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TULANE / Psychology / PSYC 3330 / What are the causes of adhd?

What are the causes of adhd?

What are the causes of adhd?


School: Tulane University
Department: Psychology
Course: Abnormal Psychology
Term: Fall 2018
Tags: abnormal psych, Abnormal psychology, and Psychology
Cost: 50
Name: Abnormal Psychology Exam 2 Study Guide
Description: This study guide covers our second unit, in which we discussed disorders in children and adolescents, disorders that cause somatic symptoms, eating disorders, and substance abuse disorders.
Uploaded: 10/26/2018
32 Pages 64 Views 8 Unlocks

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PSYC 3330 Exam 2 Study Guide | Sterkel 1

What are the causes of adhd?

Disorders Common Among Children & Adolescents Abnormal Psychology Chapter 17

Childhood and Adolescence 

● Emotional and behavioral problems are common in childhood and adolescence, but in addition, at least 20% of all children and adolescents in the US have a diagnosable psychological disorder.

● A particular concern among children is that of being bullied:

○ according to surveys, more than 25% of students are bullied frequently and more than 70% have been victims of bullying at least once

○ cyberbullying is on the rise

Anxiety Disorders in Children & Adolescents 

● Separation Anxiety Disorder - a developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidence by:

What are the causes of autism spectrum disorder?

○ three or more of the following:

■ recurrent excessive distress when separation from home or major

attachment figures occurs or is anticipated

■ persistent and excessive worry about losing, or about possible harm befalling, major attachment figures

■ persistent and excessive worry that an untoward event will lead to

separation from a major attachment (ex. getting lost or being kidnapped) ■ persistent reluctance or refusal to go to school or elsewhere because of fear of separation

■ persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings

What are the biological causes of intellectual disability?

We also discuss several other topics like Why is physical attractiveness so important?

■ persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home We also discuss several other topics like Why is voter participation low?

■ repeated nightmares involving the theme of separation

■ repeated complaints of physical symptoms (such as headaches, stomach aches, nausea or vomiting) when separation from major attachment

figures occurs or is anticipated

PSYC 3330 Exam 2 Study Guide | Sterkel 2

○ The duration of the disturbance is at least 4 weeks

○ the onset is before age 18 years

○ The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning

○ The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other psychotic disorders and, in adolescents and adults, is not better accounted for by panic disorder with agoraphobia If you want to learn more check out What are the three magnets of ebenezer howard's garden city concept?

● selective mutism - a disorder marked by failure to speak in certain social situations when speech is expected, despite ability to speak in other situations

● Treatments for Childhood Anxiety Disorders

○ play therapy - an approach to treating childhood disorders that helps children express their conflicts and feelings indirectly by drawing, playing with toys, and making up stories Don't forget about the age old question of What are the requirements for surface habitability

Depressive Disorders in Children & Adolescents 

● Childhood Major Depressive Disorder

○ 2% of children and 8% of adolescents experience depression Don't forget about the age old question of What are the 3 layers of the pericardium?

○ Depressed or irritable mood We also discuss several other topics like What are the different types of savings?

○ Difficulty sleeping or concentrating

○ Change in grades, getting into trouble at school, or refusing to go to school ○ Change in eating habits

○ Feeling angry or irritable

○ Mood swings

○ Feeling worthless or restless

○ Frequent sadness or crying

○ Withdrawing from friends and activities

○ Loss of energy

○ Low self-esteem

○ Thoughts of death or suicide (just being inquisitive usually isn’t enough) ● Disruptive Mood Dysregulation Disorder -> DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18

PSYC 3330 Exam 2 Study Guide | Sterkel 3

○ disruptive mood dysregulation disorder - a childhood disorder marked by severe recurrent temper outbursts and a persistent irritable or angry mood ○ Severe temper outbursts at least three times a week

○ Sad, irritable or angry mood almost every day

○ Reaction is bigger than expected

○ Child must be at least six years old

○ Symptoms begin before age 10

○ Symptoms are present for at least a year

○ Child has trouble functioning in more than one place (ex. home, school, and/or with friends)

Oppositional Defiant Disorder and Conduct Disorder ● oppositional defiant disorder - a disorder in which children are repeatedly argumentative, defiant, angry, irritable, and perhaps vindictive

○ a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling:

■ Angry/Irritable Mood

● often loses temper

● is often too touchy or easily annoyed

● Is often angry and resentful

■ Argumentative/Defiant Behavior

● often argues with authority figures or, for children and

adolescents, with adults.

● Often actively defies or refuses to comply with requests from

authority figures or with rules

● Often deliberately annoys others

● Often blames others for his or her mistakes or misbehavior

■ Vindictiveness

● Has been spiteful or vindictive at least twice within the past 6


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■ The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (ex. family, peer group, work colleagues), or it impacts negatively on social, educational,

oppositional, or other important areas of functioning

■ The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, if the criteria are not met for disruptive mood dysregulation disorder

● conduct disorder - a disorder in which children repeatedly violate the basic rights of others and display significant aggression (several types of them have been identified) ○ Conduct Disorder is more physical

○ Four Categories of Conduct Problems:

■ Nondestructive vs. Destructive, Covert vs. Overt

● non destructive covert: status violations (runaway, substance use, breaks rules)

● non destructive overt: oppositional behavior

● destructive covert: property violations

● destructive overt: aggression

○ A repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories:

■ Aggression to People and Animals

● often bullies, threatens, or intimidates others,

● often initiates physical fights

● has used a weapon that can cause serious physical harm to others (ex. bat, brick, broken bottle, knife, gun)

