axial Tomography (CT)
-Uses x-rays to identify structural abnormalities; uses iodine
-Can detect brain tumors and other abnormalities (enlarged ventricles; hollow spaces, which is related to schizophrenia)

-(2) Magnetic Resonance Imaging (MRI)
-Can produce high-resolution images of brain structure
-Can detect tumors, blood clots, and other abnormalities
-Uses big cylindrical magnet

-(3) Functional MRI (fMRI)
-Asses brain structure and function as well as metabolic changes
-Asses how brain is working

-(4) Positron Emission Tomography (PET)
-Invasive way to assess brain structure and functioning
-Can identify seizure activity and even brain sites activated by psychoactive drugs

110

What are the 3 steps of systematic desensitization therapy? What model does it come from?

-Typically used to treat stress and phobia

-Traditional ERPT
-10-20 sessions
-(1) Learn relaxation skills
-(2) Construct a fear hierarchy
-(3) Confront feared situation

-Model: Cognitive Behavioral Model

111

The ABCDE’s of Ellis’ Rational Emotive Restructuring therapy. What model does it come from?

-Typically used to treat mood and anxiety issues

-Problem: ABCs:
-A = Activating Event - Fail Exam
-B = Distorted Belief - I’m stupid; I will fail this course
-C = Emotional Consequence of Belief - Depression

-Solution: DEs
-D = Dispute Belief - You can still pass this course; You are skilled, wise in other things
-E = Evaluate Emotional Consequences - Less depressed

112

4 Common Factors of Treatment Effectiveness? Which 2 factors are most responsible for treatment effectiveness?

-(1) Extra Therapeutic Factors
-Client factors
-Illness course factors
-Social/cultural factors

-(2) Expectancy
-Client believes in therapy/therapist

-(3) Therapeutic Relationship
-Client-therapist alliance
-Empathy, positive regard (Rogers)

-(4) Technique
-Factors unique to approach

-2 Factors Most Responsible: Client factors (part of extra therapeutic factors) & Relationship factors (therapeutic relationship)

113

How are the Amygdala and GABA associated with anxiety?

-Amygdala:
-Anxiety response
-Septal-hippocampal system
-Memory association triggers anxiety

-In normal fear reactions:
-Key neurons fire → excitability
-Brain then tries to reduce excitability
-GABA released to inhibit neuron firing
-Gad linked to:
-Too few GABA receptors
-Ineffective GABA receptors
-Benzodiazepines (valium, xanax) enhance GABA -- increase GABA to reduce cortisol (anxiety)

114

What is the most common antianxiety drug? How does it work? What is its biggest side effect?

-Benzodiazepines (late 1950)
-Provide temporary, modest relief
-Rebound anxiety with withdrawal and cessation of use
-Physical dependence is possible
-Mix badly with certain other drugs (especially alcohol)

-Biggest side-effect - drowsiness, sleepiness

-Early 1950s = barbiturates (hypnotics)

-More recently = antidepressant and antipsychotic drugs

115

3 general symptoms associated with Stress DOs?

-9 or more of 14 possible symptoms, e.g.,:
-(1) Intrusion symptoms
-Recurrent & Intrusive memories/dreams
-Flashbacks
-Distress at cues

-(2) Dissociative symptoms
-Distorted cognitions about cause or consequences of event → self blame (just-world hypothesis → bad things only happen to bad people, so if I’m hurt, it’s because I did something bad)
-Altered sense of reality
-Inability to remember event

-(3) AvoidanceSymptoms (internal or external)
-External = avoid situation that caused it OR
-Internal = avoid things that even just remind me of it (ex: avoiding school because assault happened on way to school)

116

What is “preparedness”?

-“Preparedness”: an evolutionary explanation (of why people have specific phobias)
-We’re afraid of things that can potentially kill us/hurt us; biologically, genetically prepared to be afraid of certain things because they were dangerous in the past, they survived because of fear and avoidance of snakes; passed down to you; ex: grandma and grandpa afraid of snakes, avoided them, and survived to have kids, while other couple didn’t make it because not afraid and died by getting close to one

117

How does stimulus generalization of specific phobias help explain GAD?

-GAD caused by stimulus generalization
-Responses to one stimulus are also elicited by similar stimuli

-Conditioning and modeling:
-Once fears are acquired → avoid object → fear enhanced and maintained
-GAD caused by stimulus generalization
-Responses to one stimulus are also elicited by similar stimuli

118

The difference between obsessions and compulsions?

-Persistent thoughts, urges, or images that are intrusive (ex: thinking cousin is going to get killed, die if I don’t keep my house very clean by vacuuming 12 times a day) (impulsive thought?)
-Takes various forms:
-Wishes
-Impulses
-Images
-Ideas
-Doubts
-Common obsessions:
-Dirt/contamination
-Sexuality
-Violence
-Orderliness
-Religion

-Compulsions:
-Repetitive behaviors or mental acts performed by rules (this is behavioral; repeated, ritualistic behaviors; set of behaviors done in specific order that helps reduce distress)
-Performing behaviors reduces anxiety
-Only for a short time
-Develop into rituals
-Common compulsions:
-Checking
-Cleaning
-Order
-Counting, touching
-According to psychiatric perspective, doing cocaine vs. washing hands are different because they have different neurochemical response) (compulsion reduces cortisol, removing stress, while drugs add positive sensations, so not the same)

119

Based on the lecture, what 2 common structures of the brain are OCD, Hoarding, & Body Dysmorphic associated with?

