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UCR / Psychology / PSYC 152 / What are passive suicidal acts?

What are passive suicidal acts?

What are passive suicidal acts?


School: University of California Riverside
Department: Psychology
Course: Abnormal Psychology
Professor: Misaki natsuaki
Term: Winter 2019
Tags: Psychology, pscyh, psyc152, abnormal psych, and Abnormal psychology
Cost: 50
Name: Psych 152- Midterm 2 Study Guide
Description: This is what is supposed to be on the test
Uploaded: 02/26/2019
13 Pages 43 Views 3 Unlocks

mveraduart (Rating: )

she didnt have all the notes i am so disappointed i paid over 100 dlls and they study guild fell 3 chapters short about 6 more mages of notes were missing hugeeee disappointment .

Psych 152 Study Guide

What are passive suicidal acts?

Midterm 2

• Creativity in Mental Disorders

o Many artists have mood disorders (artists meaning painters, composers, writers) o Many artists worry that taking meds/seeking treatment will limit their creativity o Mania limits creativity, so seeking treatment that targets mania will improve  creativity  

Suicide and Self Harm

• Continuum of Suicide Behaviors

o Risk-taking behaviors: doesn’t look suicidal

o Passive suicidal acts: doesn’t look suicidal

o Suicidal ideation (with varying degrees of severity, frequency or intention):  thinking about it  

o Suicide attempts (different means and levels of lethality): tries and survives  ▪ More suicide attempts than completed suicides  

Which gender attempts suicide more?

o Suicide: Death  

• Public health issues related to suicide

o More common than death by homicide or aids  

o 30% increase in rates since 1999

• Suicide in youth  

o 2nd leading cause of death in youth  

o Many attempts made

• Gender differences in suicide attempts and success

o Woman and girls make 3x the attempts  

o Men are 4x more likely to complete  

▪ This is bc of ways they decide to attempt suicide

▪ Men are more likely to choose something like a gun and correlated with  the increase of substance abuse in males

What is the clinical description of panic disorder?

If you want to learn more check out When did the civil war amendments happen?

• Biological etiology

o Role of neurotransmitters

▪ Serotonin involved bc impulsivity and aggression

▪ Low serotonin levels have been associated with self-directed and other directed violence

o Genetic component

▪ Suicide is heritable but likely due to heritability of comorbid mood  disorders  

• If a fam member committed suicide it is more likely that someone  else in the fam will

• Odds are 6x higher in MZ twin suicides and 4x higher for DZ  


• Psychological etiology

o Psychopathology

▪ Depression (more than 50% of those who try to kill themselves are  depressed at the time of the act), psychosis, anxiety  

• 10-15% of schizophrenics attempt

o Experiential

▪ Experiences (problematic substance abuse, job/financial problems, loss of  housing, relationship problems, crisis in the past or upcoming 2 weeks,  physical health problems, criminal legal problems)  

o Behavioral If you want to learn more check out How risky is franchising?

▪ Previous attempts or non-suicidal self-injury

• Ex: cutting  

▪ Access to lethal means

• Ex: gun access  

▪ Social learning- if you have someone who was close to you that  

committed suicide you are more likely to  

• Protective factors

o Self-esteem

o Social support/ pos relationships  

o Fam cohesion and communication  

o Problem solving skills  

o Hopefulness

o Religious/spiritual pract

o Help-seeking behavior

o Limited access to lethal means  

Anxiety Disorders

• Fear vs anxiety

o Fear: reaction to immediate danger that prepares for immediate action  ▪ Ex: flight or fight  

o Anxiety: more diffused sense of apprehension about anticipated threat or danger,  the course of action is not clear and the person does not know how to stop  • Yerkes-Dodson Law If you want to learn more check out What is maximized in best response function?

o Small degree of anxiety improves performance, too much interferes with  performance, not enough also interferes with performance  If you want to learn more check out How much can we produce and what will it cost to change the mix of production?