● has been physically cruel to people

● has been physically cruel to animals

● has stolen while confronting a victim (ex. mugging, purse

snatching, extortion, armed robbery)

● has forced someone into sexual activity

■ Destruction of Property

PSYC 3330 Exam 2 Study Guide | Sterkel 5

● has deliberately engaged in fire setting with the intention of causing serious damage

● has deliberately destroyed others’ property (other than by fire) ■ Deceitfulness or Theft

● has broken into someone else’s house, building or car

● often lies to obtain goods or favors or to avoid obligations

(ie “cons” others)

● has stolen items of nontrivial value without confronting a victim (ex. shoplifting, but without breaking and entering; forgery)

■ Serious Violations of Rules

● often stays out at night despite parental prohibitions, beginning before age 13 years

● has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without

returning for a lengthy period

● if often truant from school, beginning before age 13 years

■ The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning

■ If the individual is 18 years or older, criteria are not met for antisocial personality disorder

■ Specifiers:

● lack of remorse or guilt

● callous--lack of empathy

● unconcerned about performance

● shallow or deficient affect

○ Biological Causes

■ Children with disruptive behavior disorders inherit decreased baseline autonomic nervous system activity--need higher levels of stimulation to achieve optimum arousal

■ Studies show that the prefrontal cortex is involved with reactive aggression (response to a trigger)

● Adults with damage to the PFC show impairments in social

awareness and decision-making

PSYC 3330 Exam 2 Study Guide | Sterkel 6

● Early damage to this religion is linked to dysfunctions in social


● How Do Clinicians Treat Conduct Disorder?

○ parent management training - a treatment approach for conduct disorder in which therapists combine family and cognitive-behavioral interventions to help improve family functioning and help parents deal with their children more effectively

■ parent-child interaction therapy

■ multisystemic therapy

■ problem-solving skills training

■ the Coping Power Program

○ Child Focused Treatments

○ Residential Treatment -> foster care

■ some individuals with this disorder have been institutionalized in

juvenile training centers

○ Prevention -> a number of prevention programs have also been developed Elimination Disorders 

● Enuresis (involuntary urination) -> largely behavioral

○ more often than not, this is a precursor to abuse (bc it’s frustrating for parents when they really can’t properly potty train their kid)

○ DSM: twice a week for more than three months

○ Cannot diagnose earlier than 5

○ Gender differences in subtypes (boys wet themselves more often at night, girls more often during the day)

○ Impacts self esteem, limitations on social life, and parental reactions ○ Treatment

■ bell and pad (pad goes underneath sheet, bell goes off if any wetness touches the pad) can also just regularly pull their kids out of bed

throughout the night to go to the bathroom without the bell & pad

○ meet DSM criteria if you wet yourself two times a week for at least three months

● Encopresis (involuntary defecation)

PSYC 3330 Exam 2 Study Guide | Sterkel 7

○ One event a month for three months (lot less frequent but a bigger deal) ○ At least 4 years old

○ specifier: With and without constipation and overflow incontinence ■ maybe the kid doesn’t want to poop at school or somewhere public or whatever and they hold it in so long which means the stuff closest to the butthole gets really hard which causes both constipation and painful

defecation, and they hold it in so long that they have an accident

● this phenomenon is called megacolon

■ in the kid’s mind, pooping is painful so i don’t wanna do it ever

○ Can be caused by toilet training, stress, and related pathology (anxiety) Neurodevelopmental Disorders 

● Neurodevelopmental disorders are a group of disabilities in the functioning of the brain that emerge at birth or during very early childhood and affect the person’s behavior, memory, concentration, and/or ability to learn

○ they often have a significant impact throughout the person’s life


○ A persistent pattern of inattention and/or hyperactivity-impulsivity ○ that interferes with functioning or development

○ and has symptoms presenting in two or more settings (ex. at home, school, or work; with friends or relatives; in other activities)

○ several symptoms must have been present before age 12 years

○ Presentations of ADHD

■ Combined

■ Inattentive

■ Hyperactive/impulsive

○ All three core features are present and ADHD is diagnosed when more than 6 symptoms of hyperactivity/impulsivity and more than 6 symptoms of

inattention that have been observed for over six months

○ Diagnosed if greater than 6 symptoms of inattention but less than 6 symptoms of hyperactivity/impulsivity, have persisted for over 6 months

○ Diagnosed if greater than 6 symptoms of hyperactivity/impulsivity but less than 6 symptoms of inattention have persisted for over 6 months

PSYC 3330 Exam 2 Study Guide | Sterkel 8

○ Symptoms of ADHD:

■ Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities

■ Often has trouble holding attention on tasks or play activities ■ Often does not seem to listen when spoken to directly

■ Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (ex. loses focus, easily sidetracked)

■ Often has trouble organizing tasks and activities

■ Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time, such as homework

■ Often loses things necessary for tasks and activities (ex. school materials, tools, wallet, keys, paperwork, eyeglasses, cell phone, etc.) ■ If often easily distracted

■ Is often forgetful in daily activities

■ Often fidgets with or taps hands or feet, or squirms in seat

■ Often leaves seat in situations when remaining seated is expected ■ Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)

■ Often unable to play or take part in leisure activities quietly ■ Is often “on the go”, acting as if “driven by a motor”

■ Often talks excessively

■ Often blurts out an answer before a question has been completed ■ Often has trouble waiting his/her turn

■ Often interrupts or intrudes on others (ex. butts into conversations or games)

○ What are the causes of ADHD?