-1. Frontal Lobe (abnormal functioning)
-Orbitofrontal cortex (overactive)
-Processes sensing “data” into thoughts and action
-Ventromedial PFC
-Anterior cingulate cortex

-2. Overactive Left Hemisphere
-Attention to details amplified

120

The common reasons why some people develop a Stress DO when exposed to stress and others do not?

-(1) Biological processes
-Some of us don’t have a lot of cortisol (a stress hormone); some of us have chill hippocampus, while others do not; amygdala (?)

-(2) Personalities
-Maddi’s Hardiness - Look for good things in the bad that happened; good takeaway; ex: advocating for social changes, share experiences, etc.) → Transformational Coping and Positive Appraisals

-(3) Childhood experiences
-Ex: divorce; some kids take personal blame, but divorce doesn’t have to be bad and create harm in kid’s life as long as it’s done in a healthy way; hiding conflict and showing only happy faces is bad, because then when you get divorced, kid doesn’t understand why and thinks it’s them; of course, screaming and yelling is not good

-(4) Social support systems

-(5) Cultural backgrounds
-Hispanic, Latin/a Americans higher in PTSD because of importance of family?

-(6) Severity of the traumas
-Ex: some people go through hurricane only had to replace a window, while for another, their whole house was destroyed; when it comes to abuse, assault, how often, community response
-Intensity, duration, frequency

121

What hormone seems most implicated in stress DOs?

-Cortisol

122

Somatosensory Awareness

-More attention devoted to body

123

The 3 core brain connections to Somatoform DOs based on lecture?

-(1) Overactive amygdala and limbic system
-Connected to experiencing physical sensations that are not genuine

-(2) Dysfunction in frontal lobe and right hemisphere (for hoarding = left hemisphere)
-Connected to attention deficits in somatization
-Many somatic complaints on left side of body

-(3) Decreased blood flow to to prefrontal cortex
-Connected to motor and sensory reports in Conversion DO

124

What are the 2 main categories of symptom dysfunction associated with Conversion DO?

-Motor Function
-Difficulty walking
-Difficulty swallowing
-Fainting
-Convulsions
-Can’t move arm or leg

-Sensory Function
-Blindness
-Deafness
-Loss of touchdown

125

What is the Sociocognitive Explanation for Dissociative Identity Disorder? Evidence for the Sociocognitive Explanation for Dissociative Identity Disorder?

-DID is not a genuine DO, but is instead caused by the media and therapist (encourage them to express)
-(1) Evidence of Media Influence
-Cultural differences in DID presentation (in India, people change personalities overnight (displayed in movies this way); in U.S., people change throughout day)
-Rapid increase from 80’s after movies/novels
-(2) Evidence of Therapist Influence
-Clients already in therapy for other DOs (client already attending therapy, and after being there for a while, they become diagnosed with DID, so it is suggested that therapists encourage their clients to elicit DID)
-False Memory Syndrome
-Hypnosis used to Assess DID (therapist uses hypnosis and drugs, and rewards client for eliciting different personalities)
-DID clients are Fantasy prone
-Clients rewarded for enacting identities

126

5 sociocultural reasons explained in lecture why women have higher rates of depression than men?

-(1) Artifact theory: women and men are equally prone to depression, but clinicians often fail to detect depression in men
-Ex: female client comes in, she expresses depressive symptoms, they diagnose them with depression; male client comes in, he expresses same symptoms, but therapist asks about alcohol abuse, and diagnoses him with alcohol abuse disorder

-(2) Life stress theory: women in most societies experience more stress than men

-(3) Body dissatisfaction theory: women in most societies are taught to seek unreasonable goals that are unhealthy
-Women feel they’re only worthy if they look a certain way, and when they don’t, they feel bad

-(4) Lack-of-control theory: women feel less control than men over their lives
-Women hold less power, but men are able to yield choice war, and depression is associated with hopelessness, and women do have less control than males do

-(5) Rumination theory: people who ruminate when sad are more likely to become depressed & stay depressed longer
-Amanda Rose: studied what men and women do when they hang out; girls/women are at much higher likelihood to co-ruminate, and when they do so, they report feeling closer, but it makes us feel bad because we confirm that life is crappy; men do not co-ruminate, so they don’t get depressed

127

How does the permissive theory of neurotransmitters explain the cause of mania versus Depression?

-Depression
-Low S + Low NE

-Mania
-Low S + High NE
-If bipolar, probably have a mix of low serotonin and high epinephrine

-(TYPICAL: Medium S + Medium NE)

128

What are the 3 common drug groups historically used to treat Depression?