• Specific phobias 

o DSM criteria and types of specific phobia

▪ Marked fear or anxiety about a specific object or situation that poses little  or no threat  

• Ex: snakes, heights  

▪ The phobic object or situation almost always provokes fear or anxiety  ▪ The phobic object or situation is avoided or endured with intense fear or  anxiety  

▪ The fear/anxiety is out of proportion to the danger  

▪ Fear/anxiety is persistent (more than 6 mo)  

▪ Fear/anxiety causes clinically significant distress or impairment  

• Social Anxiety Disorder (SAD) 

o DSM criteria

▪ Persistent, unrealistic and intense fear or anxiety about one or more social  situations in which the individual is exposed to possible scrutiny by others  ▪ Person fears they will act in a way or show anxiety symptoms that will be  evaluated neg or be humiliating If you want to learn more check out How do you calculate linear momentum?

▪ Triggering social sit are avoided or endured with intense anxiety  

▪ Symptoms may be similar to a panic attack but ONLY occur in social sit.  ▪ 33% also diagnosed w/ Avoidant Personality Disorder (APD) We also discuss several other topics like What do you actually do in grad school?

o Epidemiology  

▪ ~12% of pop

▪ High comorbidity (up to 80%), especially w/ depression  

• Genetic Etiology of SAD and specific phobias

o Structural

▪ Amygdala- hyperactivation (hypersensitivity of the fear circuit)

▪ Medial Prefrontal Cortex- hypoactivation (poor cognitive control of the  amygdala and emotion)  

o Genetic predisposition

▪ Genetic diathesis: MZ concordance > DZ Concordance  

▪ 1st degree relatives of persons with phobia are 3-4 times more likely to  have a phobia  

▪ Heritability- genetics account for ~30-40% of phobia variance in the  population  

o Evolutionary preparedness

▪ Some phobias are more readily acquired  

• Behavioral etiology of SAD and specific phobias

o Mowrer’s Two Factor Model of Avoidance Learning

▪ 1) classical conditioning via traumatic experience with a formerly neutral  object  

▪ 2) operant conditioning reinforces the phobia via neg reinforcements ▪ The person avoids the very exposure need to extinguish the phobia • Cognitive Etiology of SAD and specific phobias

o Biased attention processes

o Unrealistic negative beliefs about consequences of behaviors

o Excessive attention to social cues

o Fear of negative evaluation by others

▪ Expect others to dislike them

o Negative self-evaluation  

▪ Harsh self-judgment  

• Personality factors  

o Behavioral inhibition: tendency to become distressed and withdraw when facing  new environments

▪ Observed in infants as young as 4 mo

▪ High BI ???? SAD in life  

▪ Might be inherited but most likely G(gene)xE(environment)  

o Neuroticism: tendency to experience frequent or intense negative affect  ▪ Predicts onset of anxiety disorder and depression  

▪ People with high levels 2x likely develop anxiety disorder

• Treatments  

o Biological: Antidepressants and anxiolytics (benzodiazepines- they increase  GABA efficiency)  

o Behavioral:

▪ Systematic desensitization: pair fear stimulus hierarchy w/relaxation  (graduated exposure)

• 80-90% success rate

▪ Participant modeling: therapist participates with client and models calm  reactions to items in anxiety hierarchy  

▪ Flooding (implosion): intense exposure to most feared stimuli ???? increase  in anxiety followed by decrease  

o Cognitive-Behavioral: confront phobic cognitions in supportive settings  ▪ Ex: group therapy  

• Panic Disorder 

o Clinical description

▪ Discrete period of intense fear or discomfort, occurs in the absence of real  danger, sudden/ unexpected onset and peaks within minutes  

▪ Includes 4 or more symptoms of fear

o DSM criteria

▪ Recurrent unexpected out of the blue panic attacks  

▪ At least 1 attack has been followed by more than 1 mo of one or both of  the following:  

• Persistent concern or worry about the possibility of more attacks or  their consequences (ex: having heart attack)  