■ Many of the attention difficulties seen in ADHD may be associated with a dysfunctional attention brain circuit whose structures display problematic interconnectivity

○ Biological Underpinnings

■ Genetics and Hereditary

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● Family, twin (*.8-.98 in mono. twins) and adoption studies

underline genetic transmission

● Considered one of the most genetically influenced mental


● No specific gene pinpointed

■ Structural Evidence

● Smaller volumes and atypical functioning of the cerebellum

● Smaller frontal lobes

● Thinning cortex

● Structural abnormalities throughout basal ganglia

● Developmental lag in cortical gray matter

■ Functional or Process-wise Evidence

● Fronto-striatal network is underrecruited in ADHD during

response inhibition or suppression of tendencies

○ Less frontal lobe activation in people with ADHD (you

need this to inhibit impulse)

○ Also less activation on the caudate region of the striatum

○ Similar findings during attention tasks

● PET imaging studies show adults with ADHD have been done

with working memory

○ less activation in frontal, temporal, and occipital lobes

■ How is ADHD treated?

● methylphenidate - a stimulant drug, known better by the trade

names Ritalin or Concerta, commonly used to treat ADHD

● Cognitive-Behavioral Therapy and Combination Therapies

● Autism Spectrum Disorder - a developmental disorder marked by extreme unresponsiveness to others, severe communication deficits, and highly repetitive and rigid behaviors, interests, and activities

○ What are the causes of autism spectrum disorder?

■ The leading explanations point to cognitive deficits, such as failure to develop a theory of mind and joint attention skills, and biological

abnormalities, such as one or more dysfunctional brain circuits

PSYC 3330 Exam 2 Study Guide | Sterkel 10

○ Theory of mind - the ability to attribute mental states, beliefs, intents, desires, knowledge, etc.--to oneself and others and to understand that others have beliefs, desires, intentions, and perspectives that are different from one’s own

○ joint attention - sharing focus with other people on items or events in one’s immediate surroundings, whether through shared eye-gazing, pointing, referencing, or other verbal or nonverbal indications that one is paying attention to the same object

■ Social -> persistent deficits in social communication and social interaction across multiple contexts

● inappropriate laughing or giggling

● may not want cuddling

● sustained unusual or repetitive play; uneven physical or verbal skills ● may avoid eye contact

● may prefer to be alone

● difficulty in interacting with others

○ deficits in social-emotional reciprocity, ranging from abnormal social approach and failure of normal back-and-forth

conversation; to reduced sharing of interests (or an uptick of

too much of one thing), emotions, or affect; to failure to initiate or respond to social interactions

○ deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of

gestures; to a total lack of facial expressions and nonverbal


○ deficits in developing, maintaining, and understanding

relationships, ranging, for example, from difficulties adjusting

behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers (usually harder on the parents than it is on the kid)

■ Communication

● difficulty in expressing needs; may use gestures

PSYC 3330 Exam 2 Study Guide | Sterkel 11

● echos words or phrases

● Inappropriate response or no response to sound

■ Behavior -> restricted, repetitive patterns of behavior, interests, or activities ● no real fear of dangers

● apparent insensitivity to pain

● inappropriate attachments to objects

● insistence on sameness

● spins objects or oneself

● Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:

○ Insistence on sameness, inflexible adherence to routines, or

ritualized patterns or verbal nonverbal behavior (ex. extreme

distress at small changes, difficulties with transitions, rigid

thinking patterns, greeting rituals, need to take same route or eat

the same food every day)

○ Highly restricted, fixated interests that are abnormal in intensity or focus (ex. strong attachment to or preoccupation with unusual

objects, excessively circumscribed or perseverative interest)

○ Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (ex. apparent indifference to

pain/temperature, adverse response to specific sounds or

textures, excessively smelling or touching of objects, visual

fascination with lights or movement)

■ Symptoms must be present in the early developmental period

■ Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

■ These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay

■ Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level

○ Biological Perspective

PSYC 3330 Exam 2 Study Guide | Sterkel 12

■ Genetics

● Concordance Rates

○ Monozygotic: 60-90% (twins that came from the same egg)

○ Dizygotic: <10% (fraternal twins)

○ Siblings: 4-8%

■ Structural Evidence

● Evidence of greater cortical white matter

● Atypical patterns of amygdala development--enlargement in childhood and decreased neurons in adulthood (amygdala is big for eye contact) ● Elevated levels of serotonin (in cerebellum)

■ Prenatal Factors

● Authoritative meta-analysis by Gardner, Spiegelman, and Buka (2009) based on 40 studies found that autism is linked with:

○ Gestational diabetes

○ Maternal bleeding during pregnancy

○ Mother’s use of medication

● Age matters

○ Chances are 27% greater is mother is a 30-34 year old versus mothers 25-29 years old

○ 106% greater if mother is over 40 versus mothers under 30

■ Family Influence

● “Refrigerator” mothers

● In 1943, Leo Kanner identified autism as a distinct neurological condition ● Small, biased sampling of children

● Incorrect assumption that autistic children were more likely born to highly intellectual parents who were white and middle or upper class ● Cold, intellectual nature = “refrigerator mother” (this does not cause autism)

● Focus on the dysfunctional mother-child relationship helped successive psychiatrics embrace a psychological cause for the disorder

○ How Do Clinicians and Educators Treat Autism Spectrum Disorder? ■ Although no treatment totally reverses the autistic pattern, significant help is available in the following forms:

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● Cognitive-Behavioral Therapy