-1. Monoamine oxidase inhibitors (MAO Inhibitors)
-First used as TB treatment
-Made patients happy
-Slows down production of MAO
-MAO breaks down Norepinephrine
-MAO inhibitors stop breakdown
-Increase in Norepinephrine activity
-~50% get better
-High blood pressure if eat tyramine

-2. Tricyclics
-Accidental, studying Schizophrenia treatments
-E.g., Imipramine
-10 days -3 weeks before improvement
-Increased Serotonin & NE effectiveness
-2/3’s improve
-More than MAO’s & no diet restrictions
-Relapse common
-> 5 months after improvement “continuation therapy”
-> 3 years after improvement “maintenance therapy”

-3. Selective Serotonin Uptake Inhibitors (SSRI’s)
-Increase serotonin activity specifically
-Fluoxetine (Prozac)
-Sertraline (Zoloft)
-Escitalopram (Lexapro)
-Effectiveness and Speed of action similar to Tricyclics
-Harder to overdose
-No dietary restrictions (than MAOs)
-Fewer side effects (than tricyclics)

129

How quickly do SSRIs work for mood DOs? What is the most common problematic side effect of SSRIs?

-10 days -3 weeks before improvement (similar to tricyclics)

-Sexual dysfunction

-Dry mouth

130

4 specialized treatments used to treat treatment-resistant depression?

-1. Ketamine
-Just approved to treat depression
-Helpful within an hour
-Desire to kill oneself decreases to almost nothing
-Increased spine number
-Increased number of “mushroom” or mature spines
-In order to get approved, it has to be administered by doctor
-Every time you go, have to pay for medication and meeting with doctor
-High expense; cost is 1000s of times higher than price available on the street

-2. MDMA (Ecstasy)
-If you take ecstasy, even a single strong dose of it, you destroy your brain’s ability to produce serotonin
-Fraudulent! Gave them LSD, not MDMA
-Ecstasy doesn’t destroy brain’s ability to produce serotonin
-So we’re probably going to get ecstasy approved

-3. Deep Brain Stimulation
-Works in ⅔ of people who were resistant to other children
-Risk is really high
-Feel it instantaneously

-4. Electroconvulsive Therapy (ECT)
-Exploring treatment for Epilepsy
-Fast and Effective
-Contemporary Use
-Given muscle relaxants
-6-12 sessions over 2-3 weeks
-Unilateral or bilateral
-Memory Loss
-Often recent, Often temporary (ex: of his friend who had it done, and forgot about her kids for a couple of months)
-Frightening, but often works

131

What are the two most common drug therapies for Bipolar DO?

-(1) Mood Stabilizers: Lithium
-Very effective for mania
-2/3’s improve
-Less helpful for depression
-Correct dosage hard
-Too low = no effect
-Too high = lithium intoxication (death)
-Little lithium, no affect → little more, no affect → little more, death; small window

-(2) Second Generation Antipsychotics often very helpful!
-E.g., Abilify

-Little success until last quarter of 20th century
-Psychotherapy alone ineffective
-Antidepressant drugs ineffective
-Often increases severity of manic episodes

132

Difference between purging and nonpurging types of eating DOs?

-Restricting Type
-Dieting, fasting, excessive exercise

-Binge-eating/Purging Type
-Vomiting & laxatives
-Bulimia vs. Anorexia Nervosa → difference is in weight, not in binging and purging (anorexia = overly thin)

133

What are the two most common compensatory behaviors associated with Bulimia?

-Compensatory behaviors to “undo” calories
-(1) Vomiting
-Only prevents half the calories
-Affects ability to feel satiated
-Greater hunger & bingeing
-(2) Laxatives and Diuretics
-Mostly fails to reduce calories absorbed
-(1) More other-oriented Experience & Concerns
-(2) Less w/ amenorrhea
-(3) Lower frustration tolerance
-(4) Poorer coping skills

134

What groups of women are more likely to suffer from eating DOs?

-Models, actors, dancers

-College athletes
-9% full criteria for eating disorder
-50% or more have symptoms

-Higher SES & European American

-Family cultures
-History of emphasizing thinness
-Mothers who
-Diet
-Perfectionistic (obsessing over physical appearance)

135

3 phases of the Maudsley approach for Anorexia?

-Phase 1: Weight restoration
-Family meal
-Model for parents uncritical stance
-After hospital setting; gain weight
-Highly monitor what/how person is eating; therapist goes to their house and observes them

-Phase 2: Return control to sufferer
-Goal: achieve healthy weight
-Address parenting concerns
-Give them back their control, so they can do it themselves

-Phase 3: Healthy Adolescent Identity
-IncreaseI Autonomy
-Negotiate parental boundaries

136

3 phases of in Interpersonal Therapy. How does it compare to CBT as an effective treatment for Bulimia?

-Phase 1: Identify interpersonal problems
-Role disputes (ex: one person wants to be in a relationship/intimate and other doesn’t)
-Role transitions (ex: parents want kid to grow up, but kid doesn’t want to; or the opposite)
-Interpersonal deficits
-Unresolved grief (ex: deaths)

-Phase 2 (pretty humanistic)
-Patient-led change (what do you think you/we should do to resolve disagreements)
-Therapist strongly encourages change

-Phase 3
-Maintenance (if, then planning; before, used to stop at phase 2 because people got better, but then people developed bulimia again, so this phase was added)
-Relapse prevention

-Bulimia isn’t a food disorder, but instead, a social/relational disorder that expresses itself through food; the focus is about relationships and ignore food problems

-CBT versus IPT:
-CBT faster improvement
-CBT overall a bit better, MAYBE
-IPT sticks better and grows more (because learning skills relationally that’ll help resolve future problems that contribute to eating disorder)

137

Differences between a depressant and stimulant?