• Significant maladaptive change in behavior related to the attacks  

(ex: behaviors designed to avoid panic situations, such as  

avoidance of situations)  

o Biological etiology

▪ Structural

• Dysregulation of Locus Coeruleus (LC) and Fear Circuit  

o Kindling effect: Poor LC regulation ???? panic???? anticipatory  

anxiety in limbic system (esp amygdala) ???? heightened  

anxiety and lover threshold for LC activation???? PA

▪ Biochemical

• Neurotransmitters  

o Poor regulation of norepinephrine(NE), especially in LC

o Poor reg of serotonin, esp in amygdala

o Too little GABA= too little inhibition

▪ Genetics

• Runs in fams (heritability= .3-.4)

▪ Suffocation False-Alarm Theory: Hypersensitivity to CO2 such that body  perceives levels as too high and levels of O2 as too low  

• Survival response is then activated so inc rate of breathing for  

more O2, inc heart rate to distribute, inc perspiration to prevent  

overheating, prepare fight or flight  

• Leads of massive release of NE and triggers panic attack (PA)

o Cognitive etiology

▪ Physical arousal  

▪ Sensitive to body sensation

• Interoceptive conditioning: pairing of bodily symp w/ panic  

heightens interoceptive awareness such that person has inc  

awareness of bodily panic cues  

▪ “faulty” threat interpretation: anxiety sensitivity- believe sump will have  harmful consequences  

▪ Catastrophic cog spiral  

▪ Panic

o Treatments  

▪ Bio

• Biological interventions  

o Antidepressants: TCAs, SSRIs, SNRis

▪ Ex: Prozac

▪ 20-50% relapse  

• Benzodiazepines  

o Ex: xanax

o Reduce anxiety by increasing GABA transmission  

o Addictive, impair cognition, 90% relapse  

▪ Psychological interventions  

• Cognitive behavioral therapy  

o Interoceptive exposure and relaxation= panic control  


o Anxiety management skills  

▪ Ex: breathing  

o Identify and challenge panic-inducing cognitions  

o Graded exposure via systematic desensitization  

o Much lower relapse rates than medications

• Agoraphobia 

o Description and DSM criteria

▪ Marked by fear or anxiety about at least 2 of the following situations  • Using public transportation  

o Ex: busses, trains, planes  

• Being in open spaces  

o Ex: parking lots, marketplaces  

• Being in enclosed places  

o Ex: shops, theaters, cinemas

• Standing in line or being in a crowd  

• Being outside of the home alone  

▪ Avoids these situations because of thoughts that it would be difficult to  escape or receive help in the event of incapacitation or embarrassment due  to panic like symptoms  

▪ These situations provoke fear or anxiety  

▪ These situations consistently provoke fear or anxiety

▪ These situations are actively avoided, require the presence of a companion  or are endured with intense fear or anxiety  

▪ Symptoms must last at least 6 mo

• Generalized Anxiety Disorder (GAD) 

o Description and DSM criteria

▪ Excessive anxiety and worry at least 50% of days for at least 6 mo; worry  about events and activities in multiple life domains  

• Ex: fam, health, finances, work and school  

▪ V difficult to control this worry  

▪ Anxiety and worry are associated w/ at least 3 of the following (only 1  required for children):  