● Communication Training

○ augmentative communication system - a method for

enhancing the communication skills of people with

autism spectrum disorder, intellectual disability, or

cerebral palsy by teaching them to point to pictures,

symbols, letters, or words on a communication board or


● Parent Training

● Community Integration

● Intellectual Disability (ID) - a disorder marked by intellectual functioning and adaptive behavioral ability that are well below average; previously called mental retardation ○ Cognitive Abilities -> Reasoning

■ reasoning

■ problem-solving

■ planning

■ abstract thinking

■ judgement

■ academic learning

■ learning from experience

■ practical understanding

○ Adaptive Skills -> applied skills

■ sociocultural standards for personal independence

■ sociocultural standards for social responsibility

■ Activities of daily life

● Communication

● Social Participation

● Independent Living

○ Mild ID vs. Moderate, Severe, Profound IDs

■ Mild ID - a level of intellectual disability (IQ 50-70) at which people can benefit from education and can support themselves as adults (by far the most common)

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■ moderate ID - a level of intellectual disability (IQ 35-49) at which people can learn to care for themselves and can benefit from vocational training ■ severe ID - a level of intellectual disability (IQ 20-34) at which people require careful supervision and can learn to perform basic work in structured and sheltered settings

■ profound ID - a level of intellectual disability (IQ below 20) at which people need a very structured environment with close supervision ○ What are the biological causes of intellectual disability?

■ Mild ID has often been linked to environmental factors such as unstimulating environments during a child’s early years, inadequate parent-child interactions, and insufficient learning experiences

■ Moderate, severe, and profound IDs are caused primarily by biological factors, although people who function at these levels also are affected enormously by their family and social environment

■ Chromosomal Causes

● Down syndrome - a form of intellectual disability caused by an abnormality in the 21st chromosome

■ Metabolic Causes

■ Prenatal and Birth-Related Causes

● fetal alcohol syndrome - a group of problems in a child, including lower intellectual functioning, low birth weight, and

irregularities in the hands and face, that result from excessive

alcohol intake by the mother during pregnancy

■ Childhood Problems (diseases and injuries)

○ Interventions for people with intellectual disability

■ What is the proper residence?

● state school - a state-supported institution for people with

intellectual disability (until recent decades, parents of kids with ID would send them to live in these public institutions)

● Today’s intervention programs for people with intellectual

disability typically emphasize the importance of a comfortable

and stimulating residence--either the family home, a small

PSYC 3330 Exam 2 Study Guide | Sterkel 15

institution or group home, or a semi-independent

residence--that follows the principles of normalization.

● normalization - the principle that institutions and community

residences for people with intellectual disability should provide

living conditions and opportunities similar to those enjoyed by

the rest of society

■ Other important interventions include proper education, therapy for psychological problems, and programs offering training in socializing

sex, marriage, parenting, and occupational skills

■ Which educational programs work best?

● One of the most intense debates in the field of education centers

on whether people with intellectual disability profit more from

special classes or from mainstreaming; research has not

consistently favored one approach over the other.

● special education - an approach to educating children with

intellectual disability in which they are grouped together and

given a separate, specially designed education

● mainstreaming aka inclusion: the placement of children with

intellectual disability in regular school classes

■ When is therapy needed?

■ How can opportunities for personal, social, and occupational growth be increased?

Disorders Featuring Somatic Symptoms Abnormal Psychology Chapter 10

Factitious Disorder - a disorder in which a person feigns or induces physical symptoms, typically for the purpose of assuming the role of a sick person ● Diagnostic Checklist

○ Factitious Disorder Imposed on Self

1. False creation of physical psychological symptoms, or deceptive

production of injury or disease, even without external rewards for such ailments

2. Presentation of oneself as ill, damaged, or hurt

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○ Factitious Disorder Imposed on Another (usually parent on child)

1. False creation of physical or physiological symptoms, or deceptive

production of injury or disease, in another person, even without external rewards for such ailments

2. Presentation of another person (victim) as ill, damaged, or hurt

Conversion Disorder and Somatic Symptom Disorder ● Conversion Disorder - a disorder in which a person’s bodily symptoms affect his or her voluntary motor and sensory functions, but the symptoms are inconsistent with known medical diseases

○ Diagnosticians are sometimes able to distinguish conversion disorder from a “true” medical problem by observing oddities in the patient’s medical picture ○ Diagnostic Checklist

1. Presence of at least one symptom or deficit that affects voluntary or sensory function

2. Symptoms are found to be inconsistent with known neurological or

medical disease

3. Significant distress or impairment

● Somatic Symptom Disorder - a disorder in which people become excessively distressed, concerned, and anxious about bodily symptoms they are experiencing, and their lives are disproportionately disrupted by the symptoms

○ Diagnostic Checklist

1. Person experiences at least one upsetting or repeatedly disruptive

physical (somatic) symptom

2. Person experiences an unreasonable number of thoughts, feelings

a. Repeated, excessive thoughts about their seriousness

b. Continual high anxiety about their nature or health implications

c. Disproportionate amounts of time and energy spent on the

symptoms or their health implications

3. Physical symptoms usually continue for more than 6 months

○ Somatization Pattern

○ Predominant Pain Pattern

● What Causes Conversion and Somatic Symptom Disorders?

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○ Psychodynamic View -> Freud proposed that the disorders represent a conversion of underlying emotional conflicts into physical symptoms

■ primary gain - in psychodynamic theory, the gain people derive when their somatic symptoms keep their internal conflicts out of awareness

■ secondary gain - in psychodynamic theory, the gain people derive when their somatic symptoms elicit kindness from others or provide an

excuse to avoid unpleasant activities

○ Cognitive-Behavioral View -> propose that the physical symptoms of these disorders bring rewards to the sufferer, and such reinforcement helps maintain the symptoms

■ some cognitive-behavioral theorists further propose that the disorders are forms of communication and that people express their emotions

through their physical symptoms

○ Multicultural View

● How Are Conversion and Somatic Symptom Disorders Treated?