What is the most commonly used stimulant?
-Cocaine
-Amphetamines
-Caffeine********
-80% consume daily
-Coffee, tea, energy drinks, supplements
-Reaches peak concentration in an hour
-Nicotine

What are the most commonly used depressants?
-Alcohol:
-A problematic pattern of alcohol use leading to clinical distress w/ 2 or more of the following in a 12 month period:
-Alcohol is taken in larger amounts or longer than intended
-Persistent desire to control alcohol use
-Time spent to obtain, use, or recover from alcohol
-Craving use of alcohol
-Use causes failure to fulfill work, school, or home duties
-Continued use despite social problems caused by it
-Use in hazardous situations (driving; operation certain/heavy machinery; sexual activities; pregnancy; using other drugs)
-Use despite physical / psychological problems caused by alcohol
-When is it too much?
-Think of context (ex: different for 40-year-old parent vs. college student)
-Think of 4 D’s
-Tolerance
-A need for increased amounts to achieve desired effect
-Diminished effect with continued use of same amount
-Sedative-Hypnotic Drugs:
-Barbiturates and Benzodiazepines
-Pill or capsule form
-Reduce excitement (like alcohol) by enhancing GABA
-At low doses
-Calming or sedative effect
-At high doses
-Sleep inducers or hypnotics
-Ativan, Halcion, Klonopin, Rohypnol, Valium, Xanax

-Opioids:
-Administered:
-Smoked
-Inhaled
-Injected under skin: “skin popped”
-Injected into bloodstream: “mainlined”
-Initial spasm: “rush”
-Hours of pleasure:“high” or “nod”
-Depress the CNS
-Bind to receptors that receive endorphins*
-Pleasurable / Calming
-Reduce pain & tension
-Also common effects:
-Nausea
-Constipation

138

What neurotransmitters do heroin, cocaine, LSD, and alcohol mimic?

-Heroin - helps GABA (an inhibitory messenger) shut down neurons and relax the drinker; enhances GABA; impairs judgement and impulse control; slows reaction time

-Cocaine - Dopamine (prevents reabsorption)

LSD - Serotonin
-Binds to serotonin receptors (enhances their activity in a big way; when getting a lot of serotonin in brain, difficult to process sensory information from outside world)

Alcohol - helps GABA (an inhibitory messenger) shut down neurons and relax the drinker; enhances GABA; impairs judgement and impulse control; slows reaction time

139

What is the self-medication hypothesis for substance use?

-Operant conditioning
-Reduce tension
-Seek more powerful drugs

-1 in 4 with diagnosed DO use

140

3 ingredients of severe addiction?

-(1) History of Childhood Trauma / Abuse (ACEs)

-(2) History of Family w/ Addiction
-Genetic Predisposition
-Family Environment
-Stress
-Modeling (coping with substance use)

-(3) Opportunity
-SES and Drug Culture
-What drugs are available to you; what’s common in your community; what’s the price of the drug

141

Association between these personality traits and addiction → Impulsivity, external locus of control, neuroticism

-Research does not support it, but positive correlations between addiction and:
-PLY disorders
-PLY Characteristics
-(1) External local of control (think things happen to you that you don’t have control over in life)
-(2) Impulsivity
-(3) Negative Affect (neuroticism)
-This is all about addictive personality DO; these three personality traits are found in people who battle addiction; these characteristics work together to help create addition (?)
-Thrill Seeking
-Emotion Dysregulation
-Low Self-Esteem
-Non-conformity

142

General Anxiety - Identify and Distinguish Symptom Presentation Gist

-“Free-floating”anxiety
-Excessive anxiety & worry under most circumstances
-Difficult to control worry (a lot of disorders are going to be difficult to control)
-Significant distress (about 95% of disorders require distress)
-> 6 months (most disorders will have a time frame)
-3 or more
-Restlessness
-Fatigue
-Difficulty concentrating
-Irritability
-Muscle tension
-Sleep disturbance
-Usually begins in childhood or adolescence

-A mental disorder marked by constant worry about nondangerous situations and physical symptoms of tension

-GAD caused by stimulus generalization
-Responses to one stimulus are also elicited by similar stimuli (ex: in car accident, scared of cars (phobia), but then realize cars are everywhere; afraid now of trucks, buses, etc; start walking to school, but then you see at school that there are cars at school too, and you start to fear school; just get scared of generally everything

143

Specific Phobia - Identify and Distinguish Symptom Presentation Gist

-Persistent and unreasonable fears of particular objects, activities, or situations
-Object almost always produces immediate anxiety
-Avoid the object or thoughts about it
-Fear is out of proportion to actual danger
-Causes clinical distress

-Most common: specific animals or insects, heights, enclosed spaces, thunderstorms, and blood

-A mental disorder marked by panic attacks surrounding, and avoidance of, objects and situations other than those involving social interaction and/or performance of others

What causes specific phobias?
-First onset triggered by
-Experiencing trauma (bad, life threatening experiences with these objects)
-Direct observation of trauma (watch it or see somebody go through it and get hurt by objects)
-Media coverage of trauma
-Panic attacks (attack so distressful and don’t want that to happen again, you avoid objects that were around you when you had attack)