• Restlessness or feeling keyed up or on edge  

• Being easily fatigued  

• Difficulty concentrating or mind going blank  

• Irritability  

• Muscle tension  

• Sleep disturbance  

o Etiology

▪ Biological

• Tends to run in families  

• Deficient GABA transmission which results in excessive firing of  

neurons, particularly in the limbic system  

• Not enough inhibition in the brain  

▪ Psychological

• Psychoanalytic: weal defenses -> anxiety  

• Stress: maltreatment, trauma

• Worry as coping  

o Avoid processing unpleasant emotion

o Might be how you cope so you don’t have to experience the  

unpleasant things in your life  

▪ Cognitive

• Threat focused cognitions, attentional bias  

o Cognitive bias to the negative things in the world, lead to  

worry spiral  

• Fear/expectation of losing control

o Treatments

▪ Biological  

• Antidepressants  

• Benzodiazepines  

▪ Cognitive Behavioral  

• CBT is the treatment of choice  

• Skills similar to those for PD

o Anxiety management skills  

▪ Relaxation training  

▪ Education and cognitive restructuring  

▪ Challenge cognitions about worry  

▪ Exposure to worry triggers  

o Differential diagnosis

▪ SAD vs AGO

• Both may avoid social situations but for different reasons  

o SAD: fearful of being judged by others, calm when alone  

bc no one there to judge them  

o AGO: fearful of situations where they cannot escape in the  

event of panic attack  

▪ The social part does not scare them, the fact that  

they can’t escape is what causes anxiety  

▪ SAD vs PD

• SAD could have panic attacks but SAD does not necessarily  

involve panic attacks

o Not part of the diagnosis  

• If panic attacks do occur in SAD they are not out of the blue and  

are cued/triggered by social situations  

OCD and Related Disorders

• Obsessive Compulsive Disorder 

o Obsession vs compulsions

▪ Obsessions

• Recurrent, distressing, intrusive thoughts, urges or images  

• The person tries to ignore or suppress the obsessions but they  

cannot be controlled  

• The obsessions are usually recognized as being irrational  

• Basically, just thoughts, urges and images  

o Typical ones= Repetitive thoughts concerning  

contamination, Repeated doubts, intense need to have  

orderliness and symmetry, Aggressive or horrific impulses,  

Repeated sexual thoughts or images

▪ Compulsions  

• Repetitive behaviors or mental acts/thoughts that the person feels  

compelled to perform in response to an obsession and the  

following rigid rules  

• The compulsion is aimed at preventing or neutralizing  

distress/anxiety or some dreaded event  

o Unlikely to prevent the dreaded situation  

• In contrast to other compulsions (eating, gambling) these behaviors  are not experienced as pleasurable  

o They feel like they have to do it or else their anxiety will  

flare up, know it is irrational

• Basically, mental or physical actions that are done a certain way  

o Typical ones= cleaning, washing, ordering, checking,  

counting, repeating actions, repeating words silently  

o Biological etiology

▪ Certain brain regions that are central to impulses and behavior regulation  appear to be dysregulated

▪ In the normal brain, orbitofrontal cortex sends message to the caudate  nucleus of the basal ganglia (via the cingulate gyrus) => activates behavior  and then the message stops

▪ In OCD, this circuit - Orbital Frontal Cortex (via cingulate) to caudate and  back to OFC (via thalamus) is hyperactive, so the message never stops • OFC is sending the info to the basal ganglia  

▪ Some evidence that Serotonin levels may be too low in these areas ▪ Genetic influences are also present

o Cognitive behavioral etiology

▪ We all have negative thoughts, we all worry, especially when we are  stressed, but in OCD, there is inability to turn off neg thoughts

• Stress-related thoughts are more intense, intrusive and enduring in  OCD.

• Person is sensitive to stress-related cognitions

• Person has a tendency toward rigid thinking

o Black or white thinking, no inbetween  

• Person feels very distressed about thoughts beyond her/his control. ▪ Compulsions develop via Operant Conditioning

• Behaviors or mental acts are negatively reinforced by reduction of  anxiety and the non-occurrence of feared consequences

• Once people with OCD develop a conditioned response, they are  slower to change their response

▪ Yedasentience: Difficulty in getting a subjective feeling of completion  (i.e., knowing that you have thought enough, done enough, or cleaned  enough)

o Treatments

▪ Biological  


o 25-75 percent improvement  

• Psychosurgery to the OFC-Caudate circuit (cingulotomy)

o risky

• Deep brain stimulation in basal ganglia

o Electrodes in the frontal cortex  

o Electrical currents targeted to that area  

▪ Cognitive- Behavioral  

• Exposure and Response Prevention (ERP)  

o Exposure: Systematic/gradual exposure to feared thoughts  

or situations

o Response prevention  

▪ Compulsions are actively prevented  

▪ Cognitions are actively challenged  

• Ex: challenge magical thinking that germs  

can jump off from a stamp and onto a couch  

▪ Allows person to experience the anxiety and  

ultimately promotes its extinction

o 50%-70% effective among those who can tolerate this kind  

of treatment  

▪ About 25% of patients cannot tolerate ERP

• Best treatment is meds+ CBT

• Improvement may last years but relapse rates are high

• Body Dysmorphic Disorder 

o Description and DSM criteria

▪ Preoccupation with one or more perceived defects in physical appearance  that are not observable or appear slight to others  