○ Treatments include insight, exposure, and drug therapies and may include techniques such as education, reinforcement, or cognitive restructuring Illness Anxiety Disorder - a disorder in which people are chronically anxious about and preoccupied with the notion that they have or are developing a serious medical illness, despite the absence of somatic symptoms

● Diagnostic Checklist

1. Person is preoccupied with thoughts about having or getting a significant illness. In reality, person has no or, at most, mild somatic symptoms

2. Person has easily triggered high anxiety about health

3. Person displays unduly high number of health-related behaviors (ex. keeps focusing on body) or dysfunctional health-avoidance behaviors (ex. avoids doctors)

4. Person’s concerns continue to some degree for at least 6 months

● Theorists explain this disorder much as they do anxiety disorders

● Treatment includes drug and cognitive-behavioral approaches originally developed for obsessive-compulsive disorder

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Psychophysiological Disorders: Psychological Factors Affecting Other Medical Conditions ● Psychological disorders - disorders in which biological, psychological, and sociocultural factors interact to cause or worsen a physical illness; aks psychological factors affecting other medical conditions

○ Diagnostic Checklist

1. The presence of a medical condition

2. Psychological factors negatively affect the medical condition by:

a. Affecting the course of the medical condition

b. Providing obstacles for the treatment of the medical condition

c. Posing new health risks

d. Triggering or worsening the medical condition

● Traditional Psychophysiological Disorders

○ ulcer - a lesion that forms in the wall of the stomach or of the duodenum ○ asthma - a disease marked by narrowing of trachea and bronchi, resulting in shortness of breath, wheezing, coughing, and a choking sensation

○ insomnia - difficulty falling or staying asleep

○ muscle contraction headache - a headache caused by a narrowing of muscles surrounding the skull; aka tension headache

○ migraine headache - a very severe headache that occurs on one side of the head, often preceded by a warning sensation and sometimes accompanied by dizziness, nausea, or vomiting

○ hypertension - chronic high blood pressure

○ coronary heart disease - illness of the heart caused by a blockage in the coronary arteries

○ What Factors Contribute to Psychophysiological Disorders?

■ Biological Factors -> defects in the autonomic nervous system or

particular organs

■ Psychological Factors -> particular needs, attitudes, or personality styles ● Type A personality - a personality pattern of hostility, cynicism,

drivenness, impatience, competitiveness, and ambition

● Type B personality - a personality pattern in which a person is

more relaxed, less aggressive, and less concerned about time

○ perfect example: Crush from Finding Nemo/Dory

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■ Sociocultural Factors: The Multicultural Perspective

● aversive social conditions; cultural pressures

● New Psychophysiological Disorders

○ Are Physical Illnesses Related to Stress?

■ Yes, many physical illnesses have been provenly linked to stress

○ Psychoneuroimmunology - the study of the connections between stress, the body’s immune system, and illness

■ stress can slow lymphocyte activity, thereby interfering with the

immune system’s ability to protect against illness during times of stress ■ immune system - the body’s network of activities and cells that identify and destroy antigens and cancer cells

■ antigen - a foreign invader of the body, such as a bacterium or virus ■ lymphocytes - white blood cells that circulate through the lymph system and bloodstream, helping the body identify and destroy antigens and

cancer cells

■ Biochemical Activity -> norepinephrine and cortisol activity

■ Behavioral Changes

■ Personality Style

■ Social Support

Psychological Treatments for Physical Disorders 

● behavioral medicine - a field that combines psychological and physical interventions to treat or prevent medical problems

● Relaxation Training - a treatment procedure that teaches clients to relax at will so they can calm themselves in stressful situations

● Biofeedback - a technique in which a client is given information about physiological reactions as they can occur and learns to control the reactions voluntarily ○ electromyography (EMG) - a device that provides feedback about the level of muscular tension in the body

● Meditation; Hypnosis; Cognitive-Behavior Interventions; Support Groups ● Emotion Expression therapy - therapies that heighten awareness and expression of emotions and needs

● Combination Approaches

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Eating Disorders 

Abnormal Psychology Chapter 11

● Rates of eating disorders have increased dramatically as thinness has become a national obsession. Two leading disorders in this category, anorexia nervosa and bulimia nervosa, share many similarities, as well as key differences. A third eating disorder, binge-eating disorder, also seems to be on the rise.

● Anorexia Nervosa - a disorder marked by the pursuit of extreme thinness and by extreme weight loss

● Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health ● Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight

● Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the low current body weight

● Restricting Type -> during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (ie. self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

● Binge-eating/Purging Type -> during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (ie. self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

● Can be in partial or full remission

Bulimia Nervosa (binge-purge syndrome) - a disorder marked by frequent eating binges followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight ● Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following

○ Eating, in a discrete period of time (eg. within any 2-hour period) an amount of food that is definitely larger than what most individuals would eat in a similar period of time under circumstances

○ A sense of lack of control over eating during the episode (eg. a feeling that one cannot stop eating or control what or how much one is eating)

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● Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise

● The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months

● Self-evaluation is unduly influenced by body shape and weight

● The disturbance does not occur exclusively during episodes of anorexia nervosa ● What do anorexia and bulimia have in common?