-Conditioning & Modeling
-Once fears are acquired → avoid object → fear enhanced & maintained
-GAD caused by stimulus generalization
-Responses to one stimulus are also elicited by similar stimuli (ex: in car accident, scared of cars (phobia), but then realize cars are everywhere; afraid now of trucks, buses, etc; start walking to school, but then you see at school that there are cars at school too, and you start to fear school; just get scared of generally everything

-“Preparedness”: an evolutionary explanation (we’re afraid of things that can potentially kill us/hurt us; biologically, genetically prepared to be afraid of certain things because they were dangerous in the past, they survived because of fear and avoidance of snakes; passed down to you; ex: grandma and grandpa afraid of snakes, avoided them, and survived to have kids, while other couple didn’t make it because not afraid and died by getting close to one)

144

Social Anxiety - Identify and Distinguish Symptom Presentation Gist

-Fear about one or more social situations person is exposed to (person develops idea that something is wrong with them, like feeling unpopular, go into social encounter thinking that, heart rate goes up, sweating, go to encounter person/people, everyone is noticing everything that’s wrong with them, sweating even more, and after, think of all indicators that people were finding everything wrong with them, and this creates a horrible model for the next time)
-Fear you will show anxiety & be judged in social situations
-Social situations avoided or *endured*
-Fear out of proportion to threat
-> 6 months
-Clinical distress

-Often kept secret, highly disruptive

-3:2, women; Poverty: 50% more likely

-Often begins in childhood
-Child: More fear, specific situations
-Adult: Less fear, broad situations

-Help by giving anti-anxiety medication and social skills training to help (need both, either one alone is not very helpful)

-A mental disorder marked by panic attacks in, and avoidance of, situations involving performance before others or possible negative evaluation

145

Agoraphobia - Identify and Distinguish Symptom Presentation Gist

-Fear about 2 or more:
-Public transportation
-Open spaces
-Enclosed places
-Standing in line or crowd
-Begin outside of home alone

-Situations provoke fear

-Feared situations are avoided

-Fear is out of proportion to actual danger

-6 months or more

-Clinically significant distress

-2:1, women

-Usually begins late adolescence

-Often associated w/ Panic DO (fear of going back into specific environment)

-A mental disorder marked by avoidance of places in which one might have an embarrassing or intense panic

-Treatment
-Behavioral → Similar to Specific Phobias
-Drug Therapy → Similar to Panic Attacks

146

Panic - Identify and Distinguish Symptom Presentation Gist

-Abrupt surge of intense fear

-4 or more, e.g., (experienced intensely in the body; can look like a heart attack, stroke)
-Palpitations, pounding heart
-Sweating
-Trembling
-Shortness of breath, smothering
-Feelings of choking
-Chest pain
-Nausea
-Feeling dizzy, faint
-Chills, or heat
-Feeling loss of control or going crazy
-Fear of dying

-1 month or more of one or both:
-Persistent worry about additional attacks or their consequences (worry)
-Maladaptive change in behavior due to attacks (avoidant behavior) (ex: somebody who went to their romantic partner’s parents’ house, has panic attack while there, and now, that person refuses to go back to partner’s parents’ house; can also be in places like work, which is really bad)

-2:1, women

-Poverty → 50% more likely

-Usually begins late adolescence

-Only 1 of 3 seek treatment

-A mental disorder marked by ongoing and uncued panic attacks, worry about the consequences of these attacks, and, sometimes, agoraphobia

147

Obsessive Compulsive - Identify and Distinguish Symptom Presentation Gist

-Obsessions
-Persistent thoughts, urges, or images that are intrusive (ex: thinking cousin is going to get killed, die if I don’t keep my house very clean by vacuuming 12 times a day) (impulsive thought?)

-Compulsions
-Repetitive behaviors or mental acts performed by rules (this is behavioral; repeated, ritualistic behaviors; set of behaviors done in specific order that helps reduce distress)
-Time consuming ( > 1 hour / day) or cause clinical distress

-Begins in adolescence / young adulthood, gradually worsens (7, 8, or 9, and slowly gets worse)

-Specify:
-With good or fair insight (understand something is wrong with cousin example)
-With poor insight (actually think your obsession is true with cousin example)
-With absent insight/delusional beliefs (psychotic belief that is not real in world)

-1:1 gender
-Men > forbidden thoughts & order
-Women > cleaning

-Panic attacks and Suicidal thoughts common

-A mental disorder marked by ongoing obsessions and compulsions lasting more than 1 hour per day (obsessive-compulsive personality disorder = personality disorder marked by rigidity, perfectionism, and strong need for control)

Observations
-Take various forms
-Wishes
-Impulses
-Images
-Ideas
-Doubts
-Dirt/contamination
-Sexuality
-Violence
-Orderliness
-Religion

Compulsions
-Performing behaviors reduces anxiety
-ONLY FOR A SHORT TIME!
-Develop into rituals
-Cleaning
-Checking
-Order
-Counting, touching
-According to psychiatric perspective, doing cocaine vs. washing hands are different because they have different neurochemical response) (compulsion reduces cortisol, removing stress, while drugs add positive sensations, so not the same)

-OCD cycle: repetitive, unwanted, intrusive thoughts are actually NORMAL
-But, see them as dangerous
-Attempt to “neutralize”thoughts w/ actions