▪ Performance of repetitive behaviors (ex: mirror checking, seeking  

reassurance, excessive grooming) and or mental acts (ex: comparing one’s  appearance with that of others) in response to the appearance concerns  ▪ Preoccupation is not limited to concerns about weight or fat (differential  diagnosis from eating disorder)

▪ Often display ideas of reference for imagined defect  

• Believe others are talking about the defect  

▪ Fixation or avoidance of mirrors  

▪ Suicidal ideation is 33%  

• Attempt is 20%

o Epidemiology  

▪ 2% prevalence rates  

▪ Slightly more common in women but with different obsessions  

• Women tend to obsess about legs, hips, weight and breasts  

• Men tend to obsess body build, penis size and thinning hair  

▪ Onset in adolescence (usually), chronic  

▪ Most remain single  

▪ Seek out plastic surgery  

▪ High comorbidity, especially with OCD (33%)  

o Etiology

▪ Unclear like OCD

▪ Focuses on details of the face/body/features  

o Treatment  

▪ Psychoanalytic: emphasis on identifying the true (i.e., unconscious) source  of the anxiety

▪ CBT : exposure to feared situations, challenge body assumptions,  

encourage to adopt a holistic approach to body image

▪ Medication with SSRIs

• Hoarding Disorder 

o Description and DSM criteria

▪ Persistent difficulty discarding possessions, regardless of actual value ▪ Difficulty due to a perceived need to save items and to distress associated  with discarding them

▪ Results in the accumulation of things that congest and clutter active living  areas

▪ Hoarding is not better explained by the symptoms of another disorder • Ex: MDD- fatigue, Sz-delusions

▪ 66% are unaware of severity of problem

▪ 33% (especially women) hoard (and neglect) animals

▪ 75% engage in spending sprees

▪ Severe consequences:  

• Squalid living conditions (poor hygiene and safety issue

• Physical illness  

• 10% eviction

• Neglect

▪ Negatively impacts relationships

▪ Prevalence: 1.5%

• Begins in childhood or early adolescence

o Etiology

▪ Cognitive-Behavioral factors

• Poor organizational abilities

o Difficulty categorizing objects and making decisions

▪ they make many small categories (almost like the  

detail orientation of BDD) and great anxiety about  

deciding where things fit

▪ Unusual beliefs about possessions  

• Extreme emotional attachment to thing

• View objects as part of identity and fear losing them

▪ Avoidance behaviors

• Thinking about giving up things causes too much anxiety

• Organizing stuff is too overwhelming ???? procrastination

o Treatments  


▪ ERP (Exposure response prevention)- getting rid of their objects and  halting the rituals that they engage in to reduce their anxiety  

• Posttraumatic Stress Disorder (PTSD) 

o Description and symptom categories  

▪ Intrusion

• Recurrent and intrusive recollections of the event  

• Recurrent distressing dreams of the event  

• Acting or feeling as if the traumatic event were recurring  

• Intense psych distress at exposure to internal or external cues that  

symbolize or resemble aspect of trauma

• Reactions to exposure to internal or external cues that symbolize or  resemble trauma

▪ Avoidance

• Avoidance of or efforts to avoid distressing memories, thoughts or  feelings about or closely associated w/ trauma

• Avoidance of or efforts to external reminders (ppl, places, convos,  activities, situations, objects) that arouse distressing mems,  

thoughts or feelings about or closely related to trauma  

▪ Negative alternations in cognition and/or mood

• Inability to remember an important aspect of the event

• Persistent negative beliefs about one’s self, others, or world

o Ex:no one can be trusted

• Persistent, excessive blame of self or others about the cause or  consequences of the event

• Persistent negative emotional state

o Ex: fear, guilt, horror, anger, shame

• Diminished interest in activities

• Feeling of detachment from others (depersonalization)