○ Follows a period of dieting

○ People are afraid of being obese

○ Driven to become thin

○ Preoccupied with food, weight, appearance

○ Disturbed attitudes towards eating

○ **Bulimics tend to want to please others more, be attractive to others, and have intimate relationships. They tend to be more sexually experienced. They also tend to experience more mood swings.

Binge-Eating Disorder - a disorder marked by frequent binges without extreme compensatory acts

● People with binge-eating disorder have frequent binge eating episodes but do not display inappropriate compensatory behaviors. Although most overweight people do not have binge-eating disorder, half of those with binge-eating disorder become overweight. Between 2-7% of the population have binge-eating disorder. Unlike anorexia nervosa and bulimia nervosa, this disorder is somewhat more evenly distributed among males and females.

○ The binge-eating episodes are associated with three or more of the following: ■ Eating more rapidly than normal

■ Eating until feeling uncomfortably full

■ Eating large amounts of food when not feeling physically hungry

■ Eating alone because of feeling embarassed by how much one is eating ■ Feeling disgusted with oneself, depressed, or very guilty afterward

○ Marked distress regarding binge eating is present

○ The binge eating occurs, on average, at least once a week for 3 months

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○ The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

● Comorbidity is a thing, particularly with depression and self harm

What Causes Eating Disorders? 

● multidimensional risk perspective - a theory that identifies several kinds of risk factors that are thought to combine to help cause a disorder; the more factors present, the greater the risk of developing the disorder

● Psychodynamic Factors -> ego deficiencies

○ Ineffective vs. Effective Parenting

○ External Guides -> no internal development

● Cognitive-Behavioral Factors

○ Improper label of needs and sensations

■ Cognitive Distortions

○ Lack of control over life

○ Family Factors

■ Emphasis on thinness, physical appearance, and dieting

■ Minuchin and enmeshment

● enmeshment -> being really really intertwined in your family

and its dynamics (can be a good and a bad thing)

● Depression

● Biological Factors

○ hypothalamus - a part of the brain that helps regulate various bodily functions, including eating and hunger

■ lateral hypothalamus (LH) - a brain region that produces hunger when activated

■ ventromedial hypothalamus (VMH) - a brain region that depresses

hunger when activated

○ weight set point - the weight level that a person is predisposed to maintain, controlled in part by the hypothalamus

● Societal Pressures

● Family Environment

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○ enmeshed family pattern - a family system in which members are over-involved with each other’s affairs and overly concerned about each other’s welfare ● Multicultural Factors: Racial and Ethnic Differences

○ African American adolescents versus non-hispanic white American women ■ Research was more polarizing before, but some recent work is not

○ Eating Disorders in Japan -> pretty rampant

■ “Japan has a rich visual culture, and one that embeds thinness as

aspirational at the centre of many of its storytelling tropes. Hansen

identified stories that code the act of not eating in a positive, even heroic light. Eating disorders are often embedded symbolically.”

● Multicultural Factors: Gender Differences

○ requirements or pressures of a job or sport

○ Body image -> muscle dysmorphia

How Are Eating Disorders Treated? 

● Treatments for Anorexia Nervosa

○ The first step in treating anorexia nervosa is to increase calorie intake and quickly restore the person’s weight, a part of treatment called nutritional rehabilitation.

■ How Are Proper Weight and Normal Eating Restored?

● motivational interviewing - a treatment intervention that uses a

mixture of empathy and inquiring review to help motivate clients

to recognize they have a serious psychological problem and

commit to making constructive choices and behavior changes

○ The second step is to deal with the underlying psychological and family problems, often using a combination of education, cognitive-behavioral approaches, and family therapy.

■ How Are Lasting Changes Achieved?

● Cognitive-Behavioral Therapy

● Changing Family Interactions

■ What is the Aftermath of Anorexia Nervosa?

○ As many as 75% of people who are successfully treated for anorexia nervosa continue to show full or partial improvements years later. However, some of

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them relapse along the way, many continue to worry about their weight and appearance, and half continue to have some emotional problems.

● Treatments for Bulimia Nervosa

○ Bulimia treatments focus first on stopping the binge-purge pattern (nutritional rehabilitation) and then on addressing the underlying causes of the disorder. Often several treatment strategies are combined, including education,

psychotherapy (particularly CBT), and, in some cases, antidepressant


○ Cognitive-Behavioral Therapy

○ Other Forms of Psychopathology

○ Antidepressant Medications

○ What Is the Aftermath of Bulimia Nervosa?

■ As many as 75% of those who receive treatment eventually improve

either fully or partially. While relapse can be a problem and may be

precipitated by a new stress, treatment leads to lasting improvements in psychological and social functioning for many people.

● Treatments for Binge-Eating Disorder

○ Similar treatments are used to help binge-eating disorder. These individuals, however, may also require interventions to address their excessive weight. Prevention of Eating Disorders: Wave of the Future 

● Prevention programs are becoming more common and more effective in addressing anorexia nervosa and bulimia nervosa.

● Biological Factors (see book for more)

○ Hypothalamus and GLP-1

Substance Abuse and Addictive Disorders Abnormal Psychology Chapter 12

● The misuse of substances (or drugs) may lead to temporary changes in behavior, emotions, or thoughts; this cluster of changes is called intoxication.

○ substance intoxication - a cluster of temporary undesirable behavioral or psychological changes that develop during or shortly after the ingestion of a substance

● Chronic and excessive use can lead to substance use disorders.