-People with OCD:
-High standards of conduct and morality
-Believe thoughts = to actions & can harm (people with OCD think things and view it equivalent to engaging in behavior)
-Ex: person feels happy and relieved when called down for dinner, they turn light switch off, but associate their happiness and relief with turning switch off, rather than being called down for dinner

148

Hoarding - Identify and Distinguish Symptom Presentation Gist

-Persistent difficulty parting w/possessions, regardless of value

-Results in accumulation of possessions that congest and clutter active living areas

-People with money have even more possessions; they buy extra houses and hoard in there

-Specify
-With good or fair insight
-With poor insight
-With absent insight/delusional beliefs (insight = understand something is wrong; delusional = you think something bad will actually happen if you don’t do it)

-Begins middle adolescence, young adulthood
-Severity increases with age
-Inconsistent gender findings

-3 of 4 comorbid with depression or anxiety

-Animal hoarding is worse! They create their own waste, have value, difficult to care for

-Poor Executive Control (executive functioning is very important; depending on level of executive control people develop as children can affect doing well in school, relationships, success; people with hoarding have poor external control)
-Diminished nonverbal attention
-Distract more easily (ex: to do well in class, have to focus, study, and know you have to avoid doing things you actually want to do for some time; hoarders have difficult time)
-Greater variability in reaction time
-Greater impulsivity (hoarders struggle with impulse control)
-Poor memory
-Poor decision making

-Abnormal Frontal Lobe functioning
-Orbitofrontal Cortex (overactivity)
-Ventromedial PFC
-Anterior cingulate cortex

149

Body Dysmorphic - Identify and Distinguish Symptom Presentation Gist

-Preoccupation w/ one or more perceived defects in physical appearance (why not weight? Because when we find something wrong with weight, we express it through eating differently, and brain is affected)

-Repetitive behaviors/mental acts in response to appearance concerns

-Clinical distress

-Specify:
-With good or fair insight
-With poor insight
-With absent insight/delusional beliefs

-Begins young to middle adolescence
-> abuse, bullied, as child

-1:1, gender

-High rates of suicide and depression

-There are common things that become obsessed: nose, wrinkles, hair, skin discoloration, bloating

-What do they do? Look in mirror, feel faces/body routinely with hands, excessive time spent grooming, skin-picking, doing different cosmetic things

-A disorder marked by excessive preoccupation with some perceived body flaw

-Overactive Left Hemisphere
-Attention to details amplified
-Family Environment
-Emphasize perfection & imperfections (family pushes for beauty, and it can trigger/make it worse)

-Direction of Cause Problem (can go both ways; it can be that your born with it, but it’s also possible that environment has caused it; different for different people)

-Left Half of Brain: (activated when looking at super detailed face)
-Logical
-Realistic
-Objective
-Analytic

-Right Half of Brain: (activated when looking at non-detailed face)
-Creative
-Emotional
-Intuitive
-Imagination

-This tells us that they really do see something, because brain activity isn’t changing, it’s just they see something we don’t, which makes it worse

150

Somatic Symptom DO - Identify and Distinguish Symptom Presentation Gist

-One or more somatic symptoms that distress or disrupt daily life

-Excessive thoughts, feelings, or behavior related to the somatic symptoms
-Disproportionate / persistent thoughts about symptoms
-Persistent high level of anxiety about symptoms
-Excessive time and energy devoted to symptoms

-> 6 months

-Functional versus Presenting
-Under diagnosed in elderly
-People with depression tend to somatize

-Somatic - feel something; a pain is there; illness - cognitive! No actual physical pain; actually feels a pain; illness anxiety: just worried about having something; leg might hurt one day, the other leg next day

Shared with Conversion DO:
-Somatization
-Communicating distress through physical symptoms

-Somatic Symptom & Related DOs
-Struggle that appears biological → actually psychosocially caused (ex: back hurts, goes to doctor and they find nothing, so the pain is not physically caused)
-And/Or, struggle that is excessive given biological cause (could have some organic dysfunction) (ex: walking to class, stub toe, unable to walk to class, and miss class; doctor says no real problem, just bruising, but he says he hasn’t been able to walk)

-DO NOT consciously want or purposely produce symptoms; it’s an unconscious response to stress
-Suffer actual changes in physical functioning
-Can be undetected organic cause

-Psychophysiological disorders - real thing going on with body, and are affected by stress (things like high blood pressure) (STOPS SHARING WITH CONVERSION DO)

-Communication of Distress through the Body
-Learn Illness beliefs → physical (not psychological) explanations of struggle
-Somatosensory awareness
-More attention devoted to body

-Mind-body Connection

-A mental disorder in which a person experiences physical symptoms that may or may not have a discoverable physical cause, as well as distress

151

Illness Anxiety DO - Identify and Distinguish Symptom Presentation Gist

-Preoccupation with having or acquiring a serious illness

-Somatic (body) symptoms are not present

-High level of anxiety about health

-Excessive health-related behaviors or maladaptive avoidance

-Illness preoccupation > 6 months

-Specify
-Care-seeking type (can cause “boy who cried wolf” when something is actually wrong)
-Care-avoidant type (think something is so wrong, that going to doctor will confirm fear, which would be unbearable, and this causes same problem; person won’t get treated when something is actually wrong)