• Persistent inability to experience positive emotions

▪ Hypervigilance/arousal

• Difficulty falling or staying asleep

• Irritability or outbursts of anger

• Reckless or self-destructive behavior

• Difficulty concentrating

• Hypervigilance

• Exaggerated startle

o Epidemiology

▪ Men experience more trauma (M:F 61% vs. 51%), but women experience  more PTSD (10% vs. 5%)

▪ Lifetime Prevalence - 7% (10% women, 5% men)

▪ Comorbidity

• Substance abuse, mood disorders, dissociative and somatic  

symptom disorders

▪ Different courses:  

• Acute* (symptoms last < 3 months)

• Chronic (symptoms last > 3 months, usually for years)

• Delayed onset (symptoms occur > 6 months after event)

o Risk factors

▪ Prior exposure to traumatic events (echo effect)

▪ Prior history of psychopathology

▪ Lower level of SES, intelligence, and/or education

▪ Poor social support Certain personality traits (e.g., neuroticism, hostility) ▪ Coping style

• Emotion-focused coping

• Avoidant coping

• Denying problems to relieve aversive emotion Dissociation  

(feeling removed from the situation)

▪ Severity and nature of trauma:

• Prolonged or repeated exposure

• Sense of vulnerability and loss of control

• Proximity and loss

o Within 8 miles of WTC on 9/11 = 7%

o Within 1 mile of WTC on 9/11 = 20%

• High Magnitude Stressors

o Rape - 65% (men), 50% (women)

o Non-Sexual Assault - 22%  

• Human caused trauma=worst

o Treatment

▪ Exposure based treatment

• Target re-experiencing, avoidance, and hyperarousal symptoms of  

PTSD via systematic desensitization

Schizophrenia and Other Psychotic Disorders

• Psychosis

o Inability to distinguish between what is real and what is not  

• Popular misconception about schizophrenia

o That they are dangerous when in fact most are shy/withdrawn

o That it is forever

o That they have multiple or split personalities but that is not true  

o That they cannot function independently  

• DSM criteria

o Criterion A: 2 or more acutely present for at least one month (at least one  must be 1, 2 or 3)  

▪ Delusions  

▪ Hallucinations  

▪ Disorganized thought or speech  

▪ Grossly disorganized or catatonic behavior  

▪ Negative symptoms  

o Criterion B: significant impairment in work, school interpersonal relationships  or self-care  

o Criterion C: Presence of some symptoms for at least 6 mo with at least 1 mo  of symptoms that meet A

• Symptom clusters

o Positive: presence of unusual perceptions thoughts or behaviors  

▪ Delusions, hallucinations

o Negative: absence of usual emotions  

▪ Deficits in motivation and pleasure, expressiveness  

o Disorganized: unusual speech and behavior  

▪ Derailment, tangential, neologism, clang associations, word salads  • Phases of schizophrenia

o Prodromal: beginning  

o Active: full blown symptoms become apparent

o Residual: lingering neg symptoms  

• Related disorders

o Schizophreniform: 1-6 mo duration, milder symp  

o Brief psychotic episode: less than 1 mo, acute onset, often bc of stressor  o Delusional disorder: more than 1 mo delusions present but has never met  criterion A (no pos symptoms)  

o Schizoaffective disorder

▪ Criterion A: An uninterrupted period of illness during which there is a  major mood episode (Mania or Depressive) concurrent with Criterion  

A of Schizophrenia

▪ Criterion B: Positive symptoms without mood symptoms for a period  of at least 2 weeks


• if the person is only psychotic when in a mood episode or if the  

person is no longer psychotic after his/her mood is stabilized, it  

would be a Mood Disorder with Psychotic Features  

▪ Criterion C: Symptoms that meet criteria for a mood episode dominate  the symptom picture for the majority of the illness period  

• Substance use and schizophrenia

o Comorbid, 47%  

o Causes more pos symptoms, relapse of psychosis, heightened risk of violence,  legal complications

• Culture and schizophrenia

o Content of delusions differ in cultures  

o Better prognosis and lower prevalence in developing countries

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