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○ substance use disorder - a pattern of long-term maladaptive behaviors and reactions brought about by repeated use of a substance

● Many people with such disorders also develop a tolerance for the substance in question and/or have unpleasant withdrawal symptoms when they abstain from it. ○ tolerance - the brain and body’s need for ever-larger doses of a drug to produce earlier effects

○ withdrawal - unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking it or reduce the dosage


● 2 of the following 11 symptoms within 12 months

○ Consuming more alcohol or other substance than originally planned ○ Worrying about stopping or consistently failed efforts to control one’s use ○ Spending a large amount of time using drugs/alcohol, or doing whatever is needed to obtain them

○ Use of the substance results in failure to “fulfill major role obligations” such as at home, work, or school

○ “Craving” the substance

○ Continuing the use of a substance despite health problems caused or worsened by it. This can be in the domain of mental health (psychological problems may include depressed mood, sleep disturbance, or “blackouts”) or physical health.

○ Continuing the use of a substance despite its having negative effects in relationships with others (for example, using even though it leads to fights or despite people’s objecting to it).

○ Repeated use of the substance in a dangerous situation (for example, when having to operate heavy machinery, when driving a car)

○ Giving up or reducing activities in a person’s life because of the drug/alcohol use

○ Building up a tolerance to the alcohol or drug; Tolerance is defined by the DSM-5 as “either needing to use noticeably larger amounts over time to get the desired effect or nothing less of an effect over time after repeated use of the same amount”

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Depressants - substances that slow the activity of the central nervous system ● Alcohol - any beverage containing ethyl alcohol, including beer, wine, and liquor ○ Alcohol intoxication occurs when the concentration of alcohol in the bloodstream reached 0.09%

○ Among other actions, alcohol increases the activity of the neurotransmitter GABA at key sites in the brain

○ Alcohol Use Disorder

■ Clinical Picture

■ Tolerance and Withdrawal

● delirium tremens (DTs) - a dramatic withdrawal reaction that

some people dependent on alcohol have; it consists of confusion,

clouded consciousness, and terrifying visual hallucinations

○ What Are the Personal and Social Impacts of Alcoholism?

■ Korsakoff’s syndrome - an alcohol-related disorder marked buy extreme confusion, memory impairment, and other neurological symptoms

■ fetal alcohol syndrome - a cluster of problems in a child, including low birth weight, irregularities in the head and face, and intellectual deficits, caused by excessive alcohol intake by the mother during pregnancy

■ Biological Mechanisms

● Neurotransmitters

○ Increases GABA

○ Inhibits Glutamate

○ Increases Dopamine

○ Structural Functioning

■ Cerebral cortex

■ Cerebellum

■ Hypothalamus and pituitary

■ Medulla -> area of the brain that handles

automatic functions like breathing and body


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● alcohol induces sleeping and decreases

heart rate and body temperature

■ Death by alcohol poisoning occur the most in the age group 45-54

followed by 35-44 and 55-64 (possibly has to do with tolerance)

■ Most people who die of alcohol poisoning are men (76%)

■ The race that dies of alcohol poisoning the most frequently is white non-hispanic far more than every other racial group

■ Louisiana actually has fewer alcohol poisoning deaths than most states ● Sedative-Hypnotic Drugs - drugs used in low doses to reduce anxiety and in higher doses to help people sleep; also called anxiolytic drugs

○ These drugs also increase the activity of GABA

○ barbiturates - addictive sedative-hypnotic drugs that reduce anxiety and help people sleep

○ benzodiazepines - the most common group of antianxiety drugs; includes xanax ● Opioids - opium, drugs derived from opium, and similar synesthetic drugs ○ opium - a highly addictive substance made from the sap of the opium poppy ○ morphine - a highly addictive substance derived from opium that is particularly effective in relieving pain

○ heroin - one of the most addictive substances derived from opium

○ All of these reduce tension and pain and cause other reactions

○ Opioids operate by binding to neurons that ordinarily receive endorphins. ○ endorphins - neurotransmitters that help relieve pain and reduce emotional tension; they are sometimes referred to as the body’s own opioids

○ Method

■ smoked, inhaled, snorted, swallowed, skin-popped

○ Mechanism

■ mimicking of endorphins

■ Overdose closes respiratory center of the brain, paralyzing breathing Stimulants - substances that increase the activity of the central nervous system ● Cocaine - an addictive stimulant from the coca plant; it is the most powerful natural stimulant known

○ Ingesting Cocaine

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■ freebase - a technique for ingesting cocaine in which the pure cocaine basic alkaloid is chemically separated from processed cocaine, vaporized by heat from a flame, and inhaled with a pipe

■ crack - a powerful, ready-to-smoke freebase cocaine

○ Method -> snorted, free based (smoked)

○ Mechanism

■ Increase of dopamine, norepinephrine, and serotonin

■ Stimulates, then depresses nervous system

● Amphetamines - stimulant drugs that are manufactured in a laboratory ○ methamphetamine - a powerful amphetamine drug that has surged in popularity in recent years, posing major health and law enforcement problems ● Abnormal use of cocaine and amphetamines Stimulant Use Disorder ● Stimulants produce their effects by increasing the activity of dopamine, norepinephrine, and serotonin in the brain.

● Caffeine - the world’s most widely used stimulant, most often consumed in coffee ● Type -> Meth/amphetamine, dextroamphetamine

● Method -> Swallowed, injected

● Mechanism

○ Increase of dopamine, norepinephrine, and serotonin

○ Stimulates nervous system

● True/False

○ Confined mostly to the west and southwestern united states: false (not confined but the origins are there)

○ Marijuana and alcohol are commonly listed as additional drugs of abuse among methamphetamine treatment admissions: true

○ Methamphetamine abuse and addiction can cause delusions, paranoia, and hallucinations: true

Hallucinogens, Cannabis, and Combinations of Substances ● Hallucinogens - substances that cause powerful changes primarily in sensory perception; also called psychedelics. People’s perceptions are intensified and they may have illusions and hallucinations.