-Somatic: actually feels a pain; illness anxiety: just worried about having something; leg might hurt one day, the other leg next day

-A somatic symptom disorder marked by excessive preoccupation with fear of having a disease

152

Conversion - Identify and Distinguish Symptom Presentation Gist

-Functional Symptom DO

-One or more symptoms of altered voluntary motor or sensory function (motor = can’t move arm or leg; senses = blind, can’t hear, can’t feel touch)

-No evidence of neurological / medical cause

-Clinical distress

-Example: Glove Anesthesia (person will come in saying they lost feeling in one or both hands; suspicious because there are three main nerves in arm, and people usually only experience damage with one nerve (in pinky or in forefingers), not in whole arm)

-Appears Suddenly (often)

-Associated with
-Childhood abuse
-High suggestibility (personality characteristic about how likely you are to go along with other people; gullible)
-La Belle Indifference (unconsciously knowing that they can still see, so they are less freaked out

-Motor ability:
-Difficulty walking
-Difficulty swallowing
-Fainting
-Convulsions

-Senses:
-Blindness
-Deafness
-Loss of touch

-A somatic symptom disorder marked by odd pseudoneurological symptoms that have no discoverable medical cause

Shared with Somatic Symptom DO:
-Somatization
-Communicating distress through physical symptoms

-Somatic Symptom & Related DOs
-Struggle that appears biological → actually psychosocially caused (ex: back hurts, goes to doctor and they find nothing, so the pain is not physically caused)
-And/Or, struggle that is excessive given biological cause (could have some organic dysfunction) (ex: walking to class, stub toe, unable to walk to class, and miss class; doctor says no real problem, just bruising, but he says he hasn’t been able to walk)

-DO NOT consciously want or purposely produce symptoms; it’s an unconscious response to stress
-Suffer actual changes in physical functioning
-Can be undetected organic cause

-Psychophysiological disorders - real thing going on with body, and are affected by stress (things like high blood pressure)

153

Factitious - Identify and Distinguish Symptom Presentation Gist

-Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception
-Presents to others as ill, impaired, or injured

-Deception is obvious even without external rewards present (sometimes for psychosocial benefits)

-Subtype: Malingering
-Symptoms reported for personal gain
-Money, time off work, escape punishment

-A mental disorder marked by deliberate production of physical or psychological symptoms to assume the sick role

154

Factitious Imposed on Another - Identify and Distinguish Symptom Presentation Gist

-Munchausen Syndrome by proxy

-Refers to adults who deliberately induce illness or pain into a child and then present the child for medical care

-Parent is usually the perpetrator and often denies knowing the origin of the child’s problem

-Child generally improves once separated from parent

-Most victims are younger than 4 years old, and most perpetrators are mothers

-A main motive = attention and sympathy the parent receives from others

-Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception

-The individual presents another individual (victim) to others as ill, impaired, or injured

-The deceptive behavior is evident even in the absence of obvious external rewards

-The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder

-Note: The perpetrator, not the victim, received this diagnosis

-Specify if there is a single episode or recurrent episodes of falsification of illness and/or induction of injury

-Used to be called “factitious disorder by proxy”

155

Major Depression - Identify and Distinguish Symptom Presentation Gist

-Begins puberty, peaks in late 20’s when often diagnosed

-2:1, women

-80% recover in a year

-Recurrence common

-Comorbidity
-Substance Use
-OCD
-Eating DO’s
-Borderline Personality DO

-5 or more in 2-week period, a change from previous functioning
-Depressed mood most of the day, nearly every day
-Diminished interest or pleasure in all or almost all activities
-Significant weight loss, or decrease or increase in appetite
-Insomnia or hypersomnia nearly every day
-Psychomotor agitation or retardation nearly every day
-Fatigue or loss of energy nearly every day
-Feelings of worthlessness or excessive guilt
-Diminished ability to think or concentrate nearly every day (can interfere with work, relationships, school work)
-Recurrent thoughts of death, recurrent suicidal ideation

-Significant distress

-A mental disorder often marked by multiple major depressive episodes

Many Varieties of Major Depressive DO
-Specify
-Mild
-Moderate
-Severe
-With psychotic features
-In partial remission
-In full remission
-Unspecified

-Specify
-W/ anxious distress
-W/ mixed features
-W/ melancholic features
-W/ atypical features
-W/ mood-congruent psychotic features
-W/ mood-incongruent psychotic features
-W/ catatonia (body becomes rigid and can’t move)
-W/ peripartum onset (during pregnancy)
-W/ seasonal pattern (fall/winter - when it gets bad)

156

Persistent Depression - Identify and Distinguish Symptom Presentation Gist

-Dysthymia

*-Depressed mood for most of day, for at least 2 years

-2 or more
-Poor appetite or overeating
-Insomnia or hypersomnia
-Low energy or fatigue
-Low self-esteem
-Poor concentration or difficulty making decisions
-Feelings of hopelessness

-Clinical distress

-A depressive disorder involving a chronic feeling of depression for at least 2 years

-Specify
-Early onset (< 21)
-Late onset

-Specify
-Mild
-Moderate
-Severe

-Comorbidity
-Substance use
-Personality disorders

157

Bipolar I - Identify and Distinguish Symptom Presentation Gist

-Full manic episodes alternate w/ major depressive episodes

-Most common form of Bipolar DO

-3:1 (more depressive episodes)

-1:1 gender

-High suicide risk

-A mental disorder marked by one or more manic episodes

Bipolar Disorder in General:
-A full manic episode
-For at least one week
-In extreme cases, symptoms are psychotic

-Less severe symptoms → Hypomanic episode

-Mania: five areas of functioning affected
-Emotional symptoms
-Active, powerful emotions
-Motivational symptoms
-Need for constant excitement, involvement, companionship
-Behavioral symptoms
-Very active –move quickly; talk loudly or rapidly
-Cognitive symptoms
-Show poor judgment or planning
-Physical symptoms
-High energy level –w/ little rest

158

Bipolar II - Identify and Distinguish Symptom Presentation Gist

-Hypomanic episodes alternate w/ major depressive episodes (not full-blown mania like in Bipolar I)

-A mental disorder marked by episodes of hypomania that alternate with episodes of major depression

Bipolar Disorder in General:
-A full manic episode
-For at least one week
-In extreme cases, symptoms are psychotic

-Less severe symptoms → Hypomanic episode

-Mania: five areas of functioning affected
-Emotional symptoms
-Active, powerful emotions
-Motivational symptoms
-Need for constant excitement, involvement, companionship
-Behavioral symptoms
-Very active –move quickly; talk loudly or rapidly
-Cognitive symptoms
-Show poor judgment or planning
-Physical symptoms
-High energy level –w/ little rest

159

Cyclothymic - Identify and Distinguish Symptom Presentation Gist

-Hypomanic episodes alternate w/ mild depressive symptoms
-For two or more years, with periods of normal mood
-May become Bipolar I or II disorder

-Rapid cycling
-4+ episodes in 1-year period

-Seasonal

-A mental disorder marked by fluctuating symptoms of hypomania and depression for at least 2 years

160

Bulimia - Identify and Distinguish Symptom Presentation Gist

-An eating disorder marked by binge eating, inappropriate methods to prevent weight gain, and self-evaluation greatly influenced by body shape and weight

-Recurrent binge eating
-Eating (w/in 2 hours) more than most would or could eat
-Lack of control over eating (what, or how much)

-Recurrent compensatory behaviors to prevent weight gain
-Purging Type
-Self-induced vomiting
-Laxatives
-Diuretics
-Non Purging Type
-Fasting
-Excessive exercise

-Occurs 1/week for 3 months

-Over Self-evaluation of body shape & weight

-Specify
-Mild: 1-3 / week
-Moderate: 4-7 / week
-Severe: 8-13 / week
-Extreme: 14 / week

-10 : 1, women

Bulimia Nervosa: Binges
-Common to experiment with
-Binge habits often carried out in secret
-Preceded by tension / powerlessness
-Massive amounts of food
-1,000 -10,000 calories
-Very rapidly àlittle chewing
-Sweet, high-calorie foods with soft texture
-Often very pleasurable
-Followed by
-Self-blame
-Guilt & depression
-Fear of weight gain

Bulimia Nervosa: Compensatory Behaviors
-Compensatory behaviors to “undo” calories
-(1) Vomiting
-Only prevents half the calories
-Affects ability to feel satiated
-Greater hunger & bingeing
-(2) Laxatives and Diuretics
-Mostly fails to reduce calories absorbed
-(1) More other-oriented Experience & Concerns
-(2) Less w/ amenorrhea
-(3) Lower frustration tolerance
-(4) Poorer coping skills

161

Anorexia - Identify and Distinguish Symptom Presentation Gist

-An eating disorder marked by refusal to maintain a minimum, normal body weight, intense fear of gaining weight, and disturbance in perception of body shape and weight

-Core Symptoms
-Refusal to maintain > 85% of normal weight
-Intense fear of becoming overweight
-Distorted view of weight & shape
-Specify
-Mild, Moderate, Severe, Extreme
-Specify
-Restricting Type
-Dieting, fasting, excessive exercise
-Binge-eating/Purging Type
-Vomiting & laxatives
-Bulimia vs. Anorexia Nervosa → difference is in weight, not in binging and purging

-Begins mid to late adolescence
-10 : 1, women

-Goal: become thin
-Motive: fear
-Giving in to desire to eat & becoming obese
-Losing control of body size & shape
-Preoccupied with food
-Reading about food & planning meals
-The “typical”case:
-Normal to slightly overweight woman dieting
-Stressful event
-Separation of parents
-Move away from home
-Experience of personal failure

-Most recover (somewhat) now
-~ 5% die
-Medical complications, suicide risk very high

-Associated with (comorbid with):
-Depression
-Anxiety
-Low self-esteem
-Insomnia or other sleep disturbances
-Substance abuse
-Obsessive-compulsive patterns
-Perfectionism
-Everything in body is going to wear down and create dysfunction

-Distorted body image thinking
-Low opinion of body shape
-Overestimate actual proportions
-Adjustable lens assessment technique
-Maladaptive attitudes & misperceptions
-“I must be perfect in every way”
-“I will be a better person if I deprive myself”
-“I can avoid guilt by not eating