● LSD )lysergic acid diethylamide) - a hallucinogenic drug derived from ergot alkaloids

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○ causes such effects by disturbing the release of serotonin

● Cannabis - cause a mixture of hallucinogenic, depressant, and stimulant effects ○ hashish is the most powerful form but most people just go with regular weed ○ marijuana - one of the cannabis drugs, derived from the buds, leaves, and flowering tops of the hemp plant

○ tetrahydrocannabinol (THC) - the main active ingredient of cannabis substances ○ Mechanism -> THC indirectly increases dopamine release and produced psychotropic effects (in terms of addiction and long-term effects it’s way better than all the other drugs we’re discussing here)

○ Marijuana is way more powerful today than it was in years past.

○ It can cause intoxication, and regular use can lead to cannabis use disorder ○ In terms of addiction and long-term effects it’s way better than all the other drugs we’re discussing here

○ Uses for pain and increasing appetite

● Combinations of Substances

○ Many people take more than one drug at a time, and the drugs interact. The use of two or more drugs at the same time--polysubstance use--has become increasingly common.

○ cross tolerance - tolerance for a substance one has not taken before as a result of using another substance similar to it

What Causes Substance Use Disorders? 

● Several explanations for substance use disorders have been put forward. Together they are beginning to shed light on the disorders.

● Sociocultural Views

○ According to sociocultural theorists, the people most likely to develop these disorders are those living in socioeconomic conditions that generate stress or whose families value or tolerate drug use.

● Psychodynamic Views

○ In the psychodynamic view, people who develop substance use disorders have excessive dependency needs traceable to the early stages of life. Some

psychodynamic theorists also believe that certain people have a substance abuse personality that makes them prone to drug use.

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○ Dependency needs

■ Personality links: antisocial, impulsive, novelty-seeking, risk-taking, depressive

● Cognitive-Behavioral Views

○ In the leading cognitive-behavioral views, drug use is seen as being reinforced initially because it reduces tensions, and such reductions lead to an expectancy that drugs will be comforting and helpful

● Biological Views

○ Genetic Predisposition

■ The biological explanations are supported by twin, adoptee, and genetic studies, suggesting that people may inherit a predisposition to the


○ Neurotransmitters

■ Researchers have also learned that drug tolerance and withdrawal

symptoms may be caused by cutbacks in the brain’s production of

particular neurotransmitters during excessive and chronic drug use.

■ Alcohol and GABA

■ Opioids and endorphins

■ Cocaine/amphetamines and dopamine

■ Cannabis and anandamide

○ The Brain’s Reward Circuit

■ Biological studies suggest that many, perhaps all, drugs may ultimately lead to increased dopamine activity in the brain’s reward circuit.

■ reward circuit - a dopamine-rich circuit in the brain that produces

feelings of pleasure when activated

● The Developmental Psychopathology View

○ Developmental psychopathology theorists suggest that a genetically inherited biological predisposition and temperamental predisposition may interact with life stressors, problematic parenting, and/or other environmental factors to bring about a substance use disorder.

How Are Substance Use Disorders Treated? 

● Usually several approaches are combined to treat substance use disorders.

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● Psychodynamic Therapists try to help clients become aware of and correct the underlying needs and conflicts that may have led to their use of drugs. ● Cognitive-Behavioral Therapy

○ aversion therapy - a treatment in which clients are repeatedly presented with unpleasant stimuli when they are performing undesirable behaviors such as taking a drug (does not have good long term effects)

○ Contingency Management

○ relapse-prevention training - a cognitive-behavioral approach to treating alcohol use disorder in which clients are taught to keep track of their drinking behavior, apply coping strategies in situations that typically trigger excessive drinking, and plan ahead for risky situations and reactions

○ Acceptance and Commitment Therapy

● Biological Treatments

○ Detoxification - systematic and medically supervised withdrawal from a drug ○ Antagonist Drugs - drugs that block or change the effects of an addictive drug ■ naloxone - one of the most widely used opioid antagonist drugs

○ Drug Maintenance Therapy

■ methadone maintenance program - a treatment approach in which clients are given legally and medically supervised doses of

methadone--a heroin substitute--to treat various opioid use disorders ● Sociocultural Therapies

○ Self-Help and Residential Treatment Programs

■ Alcoholics Anonymous (AA) - a self-help organization that provides support and guidance for people with alcohol use disorder

■ residential treatment center - a place where people formerly addicted to drugs live, work, and socialize in a drug-free environment; also called a therapeutic community

○ Culture- and Gender-Sensitive Programs

○ Community Prevention Programs

● Positive Psychology

○ Focuses on factors and actions that lead to, “individual well-being, positive outlook and thriving communities

○ Emphasis on positive affect -> lower stress and reduced craving

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● Diclemente’s Model -> addiction represents a habitual pattern of intentional behavior ○ Precontemplation -> contemplation -> preparation -> action -> maintenance ● Dialectical Behavioral Therapy

○ Balances behavioral change

○ Problem-solving

○ Emotional regulation

○ Emphasizes validation, mindfulness, and acceptance

○ Encourages psychological flexibility

○ Engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations

● AA’s Original 12 Steps

Other Addictive Disorders 

● Gambling Disorder - a disorder marked by persistent and recurrent gambling behavior, leading to a range of life problems

● Internet Gambling Disorder: Awaiting Official Status

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